Youth are recognised as ‘change-makers’ within the climate change literature due to their roles in knowledge-transfer at community level, instigating behavioural changes in the longer term1. Antimicrobial resistance (AMR) is another global challenge which may benefit from the change-making potential of youth, yet policy, research and action traditionally target adult populations. However, in 2022, ‘Youth’ were identified as a priority audience in a global consultation organized by the Quadripartite Joint Secretariat on AMR - a collaboration between Food and Agricultural Organization (FAO), United Nations Environment Programme (UNEP), World Health Organization (WHO) and World Organisation for Animal Health (WOAH)2. No formal definition of youth was given in recognition of the heterogeneity and diversity of youth globally and across Quadripartite membership, which is not always appropriate to classify by age alone. This broad recognition of youth acknowledged existing youth-focused AMR initiatives and spurred the inception of more across the globe. The Quadripartite responded by convening a Working Group on Youth Engagement for AMR, comprising 14 individuals representing youth-led or youth-facing organisations across 14 countries3.

Co-creating a Youth Manifesto on AMR

Between March and May 2024, the Working Group co-created a Youth Manifesto on AMR4. An extensive consultation process of online meetings, surveys, reviews and feedback engaged over 90 global stakeholders from One Health sectors, private, public, charitable, and grassroots organisations and educational bodies. Co-creators emphasized the urgent need to broaden public understanding of AMR via education for all youth, not just those in human, environmental and animal (One Health) professions. They identified a critical challenge of retaining talent in AMR fields, particularly in low-and-middle-income countries (LMICs), where ‘brain drain’ threatens local capacity. Consultations highlighted the complex interplay of poverty, gender, intersectionality, power and emergency conditions exacerbating AMR challenges among youth. Early Manifesto feedback stressed that educational materials should be co-created with, rather than simply delivered to youth, and that dedicated financing for youth engagement, especially in LMICs, is essential.

The Manifesto defines four Top Priorities: Advocacy and Engagement, Education and capacity building, Patient Care (humans and animals) and Addressing AMR with a One Health approach (Table 1). Emphasizing the interlinkages between these priorities, it outlines actionable steps that extend beyond awareness-raising, positioning youth as innovators and decision-makers in AMR policy, practice, and advocacy. It calls for the inclusion of young people on global decision-making platforms and capacity-building initiatives to enable youth-led action against AMR at all levels. The Manifesto was launched in advance of the multistakeholder hearing associated with the United Nations General Assembly High-Level Meeting on AMR (UNGA HLM) in September 2024 and further disseminated during other high-level convenings.

Table 1 Top priorities identified by youth highlighted in the Youth Manifesto for the United Nations General Assembly High-level Meeting on Antimicrobial Resistance, 2024
Full size table

Realising the priorities of the Youth Manifesto on AMR

The publication of the Political Declaration of the UNGA HLM now provides an opportunity for forward-facing reflection on the Youth Manifesto, considering global AMR actions endorsed by current world leaders5. Notably, the Political Declaration and Youth Manifesto share core elements, including emphasis on One Health, training and education, importance of Infection Prevention and Control and the need to reduce inequities in (One) Health care. However, current youth involvement in AMR is often confined to education and awareness-raising initiatives6. Here, youth are positioned at worst as passive recipients of knowledge and at best as potential conduits for the spread of such knowledge within their immediate communities7,8,9. Indeed, the UNGA Political Declaration’s first mention of youth within outcome 14 “Acknowledge the need to leave no one behind” discusses youth and children within the context of “supporting and empowering” only. More promisingly, Governance commitment 29 “Promote participatory, inclusive and transparent approaches to health governance for antimicrobial resistance at local, national, regional, and global levels” lists Youth among other relevant stakeholders to be included “in the design, implementation and review of national action plans on antimicrobial resistance, to systematically inform decisions”. This represents a major step forward in realising the priorities of the Youth Manifesto on AMR which calls for conscious, strategic and meaningful engagement of young people on AMR. The Manifesto’s objectives to guide such action are now being recognised globally including being cited by ReAct’s Youth Engagement on antibiotic resistance Toolbox10.

Youth engagement with AMR: why now?

The engagement of youth in AMR is timely. The COVID-19 pandemic, political changes and global conflicts are impacting on funding and aid landscapes, many of which previously supported global AMR action. In January 2025 the USA cut aid programmes dramatically which impacted human and animal vaccine programmes, infectious disease and emergency medicine (including antimicrobial) access across the globe11. One month later the UK government released plans to cut overseas aid budgets, and in July 2025 confirmed it would not fund the planned third phase of its flagship Fleming Fund. This globally recognised programme included fellowships, training, mentoring and grants to support LMICs tackle AMR from a One Health perspective with a particular focus on capacity development of early career professionals in their home countries. Such drastic reductions in global aid (generally) and AMR funding are concerning. They speak to the ‘brain drain’ of AMR professionals in LMICs, an issue highlighted by the Youth Manifesto, but also make it challenging to meet objectives of country specific National Action Plans (NAPS) on AMR. The long-term funding cuts of the UK government for example could derail progress toward theme 4 of their NAP: ‘being a good global partner’. Although the UK’s research councils still fund overseas work there are budgetary limitations and this has impacts for One Health challenges such as AMR which require extensive in-country partners and resources to operationalise12. Youth engagement is clearly no substitute for globally robust aid and funding mechanisms, nor is it without cost. However, investing in AMR-literate youth could offer a route to sustaining the personnel required to operationalise NAPs and other AMR policies, whilst maximising the impact of recent AMR action and investment via cross-generational knowledge exchange.

A blueprint for inclusive action on AMR

Young people engage directly in AMR-associated behaviours including health seeking, animal husbandry, aquaculture, household cleanliness, and food preparation. Thus, NAP objectives including; Increasing public awareness of AMR, appropriate antimicrobial use in human and animal health, and increased infection prevention could be supported by the engagement of AMR-literate young people. Whilst education may be a component, the Youth Manifesto is clear that AMR teaching should be de-siloed beyond traditional fields of science and health. Rather, it should allow youth to conceptualise AMR as a lived experience upon which everyone has knowledge to share, and requiring interdisciplinary input to solve. This opens AMR education to a range of pedagogical approaches and curriculum alignments including the engagement of youth in material design. This latter point is reiterated by the WHO-led policy brief on Antimicrobial Resistance prevention and engagement in schools which calls for the co-creation of educational materials and methods with, not just for, young people13. Non-educational engagement is also a priority. Across the world, antibiotics are the most prescribed medication for children in hospital and community settings, raising concerns over inappropriate use the risk of AMR infections14. The Manifesto calls for strengthened paediatric antimicrobial stewardship and youth-centred counselling to guide infectious care of youth, not only as means to safeguard immediate health outcomes, but to foster an environment of rational use in the long-term. Finally, the Youth Manifesto calls for youth to be given a seat at the table within AMR policy and governance decisions across One Health. We do see positive examples of such engagement. The president of Barbados (also chair of the global Leaders Group on AMR) hosts annual youth dialogues on AMR providing a platform to exchange knowledge. The FAO’s Reduce the Need for Antimicrobials on Farms for Sustainable Agrifood Systems Transformation (RENOFARM) initiative includes a specific youth engagement workstream and supports regional youth association meetings to discuss AMR in agrifood contexts. A sustained increase in such active and equitable youth participation in AMR education, patient care, advocacy and One Health dialogues should become a global priority in AMR action. This would transition youth from passive recipients of knowledge and into changemakers.

Conclusions

The Youth Manifesto on AMR stresses that confining youth to passive roles could dimmish their autonomy in AMR action. Youth are a multifaceted demographic representing AMR survivors, indigenous voices, marginalised and privileged communities, parents, carers, laypersons and professionals. Their voices matter in a myriad of different ways. We believe the Youth Manifesto on AMR provides a blueprint for how their change-making potential can be harnessed to promote equitable, meaningful and sustainable action on AMR from a global, One Health perspective. However, this is only the beginning of the story. We need to understand the cost, and cost effectiveness, of AMR education and wider youth engagement, which will require consensus on what success looks like. Future questions include; what measurable outputs can be built into policy level documentation? How sustainable are the Youth Manifesto’s four Top Priorities? Who will pay for One Health actions which straddle traditional governmental budgets? What nuance is needed to implement and maintain them differentially across high- and low-income contexts? By aligning with established AMR guidance, including the NAPs, the Manifesto takes a first step to amplify existing voices and consensus on how youth can engage with AMR. Yet the call-to-action, in terms of implementation, remains open across the research, policy and education landscapes.