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Check The Box

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What is the Check the Box?

Check the Box AMR is a tracking initiative developed by the Health Diplomacy Alliance to assess whether AMR commitments are translating from declaration to measurable, traceable actions.

The central question is not whether a commitment exists, but whether it is assigned to an institution, linked to financing, placed within a timeline, and supported by transparent reporting mechanisms.

AMR: The Scale of the Challenge

1.14 Million

Deaths directly caused by bacterial AMR globally in 2021.

0%

Pathogen-Antibiotic Combinations – Monitored combinations that showed increased resistance between 2018 and 2023.

1 in 6 Infections

Laboratory-confirmed bacterial infections worldwide in 2023 that were resistant to antibiotic treatment.

0%

Rise in AMR mortality among adults aged 70 years and older between 1990 and 2021.

8.22 Million

Projected annual deaths associated with bacterial AMR by 2050.

0%

Global target for reducing deaths associated with bacterial AMR by 2030

1.91 Million

Projected annual deaths directly attributable to bacterial AMR by 2050.

0%

121 Countries reporting implementation of some elements of their AMR plans.

US$412 Billion

Estimated annualy cost of treating drug-resistant bacterial infections alone.

0%

Healthcare facilities in LMICs lacking basic water services in 2023.

US$100 million

Catalytic funding commitment announced at the 2024 UN General Assembly High-Level Meeting.

0%

20 Countries that allocated national budget resources for AMR plan implementation.

0%

Healthcare facilities with basic sanitation services.

0%

Target share of countries expected to achieve funded national AMR Action Plans by 2030.

0%
0%

Average annual increase in antimicrobial resistance rates.

US$1 – 3.4 Trillion

Potential annual GDP losses linked to AMR by 2030.

0%

Healthcare facilities lacking basic hygiene services.

1 in 3 Infections

Reported infections resistant to treatment in the South-East Asia and Eastern Mediterranean regions.

0%

49 countries with fully costed, budgeted, implemented, and monitored AMR action plans.

Why Check The Box?

Political declarations, national action plans, and global targets represent an important foundation for the global AMR response and reflect genuine commitment across governments, institutions, and the broader AMR community.

 

The next step is understanding how these commitments are being translated into action across the system as a whole.

Check the Box AMR responds to this need, providing governments, donors, and civil society with a shared evidence base for assessing progress, identifying where gaps remain, and directing collective attention and investment where it is most needed.

The Evolution of the Global AMR Response

COUNTRY SPOTLIGHT

AMR - UNGA Commitments Chart

Commitments:

  • Ensure, by 2030, that all countries have developed or updated and are implementing multisectoral national action plans on antimicrobial resistance with national targets informed by analysis of existing capacities and priorities, with inclusive and effective national functioning multisectoral coordination mechanisms, and appropriate and sustainable human and financial resources, according to national contexts and priorities.
  • Request the Quadripartite organizations, in consultation with Member States, to update the Global Action Plan on Antimicrobial Resistance by 2026 to ensure a robust and inclusive multisectoral response, through a One Health approach, that aligns with current realities to drive greater impact against antimicrobial resistance, and request the Quadripartite to report biennially on progress made towards their specific and joint commitments.
  • Request the Quadripartite organizations to formalize the standing Quadripartite Joint Secretariat on Antimicrobial Resistance as the central coordinating mechanism to support the global response to antimicrobial resistance, according to the mandates and roles of the respective organizations.
  • Invite the Quadripartite Joint Secretariat to facilitate cooperation and exchange with relevant multilateral organizations, including the United Nations Development Programme (UNDP), the World Bank, the United Nations Children’s Fund (UNICEF), and the World Customs Organization (WCO), on aspects of their mandates related to antimicrobial resistance.
  • Enhance existing frameworks and mechanisms, including but not limited to the Multistakeholder Partnership Platform, biennial ministerial conferences on antimicrobial resistance and other relevant conferences, in order to facilitate the multisectoral exchange of experiences and best practices and assessment of Member States’ progress in implementing national action plans on antimicrobial resistance, and which could also be an opportunity to promote the voluntary expansion of the donor base of the Antimicrobial Resistance Multi-partner Trust Fund.
  • Promote participatory, inclusive and transparent approaches to health governance for antimicrobial resistance at local, national, regional, and global levels, including by exploring modalities for enhancing a meaningful whole-of-society approach and social participation, by involving all relevant stakeholders, such as local communities, health workers and care workers in the health sector, patients, survivors of antimicrobial resistant infections, farmers, animal health and environmental and ecosystem sector professionals, academia, volunteers, civil society organizations, humanitarian personnel, faith-based organizations, private sector and youth in the design, implementation and review of national action plans on antimicrobial resistance, to systematically inform decisions that affect health so that policies, programmes and plans better respond to needs, while fostering trust in health systems.
  • Invite the Quadripartite organizations to establish an independent panel for evidence for action against antimicrobial resistance in 2025 to facilitate the generation and use of multisectoral, scientific evidence to support Member States in efforts to tackle antimicrobial resistance, making use of existing resources and avoiding duplication of on-going efforts, after an open and transparent consultation with all Member States on its composition, mandate, scope, and deliverables.

Commitments:

  • Commit to sustainable financing and budgeted activities, as identified in the national action plans on antimicrobial resistance, for their effective implementation, in accordance withnational contexts;
  • Strengthen sustainable financing through existing funding structures and promote the mobilization of financial resources and investments through national, bilateral and multilateral channels, in particular for developing countries, especially low- and middle-income countries, to support implementation of national action plans on antimicrobial resistance, as well as their monitoring and surveillance, in accordance with national contexts;
  • Facilitate sustainable funding from international cooperation to support the implementation of national action plans on antimicrobial resistance, with the target of achieving US$ 100 million to catalyse the achievement of at least 60 per cent of countries having achieved funded plans by 2030, through, inter alia, diversifying funding sources and increasing the number of contributors to the Antimicrobial Resistance Multi-Partner Trust Fund;
  • Encourage existing financing mechanisms, including but not limited to the World Bank, Global Fund to Fight AIDS, Tuberculosis and Malaria, Gavi, the Vaccine Alliance, Green Climate Fund, Pandemic Fund, Climate Health Fund, Global Environment Facility, Nature4Health, and the Global Biodiversity Framework Fund, to facilitate access to existing relevant funding sources or expand, as appropriate, their scope to include investments to increase access to effective antimicrobials, prevention of infections through vaccines, research and development of new antimicrobials, diagnostic tools or technologies, water, hygiene and sanitation, and infection prevention and control, surveillance, and support implementation of multisectoral national action plans on antimicrobial resistanceand leverage procurement and market-shaping instruments such as Stop TB Partnership’s Global Drug Facility and UNITAID.
  • Request the Quadripartite Joint Secretariat, in collaboration with relevant financial institutions, to map existing and catalytic funding, including from the private sector, philanthropic organizations, and development banks, in order to improve access to resources and leverage capacity-building and implementation of national action plans on antimicrobial resistance

Commitments:

  • Accelerate efforts to achieve universal health coverage as a means to ensure access to essential health services as well as to strengthen veterinary services for the optimal prevention, diagnosis, and appropriate treatment of infections and antimicrobial stewardship measures;
  • Ensure equitable and timely access to and greater supply of antimicrobials, vaccines and diagnostics in developing countries, especially in low- and middle-income countries, in line with global lists ofessential medicines, including WHO Model List of Essential Medicines and the Global Essential Veterinary Medicines List, taking into account national contexts and updating country-aligned lists and treatment needs, as appropriate.
  • Encourage the Quadripartite organizations, in collaboration with relevant entities of the United Nations development system, within their respective mandates, and other stakeholders as appropriate, to coordinate efforts and take actionable steps to support global and regional access initiatives, to ensure effective infectious disease management including enhancing timely and equitable access to and affordability of quality antimicrobials, diagnostics, vaccines, and alternatives to the use of antimicrobials, while promoting their prudent, responsible, and sustainable manufacturing, appropriate use and disposal;
  • Call on the Quadripartite organizations, in collaboration with Member States upon their request and other stakeholders including private sector and partnerships, such as Global Antibiotic Research and Development Partnership (GARDP), through the SECURE initiative, and the Global Drug Facility, as applicable, to take steps to increase global access to and appropriate use of antimicrobials in settings with the highest unmet need, including by aligning regional and subregional medicine registration and reforming regulatory and policy pathways, as necessary, to accelerate authorization of safe and effective products, especially for new antimicrobials, and to consider implementing new, sustainable procurement models, such as pooled procurement, tiered pricing and by supporting measures to ensure the resilience of supply chains for health products;

Commitments:

  • Enhance and sustain targeted efforts, including through a One Health approach, to promote awareness of antimicrobial resistance and the appropriate use and disposal of antimicrobials, through education and training, social science approaches, communication and information campaigns, including through the media, behavioural change initiatives, the sharing of best practices and strengthening stewardship competencies and programmes across all relevant workforce sectors by integrating antimicrobial resistance modules in primary, secondary and tertiary education and training curricula through systematic public, private, stakeholder and community engagement, and in this regard acknowledge the importance of engaging patients and families as partners in promoting safe care, and working towards locally meaningful and
    sustainable solutions;
  • Promote the alignment of national action plans on antimicrobial resistance and national vaccination and immunization strategies, both in the human and animal health sectors;
  • Enhance the appropriate, prudent and responsible use of antimicrobials across sectors through better valuation of and investment in innovative, rapid, effective, validated and affordable diagnostics and laboratory systems, ensure the accessibility of quality testing, and promote the optimal utilization of these diagnostics across sectors;

Commitments:

  • Explore, encourage and promote a range of innovative incentives and financing mechanisms for multisectoral health research and development to address antimicrobial resistance, and a stronger and transparent partnership between the public and the private sectors as well as academia and the scientific community, acknowledging the important role played by the private sector in research and development of innovative medicines, while recognizing the need for increasing public health-driven research and development that is needs-driven and evidence-based, guided by the core principles of safety, availability, affordability, effectiveness, efficiency, equity and accessibility, as well as appropriate incentives, including push and pull incentives, in the development of new health products and technologies, while ensuring that mechanisms are in place for equitable access, particularly in developing countries;
  • Promote the transfer of technology and know-how and encourage research, innovation and commitments to voluntary licensing, where possible, in agreements where public funding has been invested in the research and development of antimicrobials, to strengthen local and regional capacities for the manufacturing, regulation and procurement of needed tools for equitable and effective access to vaccines, therapeutics, diagnostics and essential supplies, as well as for clinical trials, and to increase global supply through facilitating transfer of technology within the framework of relevant multilateral agreements;
  • Improve availability, affordability and efficiency of health products by increasing transparency of prices of medicines, vaccines, medical devices, diagnostics, assistive products, cell- and gene-based therapies and other health technologies across the value chain, including through improved regulations and building constructive engagement and a stronger partnership with relevant stakeholders, including industries, the private sector and civil society, in accordance with national and regional legal frameworks and contexts, to address the global concern about the high prices of some health products and in this regard encourage the World Health Organization to continue its efforts to biennially convene the Fair Pricing Forum with Member States and all relevant stakeholders to discuss the affordability and transparency of prices and costs relating to health products;
  • Recognize the important role played by the private sector in research and development of innovative medicines and continue to support voluntary initiatives and incentive mechanisms that separate the cost of investment in research and development from the price and volume of sales, facilitate equitable and affordable access to new tools and other results to be gained through research and development;
  • Recognize the need to support developing countries to build expertise and strengthen local and regional production of vaccines, medicines, diagnostics and other health technologies in order to facilitate equitable access, recognizing that the high prices of some health products and the inequitable access to such products impede progress towards addressing antimicrobial resistance, particularly for developing countries;
  • Prioritize the sustainable production of antimicrobials, including through developing and incentivising the adoption of manufacturing standards to reduce the risk of developing antimicrobial resistance and aquatic ecotoxicity in the environment resulting from manufacturing operations;
  • Undertake and enhance targeted measures, including activities identified by the WHO Member State Mechanism on Substandard and Falsified Medicines, to address the trade in sub-standard, counterfeit and falsified medicines, through, inter alia, improving supply chain management and strengthening regulatory and surveillance capacity,
  • Promote the development of research strategies and innovation programmes and their integration into national action plans on antimicrobials resistance, taking into consideration national contexts, as well as the Quadripartite One Health Priority Research Agenda and the WHO Global Research Agenda for Antimicrobial Resistance in Human Health;
  • Strengthen national capacities by investing in the training, development, recruitment and retention of a competent and skilled workforce in human, animal, and plant health and the environment, as relevant, especially in low- and middle-income countries, as well as through capitalizing on antimicrobial resistance expertise from the Quadripartite organizations and their regional offices, collaborating centers, and relevant Secretariat departments, as well as the WHO Academy;
  • Undertake measures to address the growing shortage of researchers and medical specialists and restore, build, and invest in the scientific talent that can spearhead an effective response to antimicrobial resistance

Commitments:

  • Strengthen national capacities for sustainable, sector-specific, integrated and interoperable surveillance systems for antimicrobial resistance and antimicrobial use, standards of diagnostics, laboratory information systems and networks, and other infrastructure to support
    collection of nationally representative data on prevalence, antimicrobial resistance patterns, re-emerging disease surveillance, mortality and morbidity attributable to antimicrobial
    resistance, data on antimicrobial use across sectors and monitoring of water, sanitation and
    hygiene in healthcare facilities and community settings and the environment, and to share
    relevant information on emerging trends to inform decision making at all levels;
  • Encourage all countries to report quality surveillance data on antimicrobial resistance and antimicrobial use by 2030, through existing global surveillance systems, including the Global
    Antimicrobial Resistance and Use Surveillance System (GLASS), Global Database for Antimicrobial Use in Animals (ANIMUSE), and International FAO Antimicrobial Resistance
    Monitoring (InFARM) platform, for use in the Quadripartite Global Integrated System for
    Surveillance of Antimicrobial Resistance and Antimicrobial Usage (GISSA);
  • Improve access to diagnosis and care, so at least 80 per cent of countries can test resistance in all bacterial and fungal GLASS pathogens by 2030;
  • Invite the Quadripartite organizations to consider, within existing resources, the development of a science- and risk-based system to analyse antimicrobial residues and resistance in the environment, complementary to, and, where appropriate, interacting with existing global surveillance systems,
  • Improve monitoring and evaluation of the implementation of multisectoral national action plans on antimicrobial resistance by building country-level technical capacity and ensure that 95 per cent of countries participate in the annual Tracking Antimicrobial Resistance Country Self Assessment Survey (TrACSS) by 2030.

Mechanism established but not active

Functional mechanism

No formal mechanism

No data / no reports

The map shows the implementation status of AMR national action plans across countries, based on TrACSS 2023 reporting.

It highlights where coordination mechanisms are functional, where they exist on policy, and where no formal mechanism or data is available.

Support the Initiative

We work at the intersection of health, diplomacy, and political monitoring to ensure that AMR commitments translate into measurable action. Through Check the Box, we track whether political declarations are assigned to accountable institutions, linked to sustainable financing, and reported through credible monitoring systems.

 

We welcome partnerships with governments, international organizations, civil society, and strategic partners committed to:

  • Closing the gap between political declaration and operational implementation on AMR
  • Strengthening monitoring frameworks across the Quadripartite, G7/G20, and UN processes
  • Ensuring financing commitments are costed, tracked, and transparently reported
  • Building the sustained multilateral engagement needed to deliver on the 2029 UNGA AMR High-Level Meeting

Join the Check the Box

We work at the intersection of health, diplomacy, and political monitoring to ensure that AMR commitments translate into measurable action. Through Check the Box, we track whether political declarations are assigned to accountable institutions, linked to sustainable financing, and reported through credible monitoring systems.

This work is only possible in partnership. We invite governments, international organizations, civil society, and strategic partners who share this commitment to join us, whether by contributing data and expertise, supporting the initiative’s development, or championing accountability within your own institutions.

  • Closing the gap between political declaration and operational implementation on AMR
  • Strengthening monitoring frameworks across the Quadripartite, G7/G20, and UN processes
  • Ensuring financing commitments are costed, tracked, and transparently reported
  • Building the sustained multilateral engagement needed to deliver on the 2029 UNGA AMR High-Level Meeting

Global Map of the Implementation Status of AMR NAPs

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