The WHO Global Antimicrobial Resistance and Use Surveillance System (GLASS) 2025 report marks an important milestone in strengthening global antimicrobial resistance (AMR) surveillance. It reflects WHO’s increasing commitment to ensure that AMR responses are inclusive, equitable, and informed by real-world data across human, animal, and environmental health sectors (World Health Organization [WHO], 2025). This reflexivity note acknowledges these advances while identifying opportunities for GLASS to further embed gender and equity as integral elements of effective AMR surveillance.

Conceptual framing: building on a strong foundation

The GLASS 2025 report demonstrates clear progress in recognizing gender and equity as priorities within AMR surveillance. For instance, the term sex appears 20 times in the report, and gender five times, an encouraging start. However, the two terms are often used interchangeably, suggesting limited distinction between biological and social determinants. As a result, gender tends to appear as a supplementary consideration rather than a central factor shaping AMR patterns.

Considering gender and equity in AMR is critical because gender and equity shape exposure, health-seeking behavior, access to diagnostics and treatment, and outcomes of antimicrobial resistance across different populations. Without sex- and gender-disaggregated data, critical inequities remain invisible, limiting the effectiveness of national and global AMR responses. Integrating gender and equity ensures that surveillance data capture the full spectrum of social determinants influencing resistance patterns and treatment gaps, ultimately leading to more inclusive and effective interventions (Okioma et al., 2025). 

The One Health framework is robust in addressing ecological connections, spanning humans, animals, and the environment but could be further enriched by integrating social dimensions such as gendered caregiving roles, informal medicine access, and occupational exposures. Expanding this framing would make surveillance more holistic and people-centred, consistent with the principles outlined in the WHO Equity Guidance for Public Health Surveillance (WHO, 2024).

The role of sex in AMR data completeness

In reflecting on the domains that define the completeness of AMR surveillance data, I commend the WHO GLASS 2025 report for explicitly recognising sex as one of the key variables in assessing data completeness. This acknowledgement marks an important step toward strengthening the interpretability and reliability of AMR surveillance globally. From my experience working on gender and AMR integration, I have seen how systematically capturing and analysing sex-disaggregated data can reveal critical differences in infection patterns, care-seeking behaviour, and antimicrobial use between men and women. When such data are missing, these gendered nuances often remain invisible, limiting our ability to design effective, equitable responses. The GLASS 2025 recognition of sex as a core data domain therefore reflects a maturing understanding that equity and data quality are deeply interconnected. It reaffirms that a surveillance system attentive to demographic diversity is one that not only tracks resistance more accurately but also moves closer to protecting all populations equally.

The BUGs and DRUGs syndrome

While the WHO GLASS 2025 report provides an impressive and detailed analysis of pathogens and antimicrobial resistance patterns across drugs, it does not explicitly present disaggregated data by sex or age. As a gender and equity practitioner, this presents a dilemma for me: without such demographic detail, we are unable to clearly identify which populations are most affected by AMR, or how patterns of resistance may vary across different groups. The absence of these insights limits our ability to understand the social dimensions of resistance, who is most exposed, who is most at risk, and who may be left behind by current responses. Nevertheless, I find hope in the report’s recognition of sex as a key domain for assessing the completeness of AMR surveillance data. These signals growing awareness that data are not neutral and that future reports can move beyond collection to deeper analysis unmasking the faces and lived realities of the people behind AMR statistics.

Visibility in data: moving toward inclusive surveillance

The report’s inclusion of sex-disaggregated data is commendable and signals a step toward more inclusive surveillance, however, broadening this to include other equity indicators such as, such as religion, gender identity/expression, place of residence, migration or displacement status, education level, income level, disability status, ethnicity or racial identity, occupation, caregiving responsibilities and level of agency over decision making, and geographic location would help capture the lived realities of populations most affected by AMR. Enhanced disaggregation would strengthen both the analytical depth and the policy relevance of GLASS data.

Progress and alignment: from recognition to practice

Compared to earlier editions, the GLASS 2025 report reflects notable progress in integrating gender and equity concepts and aligning with the WHO Equity Guidance (WHO, 2024; WHO, 2025). The next step is to translate this conceptual recognition into practice through the inclusion of operational tools, case studies, and practical country-level examples. This would help countries operationalise equity in AMR surveillance planning, data collection, and analysis.

Governance and accountability: strengthening inclusion

WHO’s leadership in coordinating global AMR surveillance is well recognised. Strengthening participation from community health actors, women’s networks, and social scientists could make GLASS governance more inclusive and context-responsive. Introducing incentives for countries to report equity-related data, or linking investments to equity-sensitive indicators, would enhance accountability and ensure that national surveillance systems capture diverse

Pathways for a people-centred surveillance system

To build on its achievements, GLASS could continue to evolve by:

• Embedding equity and gender as cross-cutting categories across all levels of analysis and reporting.
• Expanding metrics beyond sex-disaggregation to include key social and economic determinants of vulnerability.
• Supporting member states to capture data from rural, informal, and low-resource settings.
• Encouraging inclusive governance by integrating community, civil society, and social science perspectives.

In conclusion the GLASS 2025 report provides a strong platform for advancing inclusive AMR surveillance. By deepening its integration of sex and gender considerations, GLASS can set a global standard for surveillance systems that are not only technically sound but also socially responsive and truly people-centred.