Pub Date : 2026-01-14DOI: 10.1016/j.lanmic.2025.101315
Claas Kirchhelle, Mirza Y Alas Portillo, Mark D M Davis, Assa Doron, Anahí Dreser, Nicolas Fortané, Christian Haddad, Stephen Hinchliffe, Samuel Kariuki, Sonia Lewycka, Sassy Molyneux, Cristina Moreno Lozano, Edna Mutua, Iruka N Okeke, Mingyuan Zhang Betancourt, Clare I R Chandler
Antimicrobial resistance (AMR) remains a major global health threat. Despite increasing international attention, AMR governance has often neglected social and equity dimensions, and there is a crucial need to synthesise evidence from social sciences and humanities scholarship to devise more people-centred approaches. In this Personal View, we report a qualitative stocktake of the intended and unintended consequences of the most recent phase of global AMR governance that started around the year 2000 and reached a high point with the 2015 Global Action Plan (GAP) on AMR. Our interdisciplinary analysis was guided by the five key objectives of current AMR governance, as organised in the 2015 GAP, to reduce AMR through awareness, surveillance, infection reduction, antimicrobial use optimisation, and research and innovation. The resulting assessment indicated mixed outcomes. Although the past decade witnessed unprecedented AMR-related action and investment, empirical studies highlight negative consequences of the decontextualised export of high-income governance frameworks and the neglect of upstream antibiotic-sensitive reforms of production, care, and innovation systems. Not embedding AMR within more general developmental and environmental challenges has also undermined local buy-in and contributed to the siloed status of AMR policies. For the next GAP, we recommend foregrounding equitable interventions; adopting a bottom-up, integrated perspective to incorporate local realities and solutions; and creating robust social sciences and humanities feedback loops for global AMR frameworks.
{"title":"(Un)intended consequences: a social sciences stocktake of a decade of Global Action Plan-inspired antimicrobial governance.","authors":"Claas Kirchhelle, Mirza Y Alas Portillo, Mark D M Davis, Assa Doron, Anahí Dreser, Nicolas Fortané, Christian Haddad, Stephen Hinchliffe, Samuel Kariuki, Sonia Lewycka, Sassy Molyneux, Cristina Moreno Lozano, Edna Mutua, Iruka N Okeke, Mingyuan Zhang Betancourt, Clare I R Chandler","doi":"10.1016/j.lanmic.2025.101315","DOIUrl":"https://doi.org/10.1016/j.lanmic.2025.101315","url":null,"abstract":"<p><p>Antimicrobial resistance (AMR) remains a major global health threat. Despite increasing international attention, AMR governance has often neglected social and equity dimensions, and there is a crucial need to synthesise evidence from social sciences and humanities scholarship to devise more people-centred approaches. In this Personal View, we report a qualitative stocktake of the intended and unintended consequences of the most recent phase of global AMR governance that started around the year 2000 and reached a high point with the 2015 Global Action Plan (GAP) on AMR. Our interdisciplinary analysis was guided by the five key objectives of current AMR governance, as organised in the 2015 GAP, to reduce AMR through awareness, surveillance, infection reduction, antimicrobial use optimisation, and research and innovation. The resulting assessment indicated mixed outcomes. Although the past decade witnessed unprecedented AMR-related action and investment, empirical studies highlight negative consequences of the decontextualised export of high-income governance frameworks and the neglect of upstream antibiotic-sensitive reforms of production, care, and innovation systems. Not embedding AMR within more general developmental and environmental challenges has also undermined local buy-in and contributed to the siloed status of AMR policies. For the next GAP, we recommend foregrounding equitable interventions; adopting a bottom-up, integrated perspective to incorporate local realities and solutions; and creating robust social sciences and humanities feedback loops for global AMR frameworks.</p>","PeriodicalId":46633,"journal":{"name":"Lancet Microbe","volume":" ","pages":"101315"},"PeriodicalIF":20.4,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145994572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-13DOI: 10.1016/j.lanmic.2025.101317
Sanjeet Bagcchi
{"title":"Agreements to provide affordable lenacapavir.","authors":"Sanjeet Bagcchi","doi":"10.1016/j.lanmic.2025.101317","DOIUrl":"https://doi.org/10.1016/j.lanmic.2025.101317","url":null,"abstract":"","PeriodicalId":46633,"journal":{"name":"Lancet Microbe","volume":" ","pages":"101317"},"PeriodicalIF":20.4,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145991271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-09DOI: 10.1016/j.lanmic.2025.101319
Lita M Proctor
{"title":"Integrating microbiomes into One Health: insights from the 2025 One Health World Microbiome Partnership Summit.","authors":"Lita M Proctor","doi":"10.1016/j.lanmic.2025.101319","DOIUrl":"https://doi.org/10.1016/j.lanmic.2025.101319","url":null,"abstract":"","PeriodicalId":46633,"journal":{"name":"Lancet Microbe","volume":" ","pages":"101319"},"PeriodicalIF":20.4,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145960214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-09DOI: 10.1016/j.lanmic.2025.101288
Lloyd Czaplewski, Usha Lamichhane, Ralf Sudbrak, Alan Hennessy, Lesley A Ogilvie, Laura Jv Piddock
Antibacterial research and development (R&D) increasingly relies on public and philanthropic investments over private investments and on academia and small businesses over large pharmaceutical companies. To complement scientific reviews of the antibacterial pipeline, we examined global public and philanthropic funding for R&D of antibacterial therapeutics from 2017 to 2023 using data obtained from the Global AMR R&D Hub's Dynamic Dashboard. Projects were analysed considering funders and recipients, geographical location, R&D stage, mechanism of action, antibacterial class, clinical novelty, spectrum of activity, and alignment with the WHO bacterial priority pathogen list 2024. A total of US$2·51 billion was invested in antibacterial R&D by 130 funders, with a marked concentration among a small number of major sources. Funding peaked at $445 million in 2020 but declined by 18% to $363 million in 2023. Universities received the most awards, yet more than half of the total funding volume went to industry recipients. Investment broadly followed the WHO bacterial priority pathogens list, with Mycobacterium tuberculosis accounting for a fifth of the total. While the funding for clinical development remained stable, that for discovery and preclinical research declined. In this environment, public-private partnerships, such as Combating Antibiotic-Resistant Bacteria Biopharmaceutical Accelerator and the Global Antibiotic Research and Development Partnership, are crucial for attracting, channelling, and targeting funding; however, these partnerships alone will be insufficient. Enhanced strategic alignment in funding priorities and continued public and private investment will be essential for ensuring the discovery and development of effective new antibacterials meeting priority public health needs.
{"title":"An overview of global public and philanthropic investments into antibacterial therapeutics (2017-23).","authors":"Lloyd Czaplewski, Usha Lamichhane, Ralf Sudbrak, Alan Hennessy, Lesley A Ogilvie, Laura Jv Piddock","doi":"10.1016/j.lanmic.2025.101288","DOIUrl":"https://doi.org/10.1016/j.lanmic.2025.101288","url":null,"abstract":"<p><p>Antibacterial research and development (R&D) increasingly relies on public and philanthropic investments over private investments and on academia and small businesses over large pharmaceutical companies. To complement scientific reviews of the antibacterial pipeline, we examined global public and philanthropic funding for R&D of antibacterial therapeutics from 2017 to 2023 using data obtained from the Global AMR R&D Hub's Dynamic Dashboard. Projects were analysed considering funders and recipients, geographical location, R&D stage, mechanism of action, antibacterial class, clinical novelty, spectrum of activity, and alignment with the WHO bacterial priority pathogen list 2024. A total of US$2·51 billion was invested in antibacterial R&D by 130 funders, with a marked concentration among a small number of major sources. Funding peaked at $445 million in 2020 but declined by 18% to $363 million in 2023. Universities received the most awards, yet more than half of the total funding volume went to industry recipients. Investment broadly followed the WHO bacterial priority pathogens list, with Mycobacterium tuberculosis accounting for a fifth of the total. While the funding for clinical development remained stable, that for discovery and preclinical research declined. In this environment, public-private partnerships, such as Combating Antibiotic-Resistant Bacteria Biopharmaceutical Accelerator and the Global Antibiotic Research and Development Partnership, are crucial for attracting, channelling, and targeting funding; however, these partnerships alone will be insufficient. Enhanced strategic alignment in funding priorities and continued public and private investment will be essential for ensuring the discovery and development of effective new antibacterials meeting priority public health needs.</p>","PeriodicalId":46633,"journal":{"name":"Lancet Microbe","volume":" ","pages":"101288"},"PeriodicalIF":20.4,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145960229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-07DOI: 10.1016/j.lanmic.2025.101334
Christoph Buchta, Jaap J van Hellemond, Karina Hellbert, Michael Neumaier, Christa M Cobbaert
{"title":"The disparaging requirements of Article 5.5 of the IVDR for laboratories.","authors":"Christoph Buchta, Jaap J van Hellemond, Karina Hellbert, Michael Neumaier, Christa M Cobbaert","doi":"10.1016/j.lanmic.2025.101334","DOIUrl":"https://doi.org/10.1016/j.lanmic.2025.101334","url":null,"abstract":"","PeriodicalId":46633,"journal":{"name":"Lancet Microbe","volume":" ","pages":"101334"},"PeriodicalIF":20.4,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145949383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-06DOI: 10.1016/j.lanmic.2025.101332
Sema Mandal, Philippa C Matthews, Monica Desai, Matthew Hickman
{"title":"Towards the endgame: achieving elimination of viral hepatitis in England.","authors":"Sema Mandal, Philippa C Matthews, Monica Desai, Matthew Hickman","doi":"10.1016/j.lanmic.2025.101332","DOIUrl":"https://doi.org/10.1016/j.lanmic.2025.101332","url":null,"abstract":"","PeriodicalId":46633,"journal":{"name":"Lancet Microbe","volume":" ","pages":"101332"},"PeriodicalIF":20.4,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145946551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-06DOI: 10.1016/j.lanmic.2025.101326
Tim Jesudason
{"title":"EMBL-EBI's AMR portal: a new gateway in global antimicrobial resistance research.","authors":"Tim Jesudason","doi":"10.1016/j.lanmic.2025.101326","DOIUrl":"https://doi.org/10.1016/j.lanmic.2025.101326","url":null,"abstract":"","PeriodicalId":46633,"journal":{"name":"Lancet Microbe","volume":" ","pages":"101326"},"PeriodicalIF":20.4,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145946606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.lanmic.2025.101216
Nelson Aghogho Evaborhene , Jessica Oreoluwa Oga , Chizaram Onyeaghala
{"title":"Is there really a need for another global body for pandemic preparedness?","authors":"Nelson Aghogho Evaborhene , Jessica Oreoluwa Oga , Chizaram Onyeaghala","doi":"10.1016/j.lanmic.2025.101216","DOIUrl":"10.1016/j.lanmic.2025.101216","url":null,"abstract":"","PeriodicalId":46633,"journal":{"name":"Lancet Microbe","volume":"7 1","pages":"Article 101216"},"PeriodicalIF":20.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.lanmic.2025.101224
Patrick Musicha PhD , Mathew A Beale PhD , Derek Cocker PhD , Fiona A Oruru MPH , Allan Zuza MSc , Chifundo Salifu MSc , George Katende MSc , Sylvia Nanono MSc , Fred Isaasi MSc , Kondwani Chidziwisano PhD , Lawrence Mugisha PhD , Henry Kajumbula MMed , David Musoke PhD , Prof Tracy Morse PhD , Shevin T Jacob MD , Prof Nicholas A Feasey PhD , Prof Nicholas R Thomson PhD
<div><h3>Background</h3><div>The One Health paradigm considers interdependence of human, animal, and environmental health. However, there is little evidence from high-income countries to support the importance of a One Health approach to addressing spread of antimicrobial resistance (AMR). Given AMR is a global threat, understanding how the close interactions of humans with animals and the environment in low-income settings affect the spread of AMR is important. We aimed to investigate diversity and transmission of extended spectrum β-lactamase (ESBL)-producing <em>Escherichia coli</em> across household-linked One Health compartments using genomic data.</div></div><div><h3>Methods</h3><div>We sequenced whole genomes of ESBL-producing <em>E coli</em> isolates from humans, animals, and the environment from a prospective, longitudinal cohort study conducted in Malawi (April 29, 2019, to Dec 3, 2020) and Uganda (July 16, 2020, to Aug 6, 2021). In the cohort study, 259 households were enrolled at baseline in Malawi and 92 in Uganda from a mix of urban, peri-urban, and rural areas. Households were followed up at months 1, 3, and 6 in Malawi and at months 1, 2, and 4 in Uganda. Samples collected at each visit included human and animal stool, environmental samples from hand-contact areas, food, and water, and broader environmental samples such as river water. Samples were cultured in buffered peptone water and then ESBL chromogenic agar to isolate ESBL-producing <em>E coli</em>. ESBL-producing <em>E coli</em> isolates underwent whole-genome sequencing. We performed phylogenetic analyses, and in-silico multi-locus sequence typing, characterised AMR determinants and linked genotypes with sample location, ecological source, and other covariates. We performed fine-scale single nucleotide polymorphism (SNP) and network analysis to infer strain and plasmid transmission across ecological compartments. The primary outcome was colonisation with ESBL-producing <em>E coli</em>. Secondary outcomes were genomic clusters and ESBL genomic determinants within and between One Health compartments.</div></div><div><h3>Findings</h3><div>We found high diversity of ESBL-producing <em>E coli</em>, with 170 sequence types and 166 genomic clusters identified from 2344 genomes, including 1814 genomes from Malawi (907 human, 221 animal, and 686 environmental) and 530 genomes from Uganda (380 human, 147 animal, and three environmental). Sequence type (ST)131 dominated in Malawi (209 [11·5%] of 1814 genomes), and ST10 dominated in Uganda (45 [8·5%] of 530 genomes). Common ESBL genes <em>bla</em><sub>CTX−M−15</sub> (1604 [68·4%] of 2344 genomes) and <em>bla</em><sub>CTX−M−27</sub> (336 [14·3%] of 2344 genomes) were carried on a complex network of 55 and 30 different plasmids. This diversity of plasmids presented multiple pathways for dissemination and revealed high force of selection. Phylogenetic analyses revealed common intermixing of isolates between humans, animals, and the envir
{"title":"Transmission of extended spectrum β-lactamase-producing Escherichia coli and antimicrobial resistance gene flow across One Health compartments in eastern Africa: a whole-genome sequence analysis from a prospective cohort study","authors":"Patrick Musicha PhD , Mathew A Beale PhD , Derek Cocker PhD , Fiona A Oruru MPH , Allan Zuza MSc , Chifundo Salifu MSc , George Katende MSc , Sylvia Nanono MSc , Fred Isaasi MSc , Kondwani Chidziwisano PhD , Lawrence Mugisha PhD , Henry Kajumbula MMed , David Musoke PhD , Prof Tracy Morse PhD , Shevin T Jacob MD , Prof Nicholas A Feasey PhD , Prof Nicholas R Thomson PhD","doi":"10.1016/j.lanmic.2025.101224","DOIUrl":"10.1016/j.lanmic.2025.101224","url":null,"abstract":"<div><h3>Background</h3><div>The One Health paradigm considers interdependence of human, animal, and environmental health. However, there is little evidence from high-income countries to support the importance of a One Health approach to addressing spread of antimicrobial resistance (AMR). Given AMR is a global threat, understanding how the close interactions of humans with animals and the environment in low-income settings affect the spread of AMR is important. We aimed to investigate diversity and transmission of extended spectrum β-lactamase (ESBL)-producing <em>Escherichia coli</em> across household-linked One Health compartments using genomic data.</div></div><div><h3>Methods</h3><div>We sequenced whole genomes of ESBL-producing <em>E coli</em> isolates from humans, animals, and the environment from a prospective, longitudinal cohort study conducted in Malawi (April 29, 2019, to Dec 3, 2020) and Uganda (July 16, 2020, to Aug 6, 2021). In the cohort study, 259 households were enrolled at baseline in Malawi and 92 in Uganda from a mix of urban, peri-urban, and rural areas. Households were followed up at months 1, 3, and 6 in Malawi and at months 1, 2, and 4 in Uganda. Samples collected at each visit included human and animal stool, environmental samples from hand-contact areas, food, and water, and broader environmental samples such as river water. Samples were cultured in buffered peptone water and then ESBL chromogenic agar to isolate ESBL-producing <em>E coli</em>. ESBL-producing <em>E coli</em> isolates underwent whole-genome sequencing. We performed phylogenetic analyses, and in-silico multi-locus sequence typing, characterised AMR determinants and linked genotypes with sample location, ecological source, and other covariates. We performed fine-scale single nucleotide polymorphism (SNP) and network analysis to infer strain and plasmid transmission across ecological compartments. The primary outcome was colonisation with ESBL-producing <em>E coli</em>. Secondary outcomes were genomic clusters and ESBL genomic determinants within and between One Health compartments.</div></div><div><h3>Findings</h3><div>We found high diversity of ESBL-producing <em>E coli</em>, with 170 sequence types and 166 genomic clusters identified from 2344 genomes, including 1814 genomes from Malawi (907 human, 221 animal, and 686 environmental) and 530 genomes from Uganda (380 human, 147 animal, and three environmental). Sequence type (ST)131 dominated in Malawi (209 [11·5%] of 1814 genomes), and ST10 dominated in Uganda (45 [8·5%] of 530 genomes). Common ESBL genes <em>bla</em><sub>CTX−M−15</sub> (1604 [68·4%] of 2344 genomes) and <em>bla</em><sub>CTX−M−27</sub> (336 [14·3%] of 2344 genomes) were carried on a complex network of 55 and 30 different plasmids. This diversity of plasmids presented multiple pathways for dissemination and revealed high force of selection. Phylogenetic analyses revealed common intermixing of isolates between humans, animals, and the envir","PeriodicalId":46633,"journal":{"name":"Lancet Microbe","volume":"7 1","pages":"Article 101224"},"PeriodicalIF":20.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145641355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.lanmic.2025.101304
Paul Adepoju
{"title":"A new chapter for pathogen surveillance in Africa","authors":"Paul Adepoju","doi":"10.1016/j.lanmic.2025.101304","DOIUrl":"10.1016/j.lanmic.2025.101304","url":null,"abstract":"","PeriodicalId":46633,"journal":{"name":"Lancet Microbe","volume":"7 1","pages":"Article 101304"},"PeriodicalIF":20.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145696506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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