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Published Global Burden of Disease estimates for 2000–2021 show a persistent geographic hierarchy of mortality, a pattern consistent with AMR burden being embedded in health system capacity rather than due to pathogen evolution alone. Furthermore, the for-profit pharmaceutical model remains structurally misaligned with the clinical necessity of restricted antibiotic use.

This Perspective argues that the next phase of AMR mitigation must pivot from a discovery-dominated paradigm to an integrated preparedness model in which innovation, stewardship, surveillance, and governance are collectively strengthened. We contend that success will be determined less by laboratory and technology breakthroughs than by the political commitment to decouple revenue from sales volume and to govern antimicrobial effectiveness as a shared, exhaustible resource.