Antimicrobial resistance is a global problem, but the response is always local. The Gulf states share features that shape their AMR risk profile: high antibiotic availability, large expatriate populations that move pathogens across borders, well-resourced tertiary hospitals sitting alongside variable primary care, and rapid adoption of advanced diagnostics. A national AMR strategy that ignores this context will not work.
Most countries can produce a resistance report; far fewer produce one that changes prescribing. The priority is not more data but actionable data: standardised laboratory methods across facilities, a national dataset combining antimicrobial consumption with resistance, and reporting fast enough to inform empirical guidelines. Genomic surveillance should be built into the strategy from the start, not bolted on later.
A large share of antimicrobial use is in animals and agriculture, and resistance genes move freely between sectors. A strategy owned solely by the health ministry will miss much of the problem. The priority is a genuine One Health governance structure bringing human health, animal health, food safety, and the environment to the same table with shared surveillance and targets.
Every downstream activity depends on clinical microbiology laboratories that can reliably identify organisms and test susceptibility to a recognised standard. Capacity varies widely between a flagship tertiary centre and a regional hospital. Levelling this up — quality systems, external quality assurance, trained staff, and molecular capability where it adds value — is unglamorous but foundational.
Ministries can accelerate progress by setting a national stewardship standard, requiring facility-level programmes, and supporting them with shared guidelines, training, and metrics. Regulating over-the-counter antibiotic sales — still widely available in parts of the region — is among the highest-impact policy levers a ministry controls.
None of the above happens without people who understand it. Sustained investment in training — clinical microbiologists, infection-control practitioners, stewardship pharmacists, and the medical educators who teach the next generation — is what turns a national action plan from a document into a capability.
A workable sequence is to secure the laboratory and surveillance foundation first, establish One Health governance in parallel because it is slow to build, then scale stewardship and workforce development on top. Each Gulf state will weight these differently depending on where it already stands.
This is a strategic overview; national action plans should be built on a formal assessment of each country's existing capacity and resistance data.
I advise health ministries and international organisations on AMR surveillance, One Health coordination, and stewardship at scale.
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