This introductory text highlights the “Systems Policy Analysis for Antimicrobial Resistance Targeted Action (SPAARTA): A Research Protocol”, published in Wellcome Open Research on July 30, 2025 (version 2), initially published on December 2, 2024. Authored by Raheelah Ahmad and an international, multi-disciplinary team, the protocol addresses the pressing global challenge of Antimicrobial Resistance (AMR).
Background and Rationale: The global community faces a significant threat from Antimicrobial Resistance, where microbes develop resistance to the drugs designed to treat them. While a large majority of countries (88%) have developed National Action Plans (NAPs V.1.0) to combat AMR, many of these plans remain largely unimplemented, often due to a lack of funding for interventions. Furthermore, there is limited understanding of which strategies are most effective in reducing antimicrobial use (AMU) and preventing untreatable infections. The current burden of AMR remains unabated despite these policy formations. The protocol emphasizes the importance of looking beyond AMR-specific factors to identify broader systemic elements at the country level that can either hinder or accelerate progress. This holistic perspective is crucial, particularly given the co-dependence between AMR and the Sustainable Development Goals (SDGs). The research also addresses priority questions from high-level forums, such as the United Nations General Assembly (UNGA, 2024), concerning the effective leveraging of domestic resources, costing and monitoring of NAPs, enhancing cross-sector collaboration, and engaging the private sector.
The primary aim of the SPAARTA protocol is to provide innovative, systematic, and comprehensive policy analysis to enable countries to compare, refine, and operationalize targeted actions against AMR, especially as they develop and implement next-generation NAPs (V.2.0). Ultimately, the study seeks to establish a standardized approach for evaluating AMR NAPs and to develop a practical tool that facilitates country comparisons and promotes knowledge sharing among stakeholders.
The study employs a mixed-method, multi-country case study approach, focusing on policies and implementation strategies for AMR across the One Health spectrum (human, animal, and environmental health). Initially, the sample includes 17 countries, purposively selected to represent all WHO regions and emerging economies. The investigation is structured into three key components:
- Textual Qualitative Analysis: This component involves an in-depth appraisal of peer-reviewed literature and policy documents from global, national, and state levels for the period 2000–2024, utilizing an all-language search. Deductive analysis is applied using multi-disciplinary frameworks such as the Expert Consensus for Implementation Research (ERIC) Framework and the PESTELI (Political, Economic, Sociological, Technological, Environmental, Legislative, Industry) Framework. Interventions are coded based on their level and maturity of implementation, barriers/facilitators, setting, target audience, theme (e.g., surveillance, antimicrobial stewardship, IPC), pathogen type, and elements driving organizational change.
- Longitudinal Quantitative Analysis: This phase assesses the potential impact of country contextual determinants and AMR interventions on Antimicrobial Use (AMU) and AMR outcomes. Data are drawn from global health indicator repositories (e.g., Global Health Observatory, World Bank Open Data, OECD data) and international/national AMU and AMR surveillance networks. The initial focus is on the BRICS countries (Brazil, Russia, India, China, South Africa), chosen for their collective global population and GDP representation, and their varying levels of NAP implementation. The analysis employs advanced econometric models and machine learning approaches, including beta regression, Extreme Bounds Analysis (EBA), Bayesian Model Averaging (BMA), and Bayesian networks, to ensure robustness and address model uncertainty.
- Interactive Dashboard Development: Utilizing Tableau, this component aims to visualize insights derived from both textual and quantitative analyses. The interactive dashboard will enable users, including policymakers and planners, to compare countries based on geography or economy, visualize demographic profiles, socioeconomic status, AMU/AMR levels, surveillance participation, and the characteristics of implemented AMR interventions. This user-friendly platform is designed to facilitate rapid knowledge mobilization and informed decision-making.
The SPAARTA protocol is expected to provide a systematic and transparent approach for countries to benchmark their AMR strategies, understand their specific contexts, and make informed decisions on resource allocation. By offering a comprehensive insight into intervention effectiveness across diverse country settings, the study aims to contribute to refining and operationalizing AMR NAPs globally. The interactive dashboard, a key output, will foster comparisons between country clusters and enable strategic and operational stakeholders to identify effective policy interventions and accelerate progress against AMR. The rigorous, multi-disciplinary approach of this protocol also serves as a template for addressing other critical public health challenges.
Reference: Ahmad, R., Zhu, N., Jain, R., Joshi, J., Mpundu, M., Gutierrez, P. A., Holmes, A., Weyde, T., & Atun, R. (2025). Systems Policy Analysis for Antimicrobial Resistance Targeted Action (SPAARTA): A Research Protocol [version 2; peer review: 2 approved]. Wellcome Open Research, 9(700). https://doi.org/10.12688/wellcomeopenres.22923.2