Antibacterial resistance (ABR) is no longer a clinical issue in a single sector, but a truly multisectoral phenomenon, influenced by use and transmission of antibiotics in human, animal, and environmental sectors. The Global Research on Antimicrobial Resistance (GRAM) Project estimated that, in 2021, 1.14 million deaths were directly caused by bacterial antimicrobial resistance (AMR), with 4.71 million deaths involving AMR, which is a contributing factor. GRAM Project estimates these figures could increase to 1.91 million and 8.22 million respectively by 2050 if current trends continue. This review reviews recent evidence (2020-2026) about the One Health drivers of ABR, quantifies the relative contribution of human, animal and environmental compartments by compartmental modelling and regional meta-analytical data, and describes the mobile colistin resistance (mcr) gene family as a case study of cross-sectoral spread. It also examines an important yet underappreciated aspect of the domain: the geographic skew in research investments in AMR, with Southeast Asia as a case study of a high-burden region that is chronically under-modelled. Lastly, the review assesses the state of global governance, based on the recently adopted WHO Global Action Plan on Antimicrobial Resistance 2026–2036, and a new, first-of-its-kind governance assessment across 193 countries, revealing that policy design has outstripped implementation, especially in the animal and environmental sectors. We suggest that the need to close the gap in One Health research and governance is now the limiting factor in the global AMR response, not the development of antibiotics.
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