Quantify the epidemiological trajectory of antimicrobial resistance (AMR), assess the economic and mortality costs across hospital and community settings, and evaluate the adequacy of global surveillance and response capacity relative to the scale of the threat.

Analysis of WHO Global Antimicrobial Surveillance System (GLASS) data from 150 countries, cross-referenced with country-level mortality estimates from the Murray et al. AMR mortality study (Lancet 2022). Surveillance system capacity assessment using WHO laboratory capacity index across 180 countries.

27 million deaths annually — ranking AMR among the top 10 causes of death globally. Resistance prevalence is accelerating: fluoroquinolone resistance in E. coli has risen from <1% globally in 1990 to 15-50% in many regions by 2024.

The most alarming trend is carbapenem-resistant Enterobacteriaceae (CRE) — the 'last-resort antibiotic' resistance — which has emerged in 180+ countries and carries 40-50% mortality in hospital settings.

Critically, surveillance capacity is concentrated in wealthy nations; 50% of WHO GLASS countries report complete blindness in antimicrobial resistance trends due to lack of microbiology capacity. The economic cost is estimated at $100 billion annually in healthcare costs plus $35 trillion in lost productivity by 2050 if current trends continue.