Self-Assessed Antimicrobial Resistance Surveillance Capacity in the WHO Eastern Mediterranean Region: An Internal Validation of the Tracking AMR Country Self-Assessment Survey

Abstract

Global antimicrobial resistance (AMR) monitoring relies heavily on the Tracking AMR Country Self-Assessment Survey (TrACSS), an unverified annual self-report instrument. This study examined whether Eastern Mediterranean Region (EMR) surveillance self-ratings corresponded with laboratory and programmatic capacities reported by the same respondents and characterized non-response. A cross-sectional analysis used the TrACSS 2025 public dataset, covering 184 responding countries. For 19 EMR respondents, we compared surveillance ratings against four criteria: reference-laboratory susceptibility testing for all 12 priority bacteria, standardized testing guidelines, external quality assurance beyond reference laboratories, and reporting a laboratory count. Ratings were also compared with national action plan (NAP) implementation. Nineteen of 22 EMR member states responded; non-responders, Libya, the Syrian Arab Republic, and the occupied Palestinian territory, were conflict-affected. EMR had the highest proportion reporting standardized national surveillance or better (73.7% versus 58.8% globally). Countries rated D–E met a mean of 3.5 corroborating criteria, compared with 1.6 among those rated A-C. However, only 7/14 countries claiming standardized national surveillance met all four criteria; 5/14 omitted laboratory counts, including three high-income countries. Furthermore, 11/14 reported NAPs at best, partially implemented with limited resources, including one with a plan neither endorsed nor implemented. Two countries provided internally contradictory responses. EMR surveillance self-ratings showed partial internal corroboration, but programmatic discrepancies and conflict-related non-response complicate interpretation. Because corroborating items share the same reporting source, these findings do not independently validate capacity. Analyses should report internal corroboration alongside ratings and distinguish reported surveillance maturity from verified operational capacity.