1. What is ICARS? And how does ICARS support countries in addressing AMR?
The International Centre for Antimicrobial Resistance Solutions (ICARS) was established in 2019 through discussions between the Government of Denmark and the World Bank, with the aim of testing solutions that could work in low-and middle-income countries. It was initially placed under the Ministry of Health in Denmark and became a self-governed organisation in 2021.
ICARS provides both funding and technical support to its partner countries. Engagement begins when a country submits an Expression of Interest, after which ICARS co-develops a project with national counterparts. Each project is built around the country’s key AMR challenges, existing interventions, national AMR action plans, and governmental priorities.
2. How does ICARS work with countries to develop and implement AMR intervention and implementation research projects?
ICARS strives for co-development that combines both top-down and bottom-up approaches. Government involvement is essential, with one or several ministries involved from the beginning to ensure alignment with national priorities. At the same time, evidence is generated by local researchers. Project formulation includes inputs from all key stakeholders, such as practitioners, communities, local organisations, the private sector researchers, and ministry agencies (depending on the project scope). The aim is to bring everyone to the table.
The solutions are tested in real-world settings and evaluated for sustainability, applicability, scalability, cross-sector benefits, user acceptability, fidelity and efficiency in reducing AMR. Many outcomes are captured. ICARS supports access to interventions by involving both ministries and researchers throughout the entire project cycle. While One Health is a core pillar of ICARS’ work, not all projects apply an integrated One Health approach, but some are more sector-specific. ICARS also issues targeted calls for proposals to address specific gaps in certain areas. There are both sector-specific and multi-sector projects.
3. How many projects does ICARS support, and where are they implemented?
ICARS currently has around 60 projects in 28 countries and territories, working with more than 170 partners globally and involving 50 post-graduate students, mostly PhD candidates, across different projects. All projects are implemented in low-and middle-income countries; none in Denmark.
Projects are completely country-driven. While ICARS provides financial support, the research is conducted by national teams as local ownership is essential; without it, impact will not be achieved.ICARS is also strengthening its tools for sustainable impact, including methods to help ensure uptake and scale-up once the project has ended.
4. How have global political commitments influenced national action and decision-making on antimicrobial resistance?
The AMR High-Level Meetings in 2016 and 2024 elevated AMR to the global political agenda, bringing the topic to the UN General Assembly for the first time. These meetings and the following discussions generated support to countries to develop national AMR action plans following the Global Action Plan on AMR.
Increased political attention was also accompanied by increased funding for planning and implementation, as well as data generation. At the High-Level Meeting in New York in 2024, countries committed to meeting agreed AMR targets. Presented data to decision-makers – including economic feasibility – has proven to increase buy-in as AMR is commonly considered complex and difficult to explain. Translating it into simple terms and demonstrating actual and anticipated impact is important. Engaging Ministers of Environment can be challenging, as they do not always see their role; hence, advocacy is key.
5. What progress and challenges do countries face when translating these political commitments into context-specific AMR interventions on the ground?
Interventions must be context-specific and tested by local teams using their own structures, which resonates more strongly with decision-makers. However, countries face a range of barriers, such as limited knowledge, data, and challenges in sharing understandable data for decision-making. Also, competing priorities add further complexity.
Despite challenges, AMR has gained higher priority in recent years. In 2016, the term was less widely known, but speaking with practitioners such as healthcare workers and veterinarians shows clear improvement over the past 10 years. The One Health approach is progressing, and countries are increasingly recognising the benefits of connecting multiple sectors. Much of this progress has been gradual (“silent work”), but it is now taking off. The COVID-19 pandemic further increased awareness of the consequences of not working across sectors.
Data availability still varies greatly between countries, and while AMR is often called a “silent pandemic,” it is far from silent.
6. So, what additional barriers need to be addressed to strengthen cross-sector collaboration and make One Health approaches truly operational in countries?
At the recent One Health conference organised during the Danish EU presidency, several key barriers were identified, like organisational and structural limitations, challenges related to the generation, sharing and use of data, and obstacles related and cultural differences such as language and ways of working across the different sectors. Bridging these silos is important. Experience shows that it may be needed to start small and expand slowly towards an effective One Health collaboration, which requires transparency, a clear mandate, legislative support, and structural change to ensure that collaboration does not depend on individuals. Building these mechanisms takes time. Trust and strong frameworks are essential, and starting informally is fine, as it can be an effective first step.
Alongside improved collaboration, there is a need for more data and for the development of models that allow different sectors to work efficiently together.
7. Can you tell us more about the impact of ICARS’ projects and how the organisation is working to ensure long-term policy change in partner countries?
Only three of the intervention and implementation projects have completed interventions to date, meaning it is not yet possible to assess the long-term policy impact fully. ICARS is developing a Monitoring, Evaluation, Accountability and Learning (MEAL) system to track progress after project closure. The organisation is also exploring whether small catalytic funding could help countries continue scaling up interventions and translating results into policy. Because policy change requires more than a three-year project;. ICARS acknowledges that not every intervention will succeed, and the organisation views this as an important part of learning. Progress in countries is beyond the direct ICARS’ control. A successful project with promising results in Colombia aimed to reduce piglet diarrhoea and antimicrobial use by improving vaccination and access to colostrum (raw milk). Diarrhoea was reduced by 50% in the intervention group, and antimicrobial use was reduced by 90%; despite this, piglet weight gain increased by 45%. Such successes demonstrate that the model is working and the results have generated strong interest from other countries, particularly in Latin America, where pig production systems are similar.
8. What mechanisms have you found most effective in translating scientific evidence into actionable policy within the One Health framework?
The co-development model is essential. Involving ministries at early stages ensures co-creation with researchers to determine what evidence is needed and how it will be used for uptake and scaling. Aligning researchers and decision-makers on the research questions is a critical component.