The Americas’ new regional antimicrobial resistance (AMR) plan goes beyond surveillance and stewardship by setting measurable goals for financing, procurement, access to novel antimicrobials, and research. But the framework stops short of establishing a regional market incentive for antimicrobial development. As countries begin translating the plan into national budgets and procurement policies, their choices will determine whether stronger commitments to access can also help create more sustainable markets for needed antimicrobials.
A New AMR Plan with a More Concrete Implementation Agenda
On September 30, 2026, health authorities from across the Americas adopted the Pan American Health Organization’s (PAHO’s) Plan of Action on Antimicrobial Resistance 2027–2031, establishing a new regional framework for strengthening national responses to AMR.1 The plan is intended to guide countries as they develop, update, and implement national AMR action plans, with measurable interventions spanning governance, surveillance, prevention, antimicrobial access and appropriate use, research, financing, and accountability.2
Much of that territory is familiar from earlier AMR strategies. What makes the new plan especially relevant to the antimicrobial innovation and access landscape is the attention it gives to implementation. The resolution accompanying the plan urges Member States to “update, adopt, finance, and implement” national action plans. The plan itself calls for sustainable financing, stronger procurement systems, regional cooperation, more resilient supply chains, access to newer antimicrobials, and greater integration of AMR activities into national budget processes.
The plan brings two different policy problems into sharper focus. One is availability: whether health systems can obtain effective antimicrobials, diagnostics, and vaccines and make them available to patients who need them. The other is commercial sustainability: whether companies have sufficient incentive to develop, launch, and continue supplying priority antimicrobials when stewardship appropriately limits their use. PAHO addresses the first problem directly and creates room for countries to experiment with procurement and financing approaches. It does not itself establish a regional market incentive for antimicrobial development.
From National Plans to Measurable Implementation
The Americas are not starting from a shortage of AMR plans. Among the 33 Member States that periodically report to PAHO, 30 had already introduced national AMR action plans by 2026, while 22 had established or expanded infection prevention and control programs and antimicrobial stewardship initiatives. The remaining weaknesses are increasingly questions of execution, including gaps in surveillance, laboratory infrastructure, access to medicines and diagnostics, procurement, and sustainable financing.
Budget integration illustrates the problem. At the plan’s 2026 baseline, only 11 countries in the region had integrated AMR planning and budgeting into other national health or development strategies. PAHO identifies this limited integration as a constraint on policy coherence, sustainability, and coordinated action. By 2031, the organization wants 20 countries to have AMR activities costed and reflected in sectoral plans, annual operational plans, or formal budget instruments.
The access targets are similarly concrete. PAHO aims to increase the number of countries and territories with strategies to optimize access to World Health Organization Access, Watch, Reserve (AWaRe) Reserve-category antimicrobials from three to 10.
These indicators move the discussion beyond whether governments have formally adopted AMR strategies to examine whether countries have built the financial and procurement systems needed to make those strategies operational.
Procurement Moves Toward the Center of AMR Policy
Strategic Line of Action 4 is where the plan becomes most concrete about access. PAHO frames the issue as a dual imperative: countries need sustainable access to essential antimicrobials, diagnostics, and related health technologies, while maintaining appropriate availability and stewardship of Reserve-category antibiotics and other newer agents. The plan also calls for stronger national essential diagnostics lists to guide priority-setting, procurement, quality assurance, service delivery, and access.
PAHO explicitly points to fragmented supply chains, variable procurement capacity, and regulatory limitations as factors contributing to persistent disparities in access to appropriate, safe, effective, and quality-assured antimicrobials, diagnostics, and vaccines across the region. Its proposed response includes regional cooperation and pooled procurement mechanisms, stronger regulatory harmonization, market oversight, more resilient supply chains, improved access to diagnostics, and tighter links between diagnostics and prescribing.
Among the plan’s indicators, one is particularly relevant to antimicrobial developers and suppliers: PAHO wants to double the number of countries and territories with procurement mechanisms, policies, or other measures that promote access to existing and novel antimicrobials from 10 in 2026 to 20 in 2031.
The wording leaves substantial room for national variation because the plan does not prescribe a single procurement model. As a result, the significance of the target will depend on how countries implement it.
A conventional procurement process can improve availability without necessarily changing the commercial viability of launching or maintaining a product in a given market. Canada has explicitly cited limited commercial viability and market-entry barriers in explaining why some priority antimicrobials are not available domestically and why it is developing an economic pull-incentive pilot.3
Financing the Response Is Not the Same as Financing the Market
The plan also gives financing a prominent role. Strategic Line of Action 6 focuses on multisectoral governance, sustainable financing, and accountability, with explicit reference to domestic resource mobilization, costing of national action plans, and integration of AMR into annual operational plans and budget processes.
The regional plan itself has a defined implementation cost. PAHO estimates that activities carried out by the Pan American Sanitary Bureau over the life of the resolution will cost US$14.29 million. The estimated requirement for the 2026–2027 biennium is $6.432 million, of which $4 million has already been programmed through existing activities, including voluntary and assessed contributions. The remaining balance is expected to come through additional resource mobilization.
The categories behind those figures are instructive. They include human resources, training, consultants and service contracts, travel, publications, supplies, regional technical cooperation, laboratory quality systems, infection prevention and control, water, sanitation and hygiene activities, and antimicrobial stewardship support.
The plan is therefore not unfunded, but its financing is directed primarily toward implementation capacity. It is not a regional antimicrobial-development fund, and it does not establish a payment model intended to alter the commercial viability of bringing a new antimicrobial to market.
This is a key distinction because stewardship can intentionally limit the use of new antibiotics, weakening the relationship between clinical value and sales volume. Some governments have therefore begun testing payment models that reward availability and value rather than units sold.
Canada Shows What a Pull Incentive Looks Like
Canada offers one of the clearest examples of how a PAHO Member State can move from broad access objectives toward a more explicit market-shaping mechanism.
The Public Health Agency of Canada (PHAC) is preparing an Antimicrobial Economic Pull Incentives Pilot Project, also referred to as the AMR Innovation Pilot.3 PHAC describes the initiative as a time-limited 2026–2029 program intended to use innovative, outcomes-based financing to address market barriers that limit access to new antimicrobial drugs in Canada.
The program’s stated objectives include improving access to priority antimicrobials that are not currently marketed in Canada and creating incentives for companies to make those products available. PHAC also explicitly identifies limited commercial viability as one reason why some new antimicrobials may not enter or remain in the Canadian market.
Current federal planning documents identify C$4 million in contributions for 2026–2027, C$6 million for 2027–2028, and C$5 million for 2028–2029, for a total of C$15 million over those three fiscal years.4 Applications are expected to open in late fall 2026, with further funding details still to be announced.5
Canada’s pilot makes explicit something the regional framework leaves open. PAHO calls on countries to improve access to existing and novel antimicrobials and to strengthen procurement mechanisms. Canada is testing a policy designed specifically to influence the commercial decision to supply a priority antimicrobial.
This comparison demonstrates how a national government can move from identifying access as a goal to modifying the economic conditions that shape product availability.
The United Kingdom provides another example. Its antimicrobial product subscription model is designed to separate payment from the volume of antibiotics sold, allowing the National Health Service to assess value based on expected benefit to the health system rather than conventional unit-based purchasing alone.6 The model aims to reduce the tension between stewardship and commercial return by creating payments that do not rise and fall directly with prescription volume.7
The European Union has pursued a different route. In September 2026, the Council of the European Union adopted its position on a pharmaceutical package that includes a transferable exclusivity voucher for qualifying priority antibiotics, providing one additional year of market protection for another product.8 Parliamentary adoption was still required before the legislation could enter into force.
The European Commission has described the broader distinction between push and pull incentives: push mechanisms support research and development before a product reaches the market, while pull mechanisms reward successful development or market availability.9
These approaches differ in design, but each translates an AMR innovation objective into a defined economic mechanism. PAHO has not done that at the regional level.
What to Watch as Countries Implement the Plan
The plan does not ignore research and innovation. Strategic Line of Action 5 calls for multidisciplinary work spanning AMR burden, policy effectiveness, implementation, behavior, economics, environmental factors, and biomedical innovation. It also supports the uptake and evaluation of diagnostics, digital tools, and surveillance technologies, particularly where those technologies are feasible and sustainable in low- and middle-income settings.
However, its formal indicators show that PAHO is primarily focused on whether countries set research priorities and use evidence in policy. By 2031, it wants 30 countries and territories to include AMR research and innovation priorities, such as novel diagnostics, in a national AMR action plan or health research agenda, up from 28 in 2026. It also wants the number using AMR research, evaluation, or innovation findings to inform national policies, programs, guidelines, or investment decisions to rise from 20 to 25.
Many of the first meaningful signs of implementation will be visible before PAHO’s formal 2030 progress report.
One signal will be whether countries move AMR spending from standalone strategies into actual health budgets. Another will be whether the target on procurement for existing and novel antimicrobials produces new purchasing mechanisms or meaningful changes to existing systems. Countries that develop specific strategies for Reserve antibiotics will provide another indication of whether access goals are being translated into operational policy.
The role of pooled regional procurement will also be worth watching. The plan explicitly encourages regional cooperation and pooled procurement mechanisms, which could become important tools for improving access where individual national markets are small or fragmented.
The most consequential question for the innovation landscape will be whether countries pair those access policies with market incentives that change how companies evaluate antimicrobial markets. Canada’s pilot provides one immediate case to follow, but it may not remain the only one.
PAHO’s new plan creates a clearer way to judge progress than a simple count of national AMR strategies. By 2031, more countries are expected to have costed programs, procurement mechanisms for novel antimicrobials, access strategies for Reserve agents, and stronger research and innovation systems.
Whether those changes are sufficient to improve the economics of antimicrobial innovation remains a separate question. The plan gives procurement, financing, and access a more explicit place in regional AMR policy. Its significance will depend on whether countries turn those commitments into budgets, procurement systems, and access mechanisms that materially change antimicrobial availability.
