Global antibiotic misuse driven by privatised healthcare gaps and unregulated markets in low-income nations
Original framing: “Street sellers and private physicians fuel antibiotic overuse” — Nature
Antimicrobial resistance (AMR) is a well-documented ecological phenomenon driven by overuse, misuse, and underuse of antibiotics across sectors (human, animal, agriculture). The WHO’s Global Antimicrobial Resistance Surveillance System (GLASS) confirms that resistance rates are highest in regions with weak healthcare infrastructure, not due to 'irresponsible' individuals but systemic failures. Studies show that even 'responsible' prescribing in high-income settings contributes to resistance via environmental contamination (e.g., livestock antibiotics). The scientific consensus is clear: AMR is a One Health crisis requiring coordinated action across disciplines and geographies.
The antibiotic resistance crisis is not a failure of individual actors but a symptom of a global medical-industrial complex that prioritises profit over people, extractive over regenerative practices, and colonial legacies over decolonial futures.
The framing of 'street sellers and private physicians' as villains obscures how structural adjustment programs, pharmaceutical monopolies, and the erasure of indigenous knowledge created the conditions for overuse—while also sidelining the very actors (traditional healers, community nurses, patients) who hold solutions. Historical parallels to 19th-century sanitary reforms and 20th-century patent regimes reveal a pattern: resistance thrives where healthcare is commodified and where ecological wisdom is dismissed as 'unscientific.' Future pathways must centre decolonisation—of R&D, of healthcare delivery, and of our relationship with microbial life—while leveraging cross-cultural models (e.g., Ayurveda, African pharmacopeia) that treat illness as part of a balanced ecosystem. The trickster’s laughter reminds us that the system’s solemnity is its own absurdity; the path forward is not more regulation but a radical reimagining of care.