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The World Health Organization (WHO) has warned of critical gaps and a limited pipeline for new antifungal drugs and diagnostics, especially in low- and middle-income countries (LMIC). These concerns were highlighted in the first-ever reports on tests and treatments for fungal infections released by the United Nations health agency on April 1, 2025.
Fungal infections vary from frequent localised and surface-level infections to serious invasive fungal diseases (IFD), which, despite being less common, are linked to alarmingly high mortality rates that often surpass 50 per cent even with the use of recommended antifungal treatments.
The fungal infections, caused by a variety of fungi, present a growing global health threat, particularly for immunocompromised individuals. According to the most recent estimates, IFDs cause over 6.5 million infections and 3.8 million deaths annually worldwide.
The rise of antifungal resistance only compounds this challenge, yet the development of new antifungal drugs has been sluggish, with only four new drugs approved in the last decade (January 1, 2014 to September 1, 2024), said WHO in the first-ever analysis of antifungal treatments in clinical and preclinical development. These drugs — Isavuconazole, Ibrexafungerp, Oteseconazole and Rezafungin — have made little impact on the broader fight against IFDs, as two of them (Ibrexafungerp and Oteseconazole) are only approved to treat superficial infections.
Antifungal drugs are medications designed to treat infections caused by fungi. The development pipeline includes everything from the early stages of discovering new compounds to clinical trials and approval for public use.
Currently, nine antifungal medications are in clinical development, but only three have reached Phase 3 trials, meaning that few new drugs will be available in the next decade. Despite 22 drugs being in preclinical development, experts warned that the high dropout rates and challenges faced in early-stage development make it difficult to sustain this pipeline.
In the past 30 years, only three new classes of antifungal drugs have been approved, with an average of just one new class every decade.
The need for new treatments is urgent, as current antifungal medications are often plagued by side-effects, drug-drug interactions and limited formulations. In addition, the emergence of antifungal resistance is threatening the effectiveness of existing therapies.
While resistance is a natural phenomenon, overuse of antifungals in both clinical and agricultural settings has accelerated the problem. As antifungal resistance increases, the effectiveness of combination therapies, often used to treat aggressive IFD diminishes.
“There is an urgent need for investment in antifungal research and development to provide patients with better therapies and diagnostics. New antifungal agents with safer pharmacological profiles and improved dosing strategies are urgently needed to address the growing crisis of drug resistance,” said Yukiko Nakatani, WHO assistant director-general for antimicrobial resistance ad interim.
WHO report emphasises the need for broad-spectrum antifungal agents for quick treatment, along with targeted therapies and more effective diagnostic tools to detect and monitor fungal infections.
In response to the rising threat of fungal diseases, the organisation published the first Fungal Priority Pathogen List (WHO-FPPL) in 2022 to raise awareness, mitigate risks and guide research efforts. Among the critical priority pathogens identified in the WHO list are Cryptococcus neoformans, Aspergillus fumigatus, Candida auris and Candida albicans.
Candida species are among the leading causes of IFD, with over 1.5 million cases of Candida bloodstream infections or invasive candidiasis reported annually, resulting in around 995,000 deaths — a staggering 66.3 per cent mortality rate.
Aspergillus fumigatus causes a range of infections, from allergic diseases to invasive aspergillosis, depending on the host’s immune status or pulmonary structure. The latest estimates suggest that invasive aspergillosis affects over 2 million patients globally each year, particularly those with pulmonary disease, lung cancer, hematological malignancies, or in intensive care, with a crude annual mortality rate of approximately 85 per cent.
A major concern highlighted in the WHO report is the critical shortage of fungal diagnostics in LMICs. Even basic testing for fungal infections is often unavailable in these regions, leaving many cases undiagnosed and untreated. WHO experts emphasise that without proper diagnostic tools, the cause of a patient’s illness remains unknown, preventing appropriate treatment.
Currently, diagnostic products for fungal pathogens exist but are typically confined to well-equipped laboratories in high-income countries. These tests require trained personnel and infrastructure, making them largely inaccessible in resource-limited settings.
To address this, WHO called for faster, cheaper and more accurate diagnostic tests that can be used at or near the point of care, especially in LMICs where healthcare facilities may lack the necessary infrastructure.
The WHO report also stressed the importance of investing in diagnostic services and the development of skilled workforces, as outlined in the World Health Assembly resolution 76.5, adopted in May 2023. This resolution emphasised equitable access to diagnostics and the need for policy measures to support research and development in this field.
WHO called for a global response to combat IFD and antifungal resistance, emphasising the need for expanded research, improved access to diagnostics and the development of effective treatments.
According to its report, the UN health agency is also developing an implementation blueprint for its FPPL to guide international efforts in addressing these growing threats.