Europe Confronts Persistent Gaps in AMR Plan Delivery

Persistent funding, workforce and surveillance gaps are slowing the implementation of national action plans on antimicrobial resistance (AMR), despite wider adoption of strategies and growing access to technical support. A 2026 WHO Regional Office for Europe meeting report, based on a June 2025 subregional meeting in Copenhagen, brings together implementation challenges and practical responses from European Union Member States and EU4Health-associated countries. The discussions point to a recurring gap between policy commitments and delivery, with long-term care surveillance, public awareness, governance and dedicated financing remaining weak in many settings. Participants also explored new tools to improve stewardship, monitoring, resource access and national accountability. 

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Implementation Gaps Persist Despite Wider Planning 

Implementation remains uneven even where national plans are already in place. Across the wider global picture presented at the meeting, nearly 170 countries had developed AMR national action plans, but only 28% were effectively implementing and monitoring them and 10% had secured specific national budget provisions for AMR activities. Within the WHO European Region, 70% of action plans were reported to lack dedicated budgets, while inadequate operational planning, non-harmonised indicators and shortages of qualified personnel continued to restrict progress. 

An earlier European Commission-commissioned assessment covering EU Member States, Iceland and Norway identified similar barriers. These included insufficient dedicated funding, shortages of specialised staff across care and government, limited measures and surveillance in long-term care facilities and weak public awareness. Monitoring systems for infection prevention and control were also absent or insufficiently developed in some settings, while pharmacies had limited involvement in antimicrobial stewardship. 

The Roadmap on antimicrobial resistance for the WHO European Region 2023–2030 is intended to help countries convert policy commitments into prioritised action. It combines a One Health approach with a health-systems and people-centred perspective, supported by the AMR Compass for assessing national capacity, identifying priorities and setting targets. Meeting discussions also emphasised integrating AMR interventions into primary health care and strengthening governance, workforce capacity and data use. Practical WHO resources include implementation and budgeting guidance, monitoring tools and the Access, Watch, Reserve classification to support more appropriate antibiotic use. 

National Models Move Policy into Practice 

Country experiences showed how implementation can be strengthened through operational tools rather than policy alone. In Belgium, acute-care hospitals had well-established outbreak response systems, microbiology collaboration and surveillance, but preventive infection prevention and control practices were inconsistently embedded. Care bundles were not systematically applied, feedback was often limited to nursing staff and continuous improvement cycles were rarely completed. Digital self-assessment and policy tools were presented to strengthen accountability, workforce planning and data-driven monitoring, although a broader Belgian proposal remained under review and awaited formal political approval. 

Spain presented CertificaPROA, a certification system designed to institutionalise antimicrobial stewardship across hospitals and primary care. The framework combines national coordination, defined standards, benchmarking and annual review with formal certification processes. Its standards cover organisational requirements, human and technical resources, indicators and measures intended to support coordination and quality. Since June 2024, 91 stewardship programmes had achieved auto-certification, with further expansion underway. 

The Netherlands highlighted a model built around prescription controls, broad surveillance and feedback tailored to national, regional and facility levels. Antimicrobial consumption and resistance data are collected across hospitals, primary care and long-term care, with digital links to prescribing systems supporting local stewardship. Regional networks also support cooperation and data-sharing among healthcare professionals. Participants tested simulation-based training that linked infection control, diagnostics and antimicrobial decisions, illustrating another approach to building practical multidisciplinary capacity and translating guidance into team-based decisions. 

Funding and Accountability Tools Support Delivery 

The meeting also focused on making technical and financial support easier to use. WHO presented implementation, budgeting, monitoring and stewardship resources, while the European Centre for Disease Prevention and Control outlined surveillance, training, data platforms and guidance. The European Commission described funding routes including EU4Health, Horizon Europe, Cohesion Policy and the Recovery and Resilience Facility, with eligibility and conditions varying by instrument. The European Union Joint Action on Antimicrobial Resistance and Healthcare-Associated Infections (EU-JAMRAI-2) supports work on national plans, surveillance, infection prevention, stewardship and awareness, while the European Centre for Disease Prevention and Control is developing a mobile application to support observation of hand hygiene compliance in hospitals. 

A resource marketplace brought these offers together so national representatives could discuss needs directly with organisations providing technical guidance, funding information and data tools. This was intended to help countries identify support relevant to their own implementation priorities rather than treating resource availability as separate from delivery. The meeting framed financial support from the European Commission as complementary to technical assistance from EU agencies and other partners. 

A central governance development is the AMR Accountability Index being developed with the London School of Economics and Political Science. The planned benchmarking tool is intended to improve transparency, compare national progress and support strategic planning and evaluation. Member States were consulted on its scope, indicators and data sources, including the advantages and limitations of proposed evidence. The index is being refined with countries to align its domains with the action areas of the regional Roadmap and to support identification of strengths and implementation gaps. 

The meeting underlined that the main AMR challenge is no longer simply the existence of national plans, but whether they are financed, staffed, monitored and translated into routine practice. Persistent gaps in long-term care surveillance, public awareness, governance and workforce capacity remain alongside examples of stronger stewardship, infection prevention and data use. Technical resources and EU funding mechanisms are available, while the developing Accountability Index is intended to add greater transparency and comparability. The overall direction is towards more coordinated implementation, with national progress depending on sustained governance, practical support and measurable follow-through. 

Source: World Health Organization. Regional Office for Europe

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