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MORU, Kanpong Boonthaworn
Antimicrobial resistance (AMR) is one of the most pressing threats to global health. Yet, interventions addressing AMR often treat it as a single, undifferentiated challenge. In a recent BMJ Global Health commentary, researchers from the University of Oxford argue that this approach fails to account for morally relevant differences between types of microbial resistance—and risks injustice as a result.
While antibacterial resistance (ABR) caused an estimated 1.27 million deaths in 2019 and was associated with nearly 5 million more, the burden of resistance to parasites like Plasmodium falciparum, the main malaria-causing agent, is less well known. However, the impact is undeniable: in 2023, 95% of malaria-related deaths occurred in Africa, primarily affecting children.
The authors emphasise that the communities most affected by antimalarial resistance are typically in low- and middle-income countries, and are often less privileged than populations most impacted by ABR. The researchers argue that this disparity makes it ethically necessary to prioritise antimalarial resistance more strongly in research and policy efforts.
“Malaria primarily affects sub‑Saharan Africa and Southeast Asia, with African children being at highest risk of mortality. This highlights the importance of giving antimalarial resistance higher priority on the research and intervention agenda. Addressing antimalarial resistance should not be sidelined in broader efforts to combat AMR,” said Professor Phaik Yeong Cheah, co-author and Professor of Global Health at the University of Oxford.
The team analysed differences in at-risk populations, mortality patterns, treatment availability, and ethical concerns around drug resistance. They argue that policy frameworks must reflect these distinctions, and they call for targeted investments and advocacy to ensure no community is left behind in the global AMR response.
The researchers plan to continue engaging policymakers to support more just, inclusive approaches to AMR strategy and funding.