Every year the World Antimicrobial Resistance (AMR) Awareness Week is observed from Nov 18 to 24. The 2025 theme, “Act Now: Protect Our Present, Secure Our Future”, reflects growing international concern. According to data published by the World Health Organization, about one in six laboratory-confirmed bacterial infections in 2023 were resistant to at least one commonly used antibiotic, and resistance increased in more than 40 percent of the pathogen–antibiotic combinations monitored between 2018 and 2023. These trends indicate that medical procedures once considered routine, including caesarean section, cancer chemotherapy and major surgery, may carry higher infection risks in the future if AMR continues to rise.

AMR has direct consequences for ordinary Malaysians. Infections that were once easily treated now require multiple courses of stronger, more toxic and more expensive antibiotics. Patients spend longer in hospital, face higher risk of complications, and are more likely to experience treatment failure. For families, AMR means prolonged caregiving, lost income and, in severe cases, the tragic reality that a routine infection could become life-threatening.

Beyond clinical risk, AMR creates hidden social and financial burdens. When a parent is hospitalised longer due to a resistant infection, households face income loss, childcare disruptions and out-of-pocket costs that compound financial stress. Businesses suffer from absenteeism and reduced productivity. These are not distant possibilities, they are already occurring in Malaysian wards, quietly raising the economic drag across sectors.

Recent research has improved our understanding of how AMR spreads beyond healthcare settings. While over-use and misuse of antibiotics in hospitals remain major drivers, environmental pathways are now clearly documented. For example, wastewater treatment plants, agricultural runoff and aquaculture operations have been identified as reservoirs of resistant bacteria and antibiotic-resistance genes. Studies have found that residual antibiotics, heavy metals and micro-plastic particles can increase the rate of horizontal gene transfer between bacterial species. These findings underscore that AMR cannot be addressed solely within hospitals but must be managed through coordinated action across human health, animal production and environmental sectors.

Malaysia’s surveillance data confirms that AMR is already a serious concern. The Ministry of Health’s MyOHAR platform provides national AMR monitoring and sets key priorities. The Malaysian Action Plan on AMR identifies methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Acinetobacter baumannii (CRAB), and extended-spectrum beta-lactamase (ESBL) producing Klebsiella pneumoniae among the highest-priority hospital-acquired pathogens.

A national study published in BMJ Open in 2025 provided further clarity on the economic consequences of AMR in Malaysia. The analysis found that hospital costs were strongly influenced by the volume of cases identified through Diagnosis Related Group (DRG) classifications, which are used to categorise hospital admissions based on clinical complexity and resource use. Length of stay was a major cost driver, averaging between 21.7 and 36.4 days for patients with resistant infections. Median admission costs ranged from RM12,476.28 to RM19,295.11, and both length of stay and total costs increased each year. The annual financial burden rose from RM3.71 million in 2017 to RM9.70 million in 2019. The study also reported that patients aged above 56 years and those with severity levels II and III were significantly more likely to exceed the national base rate for hospital charges. These findings suggest that AMR is causing a substantial and escalating economic impact on Malaysia's health system.

In response to the growing challenge of AMR, the Ministry of Health launched the Malaysian Action Plan on AMR (MyAP-AMR 2022–2026). The plan aligns with the World Health Organization’s global action framework and uses a One Health approach covering human health, animal health, agriculture, the environment and food safety. It sets out four strategic priorities: strengthening awareness and understanding among the public and health professionals; enhancing national surveillance and research capacity; improving infection prevention and control; and optimising use of antimicrobials across all relevant sectors.

A policy blueprint is necessary but not sufficient. Implementation is the decisive challenge and the source of economic risk. First, diagnostics must be scaled up. Many hospitals continue to rely on empirical therapy because access to rapid, high-quality diagnostics is limited and laboratory turnaround times can be long. Faster diagnostics reduce unnecessary broad-spectrum antibiotic use, shorten hospital stays and lower costs. Public investment in modern microbiology platforms and point-of-care testing therefore yields direct economic returns by reducing avoidable hospital expenditure and freeing up bed capacity for elective care.

Second, antimicrobial stewardship must be operationalised at the bedside. Stewardship that is policy-only, checkbox-based or siloed within pharmacy departments will not drive change. Effective stewardship requires daily collaboration between clinicians, pharmacists and microbiologists, real-time prescription review, and incentives aligned to quality outcomes rather than volume. Embedding stewardship in accreditation and linking it to departmental performance metrics will help convert plan into practice.

Third, the One Health commitments in MyAP-AMR must be funded and governed in ways that overcome institutional fragmentation. Surveillance gaps persist in animal production, aquaculture and wastewater monitoring. These are not technical niceties; uncontrolled reservoirs in the environment and food chain can continuously reseed hospitals with resistant organisms, undermining costly in-hospital infection control investments. Targeted surveillance pilots in high-risk sectors, paired with regulatory tightening on antibiotic use in livestock and aquaculture, are cost-effective steps.

Fourth, transparency and data disclosure are levers for improvement. Public reporting of aggregated hospital indicators, for example antimicrobial consumption per defined daily dose, hand hygiene compliance and participation in national surveillance would shift behaviour through accountability. Other countries have demonstrated measurable improvements after introducing public reporting linked to quality improvement programs.

Finally, Malaysia must invest in innovation. The economic case for funding diagnostics, vaccines, alternative therapeutics and research into resistance mechanisms is strong. The country has universities, hospital networks and public research institutions capable of conducting translational work. What is needed is sustained funding, clearer commercialisation pathways and public-private partnerships to bring innovations from bench to bedside and to regional markets.

For business leaders and policymakers, the message is straightforward. AMR imposes measurable economic costs and risks on the healthcare system and on the wider economy. Malaysia possesses a coherent Action Plan and professional capacity, but the gap between strategy and execution is the source of economic exposure. Addressing AMR effectively will require upfront investment, stronger cross-sector governance and an emphasis on diagnostics, stewardship and surveillance that yields both health and economic returns.

World AMR Awareness Week is a clear reminder that decisions on diagnostics, stewardship, environmental surveillance and research investment cannot be postponed. The evidence is already in front of us. AMR is raising the cost of care, prolonging hospital stays and eroding the effectiveness of essential medical services. Malaysia has a coherent national plan, but plans do not protect patients unless they are implemented with discipline and adequate resources. The public sector, industry and clinical professionals must now treat AMR as a national priority that requires coordinated action. The alternative is a steady increase in avoidable deaths, rising hospital expenditure and long-term economic losses that will be far more costly than acting now.

David Chang is a research officer at BranX-ON Marketing.