Global governance, regulations, and policy responses to environmental antimicrobial resistance

Antimicrobial resistance (AMR) has become a critical global threat, often described as a “silent pandemic.” Although the broad application of antibiotics across various sectors has yielded significant benefits, inadequate regulation has led to inappropriate antimicrobial use, reducing treatment effectiveness. Thus, the development of resistance genes has accelerated, leading to rising global mortality. The rapid spread of these genes through soil, water, and air highlights the environment’s role as a critical reservoir and transmission pathway. This review provides a comprehensive analysis of the environmental dimensions of AMR alongside the associated governance, regulatory, and policy challenges through a One Health perspective. Literature was drawn from recent peer-reviewed studies and key international reports to evaluate global governance structures, including the WHO Global Action Plan, National Action Plans (NAPs), and the One Health approach. Major policy gaps include weak enforcement of environmental regulations and insufficient integration of the environmental sector into One Health initiatives. Furthermore, regulatory oversight is limited by a lack of specific antibiotic discharge standards and inadequate monitoring of pharmaceutical effluents and agricultural runoff. The review also examines the potential of digital technologies and artificial intelligence to enhance AMR surveillance and early detection. Eventually, stronger global governance, enforceable environmental standards, improved intersectoral coordination, and the integration of environmental indicators into NAPs and Sustainable Development Goals are essential to mitigate AMR and maintain intergenerational equity. By aligning policy frameworks with scientific evidence and technological innovations, more resilient systems can be established to protect global health.