Bridging the Gap Between Genomic Surveillance of Antimicrobial Resistance and Public Health Decision-Making: A Review

Antimicrobial resistance (AMR) poses an escalating threat to global public health, undermining the effectiveness of infectious disease prevention and treatment and placing sustained pressure on health systems worldwide. Advances in genomic technologies, including whole-genome sequencing and metagenomic analyses, have substantially enhanced the resolution and scope of AMR surveillance. However, despite growing investments in genomic surveillance, the routine translation of genomic data into public health policy and action remains limited. This review examines the persistent data-to-decision (D2D) gap that constrains the public health impact of genomic AMR surveillance. Using a narrative review approach, the literature on genomic AMR surveillance, public health surveillance systems, and decision-making frameworks was synthesized to assess how genomic data are generated, interpreted, and operationalized within public health systems. The review integrates evidence from international and national surveillance initiatives, policy analyses, and implementation studies, with particular attention to organizational, analytical, and governance factors influencing data use. Findings indicate that while genomic surveillance offers high potential for early detection of resistance, transmission tracking, and proactive intervention, its public health utility is frequently limited by insufficient integration with decision-making structures, lack of standardized reporting and interpretation frameworks, and unclear action thresholds. The review highlights emerging best practices, including standardized translational reporting, decision-support tools, predefined genomic action triggers, and multidisciplinary collaboration, as critical mechanisms for closing the D2D gap. Persistent inequities in access to genomic surveillance capacity, particularly in low- and middle-income countries, further underscore the need for governance models that prioritize sustainability, local ownership, and equitable capacity building. Overall, this review argues that realizing the full public health value of genomic AMR surveillance requires moving beyond technological advancement toward intentional systems-level integration that aligns genomic intelligence with timely, evidence-informed public health decision-making.