WHO GLASS AMR Surveillance and antimicrobial use in 55 Member States: gaps and stewardship insights

Background: Robust antimicrobial resistance (AMR) surveillance is foundational to effective stewardship and global health security. The WHO Global Antimicrobial Resistance and Use Surveillance System (GLASS), established in 2015, provides the primary international framework for standardised monitoring of AMR and antimicrobial use (AMU). Despite its expansion, underrepresentation of low- and middle-income countries persists, limiting global visibility of resistance trends in regions bearing the highest burden. Objectives: To evaluate participation of the 55 South Centre Member States, representing developing countries across Africa, Asia, Latin America and the Caribbean, in WHO GLASS AMR and AMU surveillance from 2016 to 2023, and to identify patterns, gaps and determinants of engagement. Methods: A cross-sectional descriptive study was conducted. Data were extracted from the publicly available WHO GLASS digital dashboard on 18 November 2024. Country-level enrolment status, year of registration, and participation in AMR and AMU surveillance modules were recorded for all 55 South Centre Member States. Findings were cross-verified against WHO GLASS Annual Reports 2022–2024. Descriptive statistics were used to characterise enrolment patterns by region, time period and surveillance type. Country case studies from India and South Africa were analysed to contextualise data quality and representativeness. Results: By the end of 2021, 33 of 55 South Centre Member States (60%) had enrolled in GLASS-AMR surveillance, increasing from 7 countries in 2016 to a peak of 8 new enrolments in 2017. The COVID-19 pandemic substantially disrupted engagement, with new enrolments declining by 77% during 2020–2021 compared with the pre-pandemic period. AMU surveillance participation was lower: only 20 countries (38%) had enrolled by the end of 2023, with 15 countries (27%) participating in both AMR and AMU components. African nations represented the largest regional group, followed by Asia and Latin America/the Caribbean. Case studies showed that sustained GLASS participation supports targeted antimicrobial stewardship, including evidence-informed empirical prescribing and improved Access antibiotic use. Conclusions: Despite progress, critical gaps remain in AMR and AMU surveillance across South Centre Member States, limiting evidence-based stewardship. Country-specific GLASS data can support tailored antimicrobial stewardship interventions and strengthen emergency preparedness. Closing data gaps through integrated national AMR action plans, interoperable digital infrastructure and regional capacity building is essential for equitable, targeted global antimicrobial stewardship.