Rethinking antibiotic use: Why the global debate misses low-and-middle-income countries’ realities

According to the 9th Annual Report on Antimicrobial Agents Intended for Use in Animals (2025), global antimicrobial use (AMU) fell by 5% between 2020 and 2022, with only 7% of products belonging to the highest-priority critically important classes for human medicine. These gains reflect strong governance and veterinary oversight, conditions that are far from universal.

In many low- and middle-income countries (LMICs), where surveillance and veterinary access remain limited and diagnostics are scarce, farmers face an impossible choice between the future risk of AMR and the immediate threat of losing their animals.  

Studies show that antibiotic use is often driven by necessity or a perceived necessity, and not negligence. Stewardship must therefore focus on building the conditions for appropriate use, rather than penalising people who have limited alternatives.

Much of the AMR animal-human discourse remains framed by a ‘farm-to-fork’ paradigm. In LMICs, pathways are far messier. Resistance travels through shared water sources, complex food chains, informal food markets, manure and water reuse, and close human–animal interactions.

Identical resistance genes are present in humans, animals, and the environment, pointing to shared contaminated ecosystems rather than linear food-borne transmission or direct zoonotic jumps. The Lancet One Health Commission (2025) calls for understanding of these interconnections through a socioecological lens. This framing resonates deeply with LMIC contexts, where AMR is not a single-sector failure but a reflection of how we manage the interfaces between food, environment, and livelihoods.  

The EcoAMR series (2024) by WOAH and the World Bank projects that AMR in livestock could cause production losses equivalent to the annual food needs of two billion people by 2050. Economic models show that the steepest losses will occur in Africa and Asia, regions where animal-sourced foods remain vital to nutrition. Yet the Global AMR R&D Hub shows that since 2017, only USD 1.85 billion has been invested in animal-health AMR research, compared to USD 15.7 billion for human health. That tenfold gap leaves veterinary vaccines, diagnostics and alternatives chronically underfunded. Meanwhile, analyses like Feukam Nzudie et al. (2025) highlight nutrient deficiencies across Africa, showing that every country is missing at least one key nutrient, and some lack all nine measured nutrients, including protein. Closing those gaps would require expanding production by almost 300%, far beyond sustainable land and water limits.

Livestock are central to nutrition, livelihoods and resilience in LMICs yet they are often portrayed as the problem, e.g. responsible for around 30% of greenhouse gas emissions. The EAT–Lancet Commission on Healthy, Sustainable, and Just Food Systems (2025) notes that current food systems mirror global inequalities, i.e. the richest 30% of the world drive 70% of food-related environmental pressures, while LMICs bear the dual burdens of climate stress and disease without safety nets. Therefore, food systems transformation is vital for climate goals, but it must also be equitable. Aligning AMR stewardship with climate adaptation is the only way to make it both just and sustainable and limit AMR-driven productivity losses that will inevitably deepen nutritional insecurity. 

Europe’s ban on antimicrobial growth promoters and new regulation restricting use of certain antimicrobials in imports of live animals and animal products sends an important stewardship signal. But it also raises a difficult question: how will low-income exporters adapt?  

Many African countries lack the surveillance and laboratory infrastructure to demonstrate compliance. Without financing and technology transfer, such policies risk creating trade barriers. What LMICs need is not more regulation from afar but support for compliance through regional labs, training, and technology transfer to ensure that global standards work for all. The upcoming WOAH Scientific and Technical Review issue: ‘Antimicrobial Resistance: Science, Standards and Stewardship’  — published 13 years after the last issue on AMR, — consolidates advances from surveillance to governance and stresses that science alone is not enough, standards must be matched by systems. 

The Animal Echo aims to promote individual and collective understanding of animal health and welfare. We bring you insights and opinions from experts across the world. The opinions expressed in The Animal Echo are those of the author (s) and may not necessarily reflect WOAH’s official position.