From governance scores to governance impact: Closing the know-do gap in AMR policy evaluation.

As the 2026 revision of the Global Action Plan (GAP) on antimicrobial resistance (AMR) approaches, attention is shifting from policy adoption to the more complex challenge of evaluating implementation. Although most countries now have national action plans, reductions in resistance remain limited, exposing a persistent know-do gap between formal commitments and real-world impact. This commentary argues that prevailing governance assessments prioritise institutional presence over functional performance, overlook political economy constraints, and insufficiently integrate environmental and agricultural domains central to One Health. We highlight how surveillance asymmetries and static scoring distort comparisons and misdirect investment. We propose an impact-oriented evaluation agenda that incorporates temporal dynamics, incentive structures, equity considerations, and causal inference approaches to distinguish genuine progress from reporting artefacts. Closing the know-do gap is essential if AMR governance is to move beyond preparedness and deliver measurable, sustained change.