AMR Awareness Week 2025: Understanding the Updated WHO Bacterial Priority Pathogens List
AMR Awareness Week highlights the growing impact of antimicrobial resistance (AMR) across bacteria, fungi, viruses, and parasites. AMR remains a major and persistent global health challenge that requires coordinated action across research, development, and policy. Often described as a silent pandemic, resistant infections continue to strain healthcare systems worldwide.
The WHO first published the Bacterial Priority Pathogens List (BPPL) in 2017. In 2024, the list was updated to reflect seven years of scientific progress, evolving resistance patterns, and improved measurement methods. While the updated methodology introduced new criteria and weighting, the relative shifts between 2017 and 2024 provide valuable insight into how the threat landscape is changing.
Key Updates in the 2024 BPPL :
- Pathogen additions and removals: Most notably, Mycobacterium tuberculosis was included following an independent assessment. This recognizes its continued contribution to the global AMR burden.
- ESKAPE pathogens remain central concerns: These pathogens retain their capacity to develop resistance to multiple antibiotic classes. Some members have shifted slightly in rank, with Carbapenem-resistant Klebsiella pneumoniae now at the top of the bacterial threat ranking.
- Gram-positive ESKAPE pathogens: Vancomycin-resistant Enterococcus faecium (VRE) continues to rank above Methicillin-resistant Staphylococcus aureus (MRSA), although both remain in the high priority group. The observed modest divergence within the relative BPPL 2024 ranks suggests that, when mortality, incidence, resistance trends, treatability, and pipeline are considered together, VRE carries a slightly higher relative priority, whereas MRSA has not increased in priority to the same extent. This may reflect a combination of evolving epidemiology, improved data on VRE, and the updated weighting of criteria, rather than a single cause.
- Middle and lower ranks: More pronounced changes are visible here, driven by improved surveillance, broader category definitions, and better burden estimates. For example, Shigella species, fluoroquinolone-resistant: 25→8 and Proteus species, third-generation cephalosporin-resistant: 8→17).
- The combination of stability at the top of the list and movement in the middle tiers illustrates two realities. The core AMR threats remain entrenched, while improved surveillance and data quality continue to refine our understanding of emerging risks.
Please note, that "rank" in the list does not mean "group".
Why pathogens end up in Critical vs High vs Medium groups
- Critical: These are pathogens/resistance types that score very high on the combination of worst-case criteria: high mortality, high incidence or global burden, rapidly rising resistance, very limited treatment options (including lack of pipeline), high transmissibility, and maybe low preventability. They represent the most urgent R&D/ public-health action needs.
- High: These still pose very serious threats, but have, e.g., somewhat better treatability or lower burden/resistance trends compared to the Critical group, or more feasible prevention. They’re less “extreme” in all criteria than the Critical ones.
- Medium: These are important and need monitoring and action, but they score lower across one or more key criteria. For example, the incidence is moderate or treatability is slightly better (more options exist). The urgency (for new antibiotic development or highest-priority intervention) is somewhat lower.
Looking Forward
Sustained progress against AMR requires aligning policy, surveillance, and R&D investment with pathogens that consistently drive the greatest burden while remaining responsive to emerging threats. The BPPL serves as a crucial guide, helping researchers, developers, and policymakers focus efforts where they can have the greatest impact.
Links and sources:
- WHO BPPL 2024: https://www.who.int/publications/i/item/9789240093461
- Sati, H., Carrara, E., Savoldi, A., Hansen, P., Garlasco, J., Campagnaro, E., Boccia, S., Castillo-Polo, J. A., Magrini, E., Garcia-Vello, P., Wool, E., Gigante, V., Duffy, E., Cassini, A., Huttner, B., Pardo, P. R., Naghavi, M., Mirzayev, F., Zignol, M., Cameron, A., Tacconelli, E., & WHO Bacterial Priority Pathogens List Advisory Group. (2025). The WHO Bacterial Priority Pathogens List 2024: A prioritisation study to guide research, development, and public health strategies against antimicrobial resistance. The Lancet Infectious Diseases, 25(9), 1033–1043. https://doi.org/10.1016/S1473-3099(25)00118-5