05-08-2025
Antimicrobial resistance and the fight to prevent a real-life The Last of Us
In the popular zombie-apocalypse TV show The Last of Us, humans become infected with parasitic fungi, causing a blooming fungal amour to sprout from their skulls. It's gripping TV but in the real-world, deaths from fungal infections have doubled in the last decade and drug-resistant fungi are showing an alarming upward trajectory, making this fictional threat feel uncomfortably close to reality.
Antimicrobial resistance (AMR), when fungi, bacteria, viruses and parasites evolve to resist the antimicrobial medicines designed to kill them, is quickly accelerating, fuelling a 'silent pandemic'. Since 1990, at least one million people have died from AMR every year. In the next 25 years, it could cause the deaths of almost 40 million people.
Low- and middle-income countries like my own, Nigeria, face a dual challenge. First, a lack of access to antimicrobials leads to more deaths from AMR and actually makes the resistance problem worse. And overuse of antimicrobials in other parts of the world – particularly in healthcare and agriculture – is also fuelling resistance. The result is not just a health crisis but a development emergency.
A recent study found that AMR economically hits low- and middle-income countries the hardest. Today, it costs approximately $66 billion and this is set to rise to $159 billion if action is not taken to effectively curb it.
In the midst of this worsening crisis, the UK Government recently announced that it is shutting the Fleming Fund – named after the discoverer of penicillin and a key player in the fight against AMR. While bad for UK science and the broader global effort to tackle AMR, it now falls on others to take up the baton to tackle one of the world's most existential threats.
The good news is that new leadership is emerging in the countries hit the hardest. This month, the Government of Nigeria announced it will host the fifth Global High-Level Ministerial Conference on AMR in 2026 – the first time the event will be held in Africa.
While promising developments, such as the antibiotic zosurabalpin, currently undergoing human trials, or the use of artificial intelligence in drug discovery, give reason for cautious optimism, there is much more to be done to ensure that life-saving treatments are available to the people that need them.
First, we must prioritise access to quality diagnostic tools, our first line of defence against AMR. Diagnostics ensure that antimicrobials are used appropriately, increasing patients' chances of recovery while slowing resistance. They also protect new discoveries by preventing unnecessary use.
Diagnostics are not just critical for individual patients, they are vital for tracking resistance patterns across animal, and environmental health; sectors which are deeply interlinked in our fight against AMR.
Today most of the world is fighting AMR without access to diagnostics. Without them, we're not just under-equipped – we're fighting blind.
Second, we must expand access to antimicrobials, create the market conditions needed for further drug development, and ensure that every country implements and enforces a national action plan for AMR.
Research in the Lancet across eight low- and middle-income countries found less than seven percent of people with drug-resistant bacterial infections could access the antibiotics they needed.
Without these medicines, both patients and the wider community are at risk, as pathogens spread and evolve.
Third, we must dramatically increase investment in innovation and strengthen the fragile antimicrobial pipeline. New antimicrobials are urgently needed to meet growing global demand and unmet needs.
At the fourth Global High-Level Ministerial Conference on AMR in Jeddah, Saudi Arabia, leaders acknowledged the weak pipeline for new antibiotics and the market failures holding back development.
The economic model is broken. Antibiotic research is costly, slow, and high-risk: for new classes of antibiotics, only one in 30 candidates will reach patients, and these are often reserved as a last resort. Government and industry must act urgently and ambitiously to reform the market to mobilise innovation. We need new economic models that reward long-term public health benefits, not just short-term profits.
Finally, diagnostic and antimicrobial access and innovations must be backed by strong national action plans. At the second high level meeting on AMR at the 79th United Nations General Assembly, global leaders committed to developing or implementing national AMR action plans. At that time, while 178 countries had developed multi-sectoral national action plans, only 68 percent were implementing these plans.
Last year, Nigeria launched its second national action plan on AMR, building on efforts to curb overuse and misuse of antimicrobials across human and animal health. But as we have learnt from Covid-19, pathogens do not know borders. Containing AMR demands global, coordinated action and accountability.
We're not in the apocalyptic world of The Last of Us just yet but AMR has long been claiming lives, and is a blight on our health systems and economies.
The decisive action we take in the next year will be key to preventing the unravelling of modern medicine.
