AMR in the Shadows: The Global South and the Crisis of Diagnostic Capacity

Abstract Antimicrobial resistance (AMR) cannot be effectively contained where microbiological evidence is lacking. Yet in many low- and middle-income settings, laboratory systems remain fragile, underfunded, and unable to sustain routine bacteriology and surveillance, leaving resistant infections poorly detected and poorly measured. This Perspective identifies a critical structural gap in the global AMR response: the absence of diagnostic sovereignty, defined as the capacity of health systems to sustainably produce, interpret, and govern microbiological evidence for clinical care and surveillance. In many settings, fragmented procurement systems, workforce instability, and reliance on externally controlled diagnostic platforms undermine this capacity and perpetuate dependency. We argue that strengthening diagnostic sovereignty is essential for effective AMR control. We propose a focused agenda centered on reinforcing routine bacteriology, improving access to genomic tools, developing regional laboratory networks, and establishing governance frameworks to support sustainable surveillance and antimicrobial stewardship. Without the capacity to generate reliable microbiological evidence, AMR will remain insufficiently visible, and global control efforts will continue to fall short.