Published: 24 September 2024

Antimicrobial Resistance

The Challenge

Today, antimicrobial resistance (AMR) is one of the top 10 global public health threats. AMR occurs when disease-causing microbes evolve to withstand the effects of drugs intended to eliminate them. This compromises the efficacy of antibiotics and other antimicrobial medications, meaning there is an increased risk of untreatable infections spreading, causing severe illness and death, and potentially overwhelming health systems.

Bacterial AMR disproportionately impacts people in low- and middle-income countries, with sub-Saharan Africa carrying the heaviest burden of AMR. Drug resistance is already threatening available treatments to fight HIV, TB and malaria. Bacterial infections are the second-leading cause of hospitalization among people living with HIV, after AIDS-related illnesses. HIV and TB patients access health care more frequently, increasing their risk of health care-related infections. Misdiagnosed or undiagnosed TB and malaria can also lead to overtreatment with antibiotics, increasing the risk of AMR.

AMR is a health equity issue – people are dying because they do not have access to or information about lifesaving antibiotics and diagnostic tests to guide the right drug choices. Until everyone has equitable access to lifesaving health tools, services and information, diseases will continue to spread beyond borders and resistance will continue to affect the tools that fight disease, threatening us all.

Our Response

The Global Fund’s Strategy 2023-2028 emphasizes our critical role in AMR efforts. Our direct investments in responses to HIV, TB and malaria (such as screening, early diagnosis, treatment, prevention, care and support) contribute to reducing resistance to the medicines for these diseases and other antimicrobials as part of improved capacity for diagnosis. This is complemented by our longstanding investments in health systems strengthening and pandemic preparedness and response, as well as supporting efforts to track and diagnose new threats, novel pathogens and dangerous disease variants.

Robust Health Systems to Tackle AMR

To address the increasing risks of AMR, we need to strengthen health and community systems. The Global Fund is the world’s largest multilateral provider of grants to strengthen health and community systems, and over the 2023-2025 period we are investing approximately US$2 billion¹ per year in this effort.

As a key means of restricting the spread of AMR, strong infection prevention and control is a core element of strengthened health and community systems. Over US$74 million of our 2023-2025 investments are from our COVID-19 Response Mechanism (C19RM) and are specifically dedicated to combatting AMR by improving laboratory networks, AMR surveillance, and infection prevention and control.

The Global Fund also supports specific targeted projects through centrally managed limited investments (CMLIs), which contribute to preventing and controlling the spread of AMR. In 2022, Project STELLAR was launched to support a group of African countries galvanize longer term strengthening of laboratory systems, which contributes to building readiness to confront bacterial AMR.

Community Engagement to Monitor and Contain Diseases

Communities are on the frontlines of disease outbreaks. It is vital that communities and civil society organizations are meaningfully engaged in the fight against AMR. The Global Fund is facilitating community engagement in national and sub-national level pandemic preparedness that integrates health equity, human rights and gender equality through two CMLI projects:

The Communities in Pandemic Preparedness and Response – Community Engagement (COPPER CE) project in eight countries (Cameroon, Cambodia, Indonesia, Kenya, Liberia, Nigeria, Philippines and Sierra Leone) with total investments of around US$2 million between 2024 and 2025.
Community-led Monitoring (CLM) in 15 countries (Burkina Faso, Cameroon, Central African Republic, Democratic Republic of Congo, Haiti, Kenya, Liberia, Malawi, Mozambique, Namibia, Nigeria, Philippines, Senegal, Sierra Leone and Zambia) with total investments of US$2 million between 2024 and 2025.

The Global Fund/Vincent Becker

The Global Fund/Andrew Esiebo/Panos

The Global Fund is the largest single investor in quality-assured medicines and diagnostics in low- and middle-income countries, investing US$2.5 billion each year in health commodities. Beyond tackling drug-resistant TB (DR-TB), our market-shaping capabilities have enabled us to negotiate lower pricing on laboratory instruments, reagents and commodities for the detection of AMR in common bacterial infections. Through our pooled procurement mechanism, we represent 25% of the global antiretroviral treatment market for HIV, with over 90% of people living with HIV receiving the latest dolutegravir-including HIV treatment. Our investments focus on surveillance to monitor the emergence of HIV drug resistance, as well as keeping people living with HIV on optimized treatment to maintain suppressed viral loads and prevent them from developing resistance.

The Global Fund’s key strengths in the fight against AMR include effectively delivering targeted grant financing and supporting health and community systems strengthening. Our unique market shaping capabilities, pooled procurement expertise in over 80 countries and longstanding partnerships with HIV, TB and malaria suppliers facilitate equitable access to quality assured health products.

To maximize efficiencies, any new AMR access initiative should leverage existing platforms, such as the Global Fund’s pooled procurement and grant financing mechanisms.

Partnerships and multilevel action are key to the global AMR response, and the Global Fund stands ready to continue our work with partners to tackle this global health threat.

WHO/Enric Catala

Antimicrobial Resistance: A Fast-growing Threat to the Fight Against HIV, TB and Malaria

We rely on antibiotics to treat a range of life-threatening infections. But bacteria are changing – becoming more resistant to the drugs we have. Infections that were once curable are now untreatable.

Antimicrobial resistance is one of the fastest-growing threats to public health. It is linked to 5 million deaths per year – the third-leading cause of death globally. People with HIV, TB and malaria are particularly vulnerable to infections that are increasingly resistant to treatment.

The Global Fund partnership invests in strong health systems that can accurately diagnose diseases and prescribe the right antibiotics to treat them, and in new drugs that can tackle resistant and emerging bacteria.

We can defeat antimicrobial resistance – and keep people everywhere safe from infectious disease.

[1] This figure is based on the recently endorsed Global Fund Strategy Committee methodology that integrates direct investments in resilient and sustainable systems for health (RSSH) and contributions to RSSH through investments in the fight against HIV, TB and malaria (contributory RSSH). The amount is derived from approved and signed grant budgets and RSSH-related catalytic investments and includes C19RM. This methodology excludes Global Fund Secretariat operating expenses.