Africa’s silent antibiotic crisis: How weak labs are fuelling deadly AMR surge
Nqobile Ndlovu, the chief executive officer of Africa Society for Laboratory Medicine.
What you need to know:
- The widespread misuse of antibiotics is a major driver. Millions of Africans take antibiotics without prescriptions, and clinicians often prescribe them without proper diagnostics.
Africa is confronting a rapidly escalating health threat as persistent antibiotic misuse drives antimicrobial resistance (AMR), now responsible for an estimated 1.2 million deaths in sub-Saharan Africa.
Experts warn the crisis is worsened by the continent’s weak laboratory systems, which limit timely diagnosis and effective surveillance.
In an exclusive interview at the Nairobi Continental Convention on Diagnostics, Africa Society for Laboratory Medicine (ASLM) Chief Executive Officer Nqobile Ndlovu highlighted the urgent need for stronger collaboration among policymakers, laboratory professionals, economists, donors and industry players.
Discussions focused on the scale of AMR, gaps in diagnostic capacity, policy shortcomings, and how to build a robust, continent-wide lab infrastructure, while ensuring the private sector plays an active, strategic role.
Why has antimicrobial resistance become one of Africa’s most urgent health threats today?
AMR has become a silent pandemic. A 2019 survey estimated that 1.3 million people globally died due to AMR, with Africa carrying the highest mortality burden: 27 deaths per 100,000 people, or about 200 deaths every day. If current trends continue, AMR will kill more people than HIV, tuberculosis and malaria combined.
The widespread misuse of antibiotics is a major driver. Millions of Africans take antibiotics without prescriptions, and clinicians often prescribe them without proper diagnostics. Our laboratory surveillance systems are also too weak to detect and monitor AMR effectively.
With 90 per cent of medical cases in Africa treated without laboratory confirmation, how much of this AMR burden is due to weak diagnostics?
A significant portion. When people take antibiotics without prescriptions, or when clinicians prescribe them without laboratory data, resistant organisms emerge and spread.
Many deaths linked to AMR arise from such blind treatment. Africa urgently needs increased investment in laboratories to guide treatment decisions and reduce resistance.
Laboratories are called the “invisible backbone of health systems.” Why are they underfunded and overlooked?
Competing health priorities such as medicines and vaccines have historically overshadowed diagnostics. As a result, investment in laboratory personnel, training, and infrastructure has remained low, leaving us with insufficient data to guide treatment.
Yet, laboratories are central to Africa’s health security architecture. They are essential for detecting outbreaks, analysing drug effectiveness, and understanding resistance patterns through strong networks.
Only about 10 African countries report AMR data regularly to World Health Organization’s GLASS platform. What holds others back?
Limited investment in functional surveillance systems. Effective AMR response requires reliable data and early detection. Countries need laboratories capable of continuously collecting, analysing, and reporting information on WHO-selected pathogens. Governments and partners must invest in policies and systems that strengthen routine surveillance.
How far is Africa from achieving a continent-wide laboratory network capable of culture and antibiotic susceptibility testing outside major cities?
A recent survey supported by the United Kingdom’s Fleming Fund found that only 1.3 per cent of laboratories have the capacity to perform culture and antibiotic susceptibility testing. This is far too low to understand the scale of AMR. However, several countries are now developing National Essential Diagnostics Lists to define and standardise tests needed at the community level, which is an important step forward.
Africa already carries 22 per cent of the global AMR burden. What happens if this trend continues to 2050?
If nothing changes, AMR could kill up to 10 million people globally by 2050. Health costs may rise by $1 trillion, and the world could lose $100 trillion in economic productivity. AMR is therefore not just a health issue; it is an existential threat to development.
In many countries, pharmacies still sell antibiotics without prescriptions. What practical policy steps can curb this?
This requires a multi-level approach, including strong national regulations that prohibit dispensing antibiotics without prescriptions, engaging pharmacies as partners in targeted interventions, community awareness to reduce demand for over-the-counter antibiotics and enforcement mechanisms that deter non-compliance among clinicians and pharmacists.
You have called funding the biggest challenge. What level of investment is needed for Africa to mount an effective AMR response?
We appreciate the support from the UK’s Fleming Fund, which is strengthening laboratory systems, data management, workforce training, and surveillance across 40 countries.
Also read: Gonorrhoea resistance to antibiotics worsens
However, sustainability remains a challenge as global donor funding declines. African governments must mobilise domestic resources and private-sector partnerships to finance long-term, resilient laboratory and surveillance systems.
10. Despite strong policies such as the Africa AMR Landmark Report, implementation is slow. Where is the real bottleneck?
The African Union has provided leadership by launching the Africa AMR Landmark Report, which highlights the urgency of funding. The next step is for countries to fully institutionalise their national AMR action plans. They must integrate AMR into broader health-system strengthening rather than treating it as a standalone issue.
How can the private sector be held accountable for antimicrobial stewardship?
Many countries have established National Antimicrobial Stewardship Committees that bring together clinicians, pharmacists, private hospitals, and animal-health practitioners. Stewardship requires collective responsibility, with private providers adhering to national regulations on antibiotic use.
Are there successful public–private partnerships (PPPs) that can model expanded diagnostics and AMR surveillance?
Yes. PPPs have been instrumental in expanding healthcare access where governments lack adequate financing. They help deliver quality diagnostics, improve equity, and strengthen AMR surveillance. Scaling these partnerships could significantly reduce diagnostic gaps.
With rapid diagnostics evolving globally, how is Africa adopting innovations that reduce empirical treatment?
Access remains a challenge, especially in remote areas without laboratory infrastructure. Near-point-of-care technologies are improving access, but regulatory processes must be faster.
National regulatory authorities need to accelerate approvals of new diagnostic technologies. Africa Centres for Disease Control and Prevention (CDC) and the African Medicines Agency are working on regulatory harmonisation to ensure the timely introduction of innovations that can close diagnostic gaps.
Is local manufacturing of diagnostics and laboratory supplies a realistic short-term goal for Africa, or are we still many years away?
Local manufacturing in Africa is a long-term objective, but one that is essential for the continent’s health security. We cannot continue to rely on external suppliers for critical tools needed to detect and respond to AMR. Under the leadership of the Africa CDC, the African Medicines Agency and with support from global partners, Africa has begun laying the groundwork for building its own manufacturing capacity. The momentum is there, but achieving full-scale production will require sustained investment, strong partnerships, and coordinated innovation across the continent.
What concrete outcomes or commitments do you expect from the Nairobi Continental Diagnostics Convention?
We expect governments to make clear commitments, backed by budget allocations, to strengthen AMR diagnostics as part of their national health strategies. We also anticipate stronger collaboration between innovators, member states, and the private sector to design affordable, Africa-appropriate diagnostic tools. In addition, we expect partners and donors to support the development of sustainable systems so that even when external funding declines, countries can continue to operate and expand their diagnostic
capacity.
If you were to send one urgent message to African heads of state about AMR, what would it be?
My message is simple: invest in diagnostics. Diagnostics are central to understanding the true scale of AMR and designing targeted interventions. Without reliable diagnostic capacity, we are essentially fighting blind. Heads of state must prioritise and fund diagnostics now if we are to meaningfully curb the AMR crisis on the continent.
