The burden of drug-resistant infections is not evenly distributed. Low- and middle-income countries carry a disproportionate share of AMR-related deaths, driven by factors that include limited diagnostic capacity, crowded healthcare facilities, over-the-counter antibiotic sales, weak regulatory oversight and heavy antimicrobial use in livestock and agriculture. Yet, as the authors note, the perspectives and innovations emerging from these same regions remain strikingly underrepresented in the scientific literature and in the international forums where AMR policy is shaped. The webinar series was designed as a deliberate corrective, bringing together speakers from Africa, Asia and the Middle East and North Africa, with a dedicated country spotlight on Nigeria.

The One Health framework that anchors the discussion recognizes that human health, animal health and the environment form a single interconnected system. Resistance genes and resistant bacteria do not respect the boundary between a hospital ward and a poultry farm, or between a river receiving pharmaceutical effluent and the drinking water drawn downstream. Technical approaches under the One Health umbrella therefore span integrated surveillance across human, animal and environmental sectors, antibiotic stewardship programs in clinics and veterinary practice, infection prevention and control, vaccination to reduce the demand for antibiotics in the first place, and environmental monitoring of resistance determinants in water and soil.

In the human health sector, the webinar discussions highlighted persistent gaps in antibiotic stewardship, the systematic effort to ensure that patients receive the right antibiotic, at the right dose, for the right duration, only when it is genuinely needed. In many low-resource settings, microbiology laboratories capable of identifying a pathogen and testing its drug susceptibility are scarce, which means clinicians frequently prescribe empirically, without knowing what organism they are treating or whether it will respond. Where diagnostics are unavailable and second-line drugs unaffordable, stewardship guidance imported from high-income countries can be difficult to apply. The authors argue that locally relevant evidence, generated in the settings where the decisions are actually made, is essential for stewardship programs to succeed.

The animal and environmental sectors present their own technical challenges. In livestock production systems across many low- and middle-income countries, antimicrobials are used not only to treat disease but also for growth promotion and mass prophylaxis, practices that create intense selection pressure for resistant bacteria. Veterinary capacity, pharmacovigilance and quality assurance of animal medicines are often limited, and the interfaces between farms, markets, slaughterhouses and waterways provide multiple routes by which resistant organisms and their genes can move into human populations. Environmental reservoirs, including hospital wastewater, agricultural runoff and manufacturing discharge from pharmaceutical production, add a further layer of complexity that conventional surveillance systems rarely capture.

Across the three regional sessions, a set of shared structural challenges emerged with striking consistency. The authors identify critical gaps in political commitment, sustainable financing and locally relevant evidence. National action plans on AMR, now adopted in most countries, frequently exist on paper but lack the budget lines, workforce and accountability mechanisms to be implemented. Surveillance data, where they exist, are often fragmented across ministries of health, agriculture and environment, making it difficult to build the integrated picture that One Health policy requires. Research funding, meanwhile, tends to flow through international channels with priorities set far from the communities most affected, leaving local scientists competing for resources to study problems defined by others.

The Nigeria spotlight offered a concrete illustration of both the scale of the problem and the ingenuity of local responses. Contributors from Nigerian institutions spanning microbiology, internal medicine, pharmaceutical microbiology, dentistry and mental health described how antimicrobials are accessed and used across human and animal health, and how gaps in laboratory infrastructure and regulation shape prescribing behavior. Their participation in the webinar series itself reflected a broader theme of the article: building research capacity and networks within the region, so that evidence generation is led by the people closest to the problem rather than parachuted in from outside.

Regional innovations featured prominently in the discussions. Speakers described context-specific approaches to surveillance, education and stewardship that adapt global tools to local realities, from training programs that reach prescribers in both human and veterinary practice to community engagement strategies that address the expectations and beliefs that drive demand for antibiotics. The Middle East and North Africa network, and regional collaborations across Africa and Asia, illustrate how shared language, geography and health system characteristics can accelerate the exchange of workable solutions. The authors emphasize that such locally driven innovation is not a supplement to global strategy but a core component of it, because interventions that ignore local economics, culture and infrastructure rarely survive contact with reality.

The article’s central argument is about governance as much as science. Integrating the voices of researchers and practitioners from low- and middle-income countries into global AMR governance, the authors contend, is essential for a response that is equitable, effective and enduring. That means representation in the bodies that set research agendas and funding priorities, recognition of regional data and publications in global assessments, and financing structures that support sustained local capacity rather than short-term project cycles. The Global Health Network, through which the AMR Knowledge Hub and its Community of Practice operate, offers one model of how such connections can be built, linking researchers across regions to share methods, training and data.

As drug-resistant infections continue to rise worldwide, the message from this perspective is that the global community cannot afford to design solutions for the hardest-hit regions without those regions at the table. The technical tools of One Health, from integrated genomic surveillance to environmental monitoring, are advancing rapidly, but their deployment depends on political will, money and trust. The webinar series that generated this article was, in a small way, a demonstration of the principle it advocates: when the people living with the burden of antimicrobial resistance help define the agenda, the resulting strategies are more grounded, more practical and more likely to endure.

Subject of Research: One Health approaches and regional innovations for tackling antimicrobial resistance in low- and middle-income countries

Article Title: One Health in action: regional innovations and shared challenges in addressing antimicrobial resistance

Article References: One Health in action: regional innovations and shared challenges in addressing antimicrobial resistance. (n.d.). https://doi.org/10.1038/s41467-026-78634-2

Image Credits: AI Generated

DOI: 10.1038/s41467-026-78634-2

Keywords: antimicrobial resistance, One Health, antibiotic stewardship, low- and middle-income countries, Nigeria, surveillance, global health governance, infection prevention and control, veterinary medicine, environmental health, AMR Knowledge Hub, World Antimicrobial Awareness Week