Antimicrobial resistance is not simply a medical problem; it is a diplomatic challenge.

BY JORGE A. HUETE-PÉREZ

Antimicrobial resistance (AMR) has emerged as a global health crisis that threatens to reverse decades of medical progress. While COVID-19 highlighted viral threats, history demonstrates that bacterial pandemics have been devastating, and rising AMR now poses a silent crisis that could surpass viral outbreaks as treatments fail.

In Latin America, the burden of AMR is particularly severe, with projected mortality rates rising sharply by mid-century. Central America, a subregion with fragile health systems and inconsistent regulations, has experienced an alarming surge in antibiotic consumption. Between 2016 and 2023, the subregion became one of the fastest-growing consumers of antibiotics among upper-middle-income countries. This trend raises urgent concerns about overprescription, self-medication, and the proliferation of drug-resistant infections.

In the following, I propose a novel approach to the crisis, one that views AMR as a shared diplomatic challenge rather than simply a medical problem. This approach positions health diplomacy as the cornerstone of a regional AMR strategy. Fortunately, the Central American Integration System (SICA) offers an established framework through which to address this critical health security threat that transcends national borders. But implementation of an effective regional AMR mitigation capability will depend on vigorous health diplomacy, where science meets foreign policy.

The time to act is now—before AMR renders essential medicines ineffective, overwhelms already strained health care systems, and deepens socioeconomic instability in a crisis that could have been prevented through decisive cooperation. A unified AMR strategy based in SICA will strengthen cross-border cooperation and policy alignment, positioning the region as a global leader in health security.

A Paradigm Shift

The proposed “Regional AMR Strategy” is a paradigm shift. Current AMR mitigation efforts in Central America remain fragmented: Surveillance is inconsistent, policies are uncoordinated, and cross-border collaboration is minimal. Immediate steps should include establishing a regional coordination mechanism and developing a comprehensive action plan through health diplomacy.

Establishing systematic mechanisms for joint research initiatives, harmonized policy development, and coordinated surveillance programs across SICA member states Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Panama, and the Dominican Republic will cement the coordination.

Unlike previous regional health efforts, this strategy deliberately integrates antimicrobial stewardship (i.e., actions to prevent, detect, and respond to AMR) into existing frameworks while, at the same time, accounting for the unique political complexities of the isthmus. To ensure effective implementation, the region’s diplomats and development professionals should actively support SICA, using their expertise to facilitate cross-border collaboration and secure resources for this critical initiative.

Despite lagging in formal health diplomacy compared to other parts of Latin America, recent advances in Costa Rica and Panama provide a foundation for this initiative. Both countries are active participants in the rapidly growing science diplomacy landscape of Latin America, employing strategies to better connect their scientific and foreign policy agendas.

Through strategic partnerships and focused health diplomacy, the subregion can overcome political and institutional barriers to effective AMR control. Shifting from ad-hoc collaborations to structured governance will enhance the management of antimicrobials and at the same time serve as a replicable model for other regions facing similar challenges.

The Escalating AMR Crisis

Despite growing awareness of AMR as a major public health threat, regional efforts remain insufficient. Several practices continue to fuel resistance throughout Central America. Unregulated antibiotic sales, self-medication, and widespread use in livestock fuel resistance, while weak antimicrobial stewardship programs allow these practices to persist. While Costa Rica has undertaken strong stewardship efforts, resource shortages and poor infection control exacerbate health care vulnerabilities in many other countries.

The evidence is clear. High AMR-related mortality rates, increasing carbapenemase-producing bacteria, and a 2021 Pan American Health Organization (PAHO) alert on emerging resistant pathogens signal a worsening crisis. COVID-19 accelerated resistance by overwhelming hospitals, reversing stewardship progress, and increasing unregulated antibiotic use. Notably, in Nicaragua and Honduras, mass ivermectin distribution was carried out despite a lack of scientific support. Meanwhile, limited research and development (R&D) capacity throughout Central America creates additional challenges.

COVID-19 accelerated resistance by overwhelming hospitals, reversing stewardship progress, and increasing unregulated antibiotic use.

Political instability, particularly in Nicaragua, has further eroded scientific institutions, weakening evidence-based policymaking and regional collaboration. The closure of the Molecular Biology Center at the University of Central America in Managua, an important hub for AMR and COVID-19 research, in August 2023 has been a significant setback. Even Costa Rica’s selective engagement in regional cooperation, prioritizing economic cooperation and creating obstacles for fully unified initiatives, poses challenges for an effective approach under SICA.

The AMR crisis in Central America threatens regional stability, economic growth, and public health security, and this, in turn, affects U.S. interests. Drug-resistant infections undermine productivity, deepen poverty, and disrupt food security, while unchecked resistance could destabilize economies, worsen health inequities, and drive migration—intensifying challenges at the U.S. southern border.

Implementing a Regional AMR Strategy

Addressing AMR in Central America requires a comprehensive, coordinated strategy that integrates health diplomacy, scientific cooperation, and policy harmonization. As the region’s primary governance mechanism, SICA is well placed to align policies, mobilize resources, and foster cross-sector collaboration. This strategy presents an opportunity to reshape how these nations tackle public health threats.

To succeed, strong political will, cooperation, community engagement, and key partnerships are essential. Establishing an AMR strategy within this framework would provide a structured, effective response to the crisis and contribute to building a more resilient and robust public health infrastructure.

We recommend the following seven priority actions for immediate implementation:

1. Establish a harmonized regional AMR surveillance system. Fragmented surveillance hinders the ability to track and respond to resistant pathogens. Addressing this requires diplomatic engagement and policy alignment. A regional strategy, supported by PAHO and the World Health Organization (WHO), should standardize data collection, establish shared protocols, and enable real-time information exchange for enhanced detection and response, even in security-compromised areas. A unified AMR database will strengthen monitoring and serve as a strategic tool for policymaking and international cooperation.

2. Strengthen antimicrobial stewardship across sectors. Reducing antibiotic misuse requires comprehensive stewardship programs that integrate health care, agriculture, and environmental policies. Key actions include enforcing prescription regulations, phasing out antibiotics as livestock growth promoters, and, crucially, raising community engagement and public awareness to promote responsible antibiotic use. Investing in rapid diagnostic tools will further curb unnecessary prescriptions by ensuring antibiotics are used only when medically necessary. Establishing laboratories and acquiring advanced diagnostic equipment, crucial for identifying emerging resistant bacteria, will likely require international financial and technical support.

3. Integrate AMR policies into broader strategies. SICA can powerfully address the intertwined crises of climate change and antimicrobial resistance by integrating AMR interventions into existing regional frameworks. By recognizing shared drivers like unsustainable agriculture and environmental degradation, SICA can leverage established programs such as the Initiative for Climate Action Transparency (ICAT) and the Central American Commission on Environment and Development (CCAD) to incorporate AMR objectives. Expanding frameworks like climate-smart agriculture and the AFOLU 2040 plan to restore degraded land and ecosystems in SICA countries so that they include promotion of antibiotic stewardship can create synergies that simultaneously strengthen regional health initiatives and advance broader diplomatic goals.

4. Expand international cooperation on AMR. To effectively implement an AMR strategy, the subregion must expand international cooperation and health diplomacy. Collaboration with PAHO/WHO is crucial for capacity-building and policy development. Building on the recently announced partnership between PAHO and the Global Antibiotic Research and Development Partnership (GARDP), a Swiss nonprofit, a focused subregional effort is essential to maximize its impact and ensure access to new antimicrobial treatments. A subregional strategy provides a more structured and sustainable framework than broader regional efforts.

5. Prioritize research and development for AMR solutions. Lasting AMR progress depends on strengthening R&D through funding for new treatments and diagnostics, reducing reliance on external markets, and driving innovation. Public-private partnerships, stronger academic institutions, and a decentralized research approach can overcome political constraints and expand regional capacity. Securing support from organizations such as the International Development Research Centre (IDRC), a Canadian government organization that promotes and funds research in developing countries worldwide, is crucial for strengthening scientific cooperation, workforce development, and research infrastructure.

6. Strengthen capacity through targeted training. Central America must enhance regional capacity to combat AMR effectively. This requires standardized AMR education across medical, veterinary, and agriculture sectors to optimize antibiotic use and infection control. Adopting proven global training models and integrating AMR curricula into university programs will efficiently build a skilled workforce. Supporting exchange programs and biomedical research fellowships will further strengthen expertise and collaboration.

7. Ensure financial sustainability and governance. For long-term success, Central America’s AMR strategy must adopt a multistakeholder funding model. A dedicated fund within SICA can streamline resource allocation, while sustained global health investments can support research, monitoring, and policy innovation. Strengthening governance and addressing institutional weaknesses will be vital in overcoming past implementation challenges. This requires targeted capacity building, including training in advanced diagnostics and susceptibility testing; data analysis; coordination across human, animal, and environmental health sectors; and health diplomacy skills to enhance cross-discipline awareness and access to scientific expertise.

Implementing these priority actions successfully will improve health and food systems, economic stability, scientific research, and population health.

Diplomatic Considerations

Diplomatic engagement is essential for implementing the “Regional AMR Strategy,” focusing on policy alignment, resource mobilization, and sustaining commitments. For example, establishing a harmonized surveillance system requires negotiating data-sharing agreements, aligning regulations, and mobilizing funding. To navigate political complexities, countries can establish a regional memorandum-of-understanding mechanism to enable data sharing and coordination, even amid diplomatic strains. This approach fosters technical collaboration, promotes trust, and generates momentum for broader cooperation.

Diplomatic coordination aligns AMR policies with existing frameworks, leveraging SICA’s governance to integrate interventions and foster cross-sector collaboration. Effective research cooperation depends on diplomacy to address intellectual property, funding access, and research harmonization across institutions.

Still, a health diplomacy approach to AMR is not without potential challenges—it may overshadow national initiatives, reinforce regional power imbalances, or marginalize nonstate actors critical to AMR efforts. Ensuring inclusivity, transparency, and accountability is the key to mitigating such risks. Evidence-based collaboration and shared governance will translate commitments into action and drive sustained progress despite regional complexities.

Because AMR’s impact on health care, agriculture, and trade is transnational, a governance-based strategy to contain it is essential. However, achieving this requires sustained diplomatic engagement to rebuild trust, restore collaboration, and overcome policy barriers.

Jorge A. Huete-Pérez is a professor at Georgetown University’s School of Foreign Service specializing in biotechnology and science policy. With a PhD in biological sciences, he has led research in molecular microbiology and served as founding president of the Academy of Sciences of Nicaragua. A former fellow at Harvard’s Kennedy School of Government, he has expertise that extends to international research collaborations and science diplomacy, fostering cooperation in science, technology, and innovation.

Read More...

• “Leveraging Health Investments for U.S. Diplomacy” by Mark. C. Storella, The Foreign Service Journal, May 2017
• “There’s a Playbook: From Ebola to COVID-19” interview with Jeremy Konyndyk, The Foreign Service Journal, July-August 2020
• “Nicaragua's COVID-19 crisis demands a response” by Jorge A. Huete-Pérez and John Hildebrand, AAAS, July 2020