WHO’s 2024 list of priority bacterial pathogens confirmed as a strong roadmap for antimicrobial research

A Science in One Health perspective has assessed the World Health Organization’s 2024 Bacterial Priority Pathogens list, praising its evidence-based prioritisation of antibiotic-resistant bacteria while warning that a narrow human-health focus risks undermining efforts to address antimicrobial resistance at a global, cross-sectoral level

A recent perspective published in Science in One Health has examined the 2024 Bacterial Priority Pathogens list issued by the World Health Organization (WHO), presenting it as a valuable strategic tool for guiding antimicrobial research and development while identifying important gaps that limit its contribution to a genuinely holistic antimicrobial resistance (AMR) strategy.

The 2024 list prioritised 24 antibiotic-resistant bacterial pathogens through an evidence-based scoring framework that accounted for clinical impact, resistance burden and treatment options. Carbapenem-resistant Klebsiella pneumoniae emerged as the sole pathogen in the critical tier – with an overall score of 84 per cent – reflecting its high mortality burden and limited therapeutic alternatives.

The updated framework also elevated several community-acquired pathogens to high-priority status, including fluoroquinolone-resistant Salmonella Typhi and Shigella species. This shift has underscored the close relationship between AMR and inadequate water, sanitation, and hygiene infrastructure – particularly in low-resource settings.

Since the first publication of the list in 2017, at least 13 antibiotics targeting priority pathogens have received regulatory approval. The authors noted that this progress has demonstrated the practical value of pathogen prioritisation in stimulating innovation. They also highlighted the inclusion of preventability metrics in the 2024 list, which has encouraged greater emphasis on interventions that reduce infection incidence rather than reliance on antibiotics alone. Typhoid conjugate vaccines were cited as a well-established example of vaccine-led approaches that can contribute meaningfully to AMR control.

Despite these strengths, the analysis has identified a fundamental limitation in the list’s predominantly human-centric design. The authors argued that this focus has resulted in insufficient attention to agricultural and environmental drivers of AMR. Environmental reservoirs of resistance genes in soil, water, and wildlife microbiomes have acted as persistent amplifiers of human exposure, yet they remain weakly represented within existing global monitoring and prioritisation frameworks.

The rise of carbapenem-resistant Enterobacterales, for example, has frequently been associated with antimicrobial use in agriculture, a factor not directly captured by the current prioritisation criteria.

The perspective has also raised concerns about geographical and surveillance bias. Data inputs for the list have remained skewed towards high-income countries, which may obscure the true scale and characteristics of AMR in low- and middle-income regions. In addition, the authors have argued that genetic heterogeneity within priority pathogens requires closer scrutiny, pointing to high-risk clones of carbapenem-resistant Klebsiella pneumoniae – such as ST11-KLC64 – as examples where lineage-level resolution could inform more effective interventions.

The authors have urged stakeholders to respond with coordinated action that extends beyond traditional biomedical boundaries. They called to integrate explicit WHO’s One Health metrics into future iterations of the list, including indicators of zoonotic transmission risk and environmental dissemination. They also emphasised the need to strengthen global surveillance systems such as the Global AMR and Use Surveillance System through more equitable data contributions from low- and middle-income countries.

In parallel, they advocated efforts to accelerate therapeutic innovation beyond conventional antibiotics, including bacteriophages, monoclonal antibodies, and vaccine research and development. This should sit alongside robust antimicrobial stewardship and sustained investment in water, sanitation and improved hygiene infrastructure for community-acquired infections.

The authors concluded that pathogen prioritisation should not be viewed solely as a technical or scientific exercise. They described it as a moral imperative with direct implications for global health equity. They argued that translating the 2024 Bacterial Priority Pathogens list into coordinated, cross-sectoral action would prove essential to strengthen resilience and fairness in the global response to AMR.

For further reading please visit: 10.1016/j.soh.2025.100145