18 August 2026

In the climate debate, low- and middle-income countries have often been blamed for rising emissions, while the vastly greater historical contribution of wealthy nations is treated as yesterday’s story.

Something similar has happened with the global antimicrobial resistance (AMR) crisis. Low- and middle-income countries (LMICs) have long been portrayed as the worst offenders of antibiotic overuse, with over-the-counter sales and weak regulation seen as one of the main reasons behind the rise and spread of drug-resistant infections. But a new study now challenges this narrative.

Research published in the Lancet Public Health found that overuse is actually concentrated in high-income settings, with these countries consuming the largest volumes of antibiotics used to treat drug-resistant infections. In contrast, many lower-income countries still lack access to these drugs, despite accounting for more than 80% of the estimated global need.