The rising threat of antimicrobial resistance (AMR) continues to expose deep structural weaknesses in global pharmaceutical markets, with drug-resistant infections projected to claim nearly two million lives annually by 2050 unless investment and policy responses accelerate, according to the 2026 AMR Benchmark published by the Access to Medicine Foundation.
The benchmark, released on March 10, evaluates the efforts of 25 pharmaceutical companies, including seven major research-based firms, ten generic manufacturers, and eight small and medium-sized enterprises (SMEs), across four domains: drug development, responsible manufacturing, stewardship, and equitable access in low- and middle-income countries (LMICs).
The report shows that while there are pockets of progress, overall investment in antibiotic development is shrinking, reflecting the economic realities facing pharmaceutical companies and the urgent need for government intervention to sustain innovation.
Currently, drug-resistant infections are responsible for over one million direct deaths per year, with AMR contributing indirectly to more than four million additional fatalities annually. If unchecked, these numbers could nearly double by 2050, according to the benchmark, highlighting a looming public health crisis that threatens global health security.
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“The scale and speed of resistance are unprecedented,” said Jayasree Iyer, CEO of the Access to Medicine Foundation. “Without immediate action, many of the next generation of antibiotics may never reach the populations that need them most.”
A shrinking pipeline amid rising resistance
The benchmark reveals a concerning 35% decline in antimicrobial research projects among large pharmaceutical firms since 2021. Analysts say this contraction stems from the economic model for antibiotics, which contrasts sharply with chronic disease treatments.
“Antibiotics are typically used for short courses, limiting their revenue potential,” Iyer explained. “Yet the clinical need is rising as resistance renders older medicines ineffective.”
Despite the declining pipeline, seven late-stage antimicrobial candidates are advancing through clinical trials or regulatory review. These include developments from large firms such as GSK, Otsuka Pharmaceutical, and Shionogi, alongside smaller innovators including BioVersys, F2G, Innoviva, and Venatorx Pharmaceuticals.
One of the most promising candidates is gepotidacin, an oral antibiotic under development by GSK for uncomplicated urinary tract infections (UTIs). UTIs affect roughly 150 million people globally each year, with women disproportionately affected. Gepotidacin represents the first new oral antibiotic class for UTIs in nearly three decades, offering hope in an area of rising resistance.
Similarly, progress has been made against gonorrhoea, a sexually transmitted infection affecting an estimated 82 million people annually. The benchmark notes that two oral drugs–zoliflodacin from Innoviva and GSK’s gepotidacin–have advanced through regulatory review for uncomplicated gonorrhoea, rare breakthroughs in a field where new treatment options have been scarce.
Access gaps and market failures
Even with scientific advances, the benchmark warns that innovation alone will not solve the AMR crisis. High development costs, uncertain returns, and weak market incentives discourage companies from investing, particularly in antibiotics for LMICs.
The report highlights that 17 countries in sub-Saharan Africa lack registered child-friendly antibiotic formulations, leaving newborns and children under five highly vulnerable to infections such as pneumonia and sepsis.
Among companies assessed, Aurobindo Pharma, GSK, Hikma, Sandoz, and Teva scored higher on pediatric access, filing child-friendly formulations in roughly 50-70% of LMIC markets where they register off-patent antimicrobials. Yet even these efforts leave critical gaps in access, especially for the most vulnerable populations.
“There are very few pipeline projects targeting children under five,” said Claudia Martinez, director of research at the Access to Medicine Foundation. “Even when pediatric formulations exist, companies often do not register them in the countries that need them most. That is a clear and fixable problem.”
Beyond development and access, the benchmark examines antibiotic manufacturing practices, which can influence resistance patterns. Improper disposal of pharmaceutical waste introduces antibiotics into rivers and soil, accelerating the evolution of resistant bacteria.
Encouragingly, the report finds that compliance with environmental standards has improved, with the number of suppliers meeting recommended antibiotic waste limits roughly doubling since 2021. Most of this progress comes from generic manufacturers, which produce the majority of active pharmaceutical ingredients globally.
However, progress remains uneven. Some companies have robust monitoring systems and strict supplier requirements, while others lag, raising concerns as countries like Kenya, Nigeria, and South Africa expand domestic pharmaceutical manufacturing. Maintaining high environmental standards will be critical to ensure that local production does not inadvertently worsen AMR.
Tracking patient reach and stewardship
For the first time, the benchmark assessed whether generic companies track how their antibiotics reach patients. Six out of ten now measure patient reach for most antibiotic and antifungal medicines, combining sales data with market research and adherence studies to estimate who receives effective treatment.
“This kind of monitoring is crucial,” Martinez said. “It highlights access gaps, identifies supply chain failures, and supports stewardship programs to ensure correct use and slow the emergence of resistance.”
The report stresses the urgency of AMR in Africa, where the burden of drug-resistant infections is growing faster than in other regions. According to a 2024 Africa CDC report, drug-resistant infections now cause more deaths than HIV, tuberculosis, and malaria combined in some sub-Saharan countries.
Neonatal sepsis linked to antibiotic resistance accounts for nearly half of all newborn sepsis deaths in parts of the region. Hospitals struggle to treat infections that were once readily manageable, amplifying the need for both new medicines and systemic interventions.
Experts stress a One Health approach, integrating human health, animal health, and environmental factors. Countries including Kenya, Uganda, and Rwanda have strengthened surveillance and laboratory capacity to track resistance patterns. Yet translating these capacities into actionable treatment and prevention remains a challenge, requiring sustained funding and political commitment.
Public sector role
The benchmark emphasizes that market-driven solutions alone cannot close the AMR gap. Governments must play a more active role in shaping markets, through advance purchase commitments, co-payment models, public-private partnerships, and financing structures that reward innovation while safeguarding equitable access.
Examples include Pfizer’s co-payment model in Nigeria, where the cost of second-line antibiotics is shared between the government, insurers, and the company, making treatments more affordable for patients.
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Other suggested interventions include harmonizing medicine registration across African countries and regional procurement mechanisms to stabilize demand and incentivize production of essential drugs.
“Governments need to step in where markets fail,” Iyer said. “The AMR Benchmark provides a roadmap for action, showing both where companies are performing well and where gaps remain most urgent.”
Looking a head, the 2026 benchmark paints a forward-looking picture of a sector at a crossroads. While scientific innovation continues, declining R&D investment among large pharmaceutical firms and persistent access gaps highlight the fragility of progress against resistant infections.
Analysts expect that public sector interventions will increasingly determine the pace of innovation. Without targeted policies, new antibiotics may fail to reach populations in need, particularly in low-resource settings.
But the benchmark also identifies reasons for cautious optimism. Late-stage pipeline candidates, improvements in environmental safeguards, increased monitoring of patient reach, and progress in pediatric formulations offer tangible levers for intervention. If aligned with strong policy frameworks, these measures could significantly reduce the projected AMR burden over the next three decades.
In Africa and globally, AMR represents a test of both market efficiency and policy foresight. The crisis is poised to expand unless pharmaceutical investment, government intervention, and international collaboration converge to ensure innovation, access, and responsible use of antibiotics.
“The clock is ticking,” Iyer concluded. “We have the tools to prevent this crisis from worsening–but only if companies, governments, and investors act decisively and together.”