Antimicrobial resistance silent pandemic that already claims more than 1.3 million lives every year. File photo
A recent global economic model warns that antimicrobial resistance (AMR) may cost the world economy up to $2 trillion annually by 2050, claiming millions more lives.
This escalating threat coincides with a decline in international support for AMR surveillance. The UK’s decision to reduce funding for the Fleming Fund, a major initiative supporting AMR monitoring in low- and middle-income countries, illustrates a concerning trend of diminishing global investment in pandemic preparedness and infectious disease control.
Low- and middle-income countries, including South Africa, are likely to bear the heaviest burden because of under-resourced health systems, limited surveillance capacity and growing barriers to effective treatments.
AMR arises when microorganisms evolve mechanisms to withstand the effects of antibiotics intended to eliminate them. As resistance spreads, infections that were once easily treatable become increasingly difficult, and sometimes impossible, to cure. This silent pandemic is already responsible for more than 1.3 million deaths each year and contributes to worsened outcomes in countless others.
By 2050, resistant infections could reduce global GDP by up to 3.1% and push millions into poverty as a result of the cost of prolonged illness and ineffective treatment. Health systems, especially in countries already facing a high burden of disease, are at risk of being overwhelmed.
The Fleming Fund, launched by the UK government in 2015, has played a key role in strengthening laboratory networks, training professionals and improving the availability of AMR data in more than 25 countries. Its One Health approach, which integrates human, animal and environmental health, has become a global model.
But recent UK budget decisions have led to a reduction in its Official Development Assistance, which includes a significant cut to the Fleming Fund. Although the programme has not been entirely defunded, the scaled-back support threatens critical infrastructure and long-term progress in AMR surveillance across low- and medium-income countries.
Experts caution that even partial reductions in funding may accelerate the spread of AMR in high-risk regions. Such cutbacks can delay the detection of resistant pathogens, disrupt surveillance efforts and weaken public health responses. The consequences are clear: more infections, higher mortality rates and mounting pressure on already overstretched health systems.
AMR does not respect borders. Resistant bacteria can emerge in one location and spread globally through travel, trade and migration. Inadequate surveillance in one part of the world increases vulnerability everywhere.
Many low- and medium-income countries face compounded problems: limited access to diagnostics, overuse or misuse of antibiotics in both clinical and agricultural settings, as well as underinvestment in water, sanitation and hygiene infrastructure. Surveillance programmes supported by international aid help fill these gaps by enabling early detection and informed response.
Cutting funding now undermines global preparedness just as AMR risks are accelerating.
While AMR is a long-term challenge, the window for effective action is narrowing. Delaying investment now will probably increase the cost and complexity of response in the future. According to recent economic analyses, every dollar spent on AMR containment today could save up to $20 in future health and productivity costs.
Continued investment in surveillance, laboratory capacity, workforce training and antimicrobial stewardship is essential for all countries and for global health security. Multilateral partnerships, sustained funding, and equitable access to innovation are critical pillars of any effective AMR strategy.
What can be done?
Given the recent decline in global funding, it is essential to explore alternative strategies to sustain and strengthen AMR efforts.
- Reinforce multilateral funding: Donor countries should explore shared funding mechanisms to sustain critical AMR programmes beyond bilateral commitments.
- Strengthen regional cooperation: Regional AMR surveillance networks can improve resilience and facilitate data-sharing, even in the face of international funding cuts.
- Mobilise domestic resources: Prioritise public health investment in laboratory systems, data infrastructure, and training to reduce reliance on fluctuating aid flows.
- Promote responsible antimicrobial use: Stewardship programmes in human and veterinary medicine are essential to slow the development of resistance.
- Invest in research and equitable access: Support for the development and fair distribution of new antibiotics, vaccines, and diagnostics must remain a global priority.
AMR is one of the most urgent and complex public health issues of our time. Progress made in the past decade, through global collaboration, investment and capacity-building now stands at risk. At the very moment when stronger action is needed, international funding is contracting.
The decisions made now will shape the trajectory of AMR for decades. Reducing support is not just a financial recalibration; it is a choice that may have irreversible consequences for millions of people worldwide.
The global community must act decisively to protect hard-won gains, support countries most at risk and uphold the shared responsibility of safeguarding the effectiveness of life-saving medicines.
Dr Jose L Balcazar is a senior microbiologist at the Catalan Institute for Water Research (ICRA-CERCA), Spain.