THE FOREIGN SERVICE JOURNAL | JULY-AUGUST 2025 39 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. 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. COVID-19 accelerated resistance by overwhelming hospitals, reversing stewardship progress, and increasing unregulated antibiotic use.
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