Antimicrobial resistance poses a significant threat, with projections of 39 million deaths by 2050.
Low- and middle-income countries face heightened risks due to inadequate diagnostics and antibiotic misuse.
Innovative, affordable tools and local governance models can empower LMICs to lead the AMR fight.
Antimicrobial resistance (AMR) is advancing more quickly than many health systems can manage. The global picture is deeply concerning.
Bacterial AMR alone will cause 39 million deaths between 2025 and 2050, which equals three deaths every minute, according to a study funded by Wellcome and the United Kingdom Department of Health and Social Care’s Fleming Fund.
The report published in the journal Lancet cited an estimated 1.27 million deaths in 2019 directly caused by antibiotic resistant infections and nearly 5 million associated deaths. Sub-Saharan Africa and South Asia carry the heaviest burden due to high prevalence of critical infections and limited diagnostic capacity.
India reflects both the risk and the possibility within this challenge. The country has the expertise and urgency to influence global progress but efforts must be communicated clearly to both experts and the wider public.
Many low- and middle-income countries (LMIC) struggle with widespread availability of antibiotics without prescriptions, circulation of counterfeit or substandard drugs and inadequate sanitation. These conditions accelerate resistance.
The most significant barrier is the lack of affordable and reliable diagnostics. In many hospitals traditional culture methods take two to three days. The absence of diagnostic capacity often leads to broad spectrum antibiotic use, explained Otridah Kapona from the Zambia National Public Health Institute. This approach fuels resistance and prevents clinicians from choosing the correct treatment.
Community clinics experience similar problems. Rapid tests that can distinguish between bacterial and viral infections are often unaffordable. C-reactive protein tests are widely used but they cannot differentiate between bacterial infections and illnesses such as malaria, dengue or COVID-19. This gap results in unnecessary antibiotic use for fevers that have viral or non-bacterial causes.
Limited diagnostic capacity means fewer samples are tested and resistance trends remain unclear. Without reliable laboratory results, hospitals cannot build accurate treatment guidelines.
Cecilia Ferreyra from the Foundation for Innovative New Diagnostics noted that the absence of quick diagnostics prevents clinical teams from knowing what type of pathogen is present and how resistant it may be. This affects prescribing decisions and surveillance quality. As a result, national-level AMR data in many LMICs remains incomplete.
Innovation in diagnostics is reshaping possibilities for regions that rely on slow or costly systems. New technologies are helping laboratories identify pathogens and understand antibiotic response within hours. These advances shorten waiting time, give clinicians clearer insight, and support faster decisions for patients who cannot afford delays.
Training and digital support systems are also being introduced so that laboratory teams can handle complex tests with confidence.
Mobile-based solutions are playing a growing role as well. Simple smartphone based applications now help technicians interpret key laboratory tests immediately, even in conflict-affected or resource-constrained areas. This gives frontline workers quick access to results that once required specialised equipment.
Affordable genetic testing tools are also becoming more common. Some of these systems use a phone camera to read fluorescent signals from amplified genetic material and have shown performance comparable to standard molecular tests for respiratory and urinary infections. They can be adapted to identify resistance genes and provide a practical option for clinics that do not have access to high-end diagnostic platforms.
The wider financing picture shows additional pressure. Official Development Assistance dropped by seven per cent last year and a further 17 per cent fall is projected. Global debt is expected to cross 100 per cent of world GDP by 2029.
Many LMICs, therefore, need to fund action plans on AMR with limited external aid. Only 29 per cent of 186 countries have costed or budgeted their national AMR plans, according to recent data.
This financial strain is encouraging new governance models rooted in local ownership. The International Centre for Antimicrobial Resistance Solutions partners with governments and research institutions to create context specific projects shaped by national priorities. The organisation supports 60 projects across 28 LMICs and collaborates with more than 170 partners.
The results reflect the power of locally driven action. In Colombia, a project with Porkcolombia improved colostrum management and vaccination while introducing antibiotic-free feed, which cut antibiotic use in feed by 91 per cent. In Kyrgyzstan, a trial involving 1,204 children used point-of-care diagnostics for respiratory infections and reduced antibiotic use by 24 per cent without any decline in health outcomes.
Stronger surveillance systems, pooled purchasing arrangements and regular exchange of experience can help countries deal with shared problems. Learning from neighbours works well because many of them face the same limits in staff, budgets and infrastructure.
Linking AMR efforts with work already happening in pandemic readiness, primary healthcare, agriculture, universal health coverage and climate related health risks can make each of these areas stronger and deliver better results overall.
The AMR challenge is getting harder, yet LMICs can shape a stronger response by focusing on what works in their own settings. This means making basic tests easier to access, giving communities tools they can use without specialists, and building laboratory systems that function reliably every day. It also means setting national goals that come from real local needs, not borrowed models.
When countries take the lead and partners back that leadership, progress becomes more steady and believable. AMR affects everyone and LMICs can move the fight forward with clear thinking, practical solutions and cooperation that feels real on the ground.
Dr Sabine Kapasi is a global health strategist and UN advisor. Views expressed are the author’s own and don’t necessarily reflect those of Down To Earth.