A new scoping review published in BMJ Global Health reveals a critical vulnerability in global antimicrobial resistance surveillance: informal healthcare providers—including unregulated pharmacists, traditional practitioners, and shop vendors—dispense antibiotics in up to 96% of patient encounters across low- and middle-income countries, yet remain almost entirely invisible to monitoring systems.
This surveillance gap poses a significant threat to global efforts to combat antibiotic resistance. With projections indicating that AMR could cause 10 million deaths annually by 2050 if left unchecked, the exclusion of informal providers from tracking systems creates a blind spot in understanding true antibiotic consumption patterns.
Experts emphasize that addressing this gap requires targeted stewardship interventions that actively engage informal providers, recognizing their substantial role in primary care delivery across LMICs. Without their inclusion in surveillance and education efforts, global resistance control strategies will remain fundamentally incomplete.
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