Pakistan has expanded its national response to Antimicrobial Resistance (AMR) through a multi-sector surveillance and laboratory strengthening programme supported by the United Kingdom’s Fleming Fund, positioning the country among a growing number of developing economies investing in advanced disease monitoring systems as drug-resistant infections increasingly threaten public health systems, economic productivity and healthcare financing globally.
Since 2019, the Fleming Fund Country Grant Pakistan (FFCGP), implemented by development firm DAI alongside partners including the Liverpool School of Tropical Medicine, Health Security Partners and Shifa International Hospital, has supported reforms across human health, veterinary medicine, aquaculture and environmental monitoring under a One Health framework designed to address the interconnected drivers of antimicrobial resistance.
The programme comes as AMR is emerging as one of the most significant long-term risks to global health systems. According to the World Health Organization, antimicrobial resistance already contributes to millions of deaths worldwide as bacteria, viruses, fungi and parasites evolve resistance to treatments previously used to control infections. The economic implications are equally significant, particularly for lower and middle-income countries where healthcare infrastructure remains under pressure, and infectious diseases continue to impose heavy fiscal and productivity costs.
Pakistan’s response has focused on strengthening surveillance systems, laboratory quality, genomic sequencing capacity and antimicrobial stewardship programmes to improve detection, reporting and policy coordination. The initiative has also supported the development of Pakistan’s National Action Plan on AMR and established One Health AMR secretariats at national and provincial levels to coordinate cross-sectoral policymaking.
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The programme reflects a broader shift toward integrated disease surveillance systems increasingly being adopted across developing economies facing rising public health risks linked to population growth, urbanization, climate change and intensive agricultural production. In many African countries, antimicrobial resistance is also becoming a growing concern due to the widespread misuse of antibiotics in human health systems, livestock production and informal pharmaceutical markets.
According to the Africa Centers for Disease Control and Prevention, weak laboratory infrastructure, fragmented surveillance systems and limited diagnostic capacity continue to constrain the continent’s ability to track resistant infections effectively. Several African economies are therefore seeking to strengthen national AMR action plans as part of wider health security and pandemic preparedness strategies.
In Pakistan, FFCGP supported 25 antimicrobial resistance surveillance sites across human health, animal health and aquaculture sectors through laboratory upgrades, equipment installation and consumables support. The project also assisted in developing Pakistan’s AMR Surveillance Strategy for the Environment, including pilot studies examining antimicrobial resistance in wastewater systems to better understand environmental transmission pathways.
The expansion of environmental monitoring reflects growing recognition that AMR is not solely a clinical issue but also an agricultural, environmental, and economic challenge. Antibiotic overuse in livestock and poultry production has increasingly been linked to resistant pathogens entering food systems and water supplies, creating wider public health risks.
Several African economies face similar vulnerabilities. Poultry and livestock industries across countries including Kenya, Nigeria, South Africa and Zambia continue to rely heavily on antimicrobial use to support production systems, often with limited regulatory oversight. According to development health specialists, improving surveillance across food systems and environmental pathways will become increasingly important as African economies attempt to balance food security, agricultural productivity and public health objectives.
Pakistan’s programme also invested heavily in laboratory accreditation and diagnostic systems. National reference laboratories including the National Institute of Health, National Veterinary Laboratory and Pakistan Council for Research in Water Resources received support to improve quality assurance systems and international accreditation standards.
Among the programme’s milestones were ISO 15189 accreditation for the National Institute of Health and ISO 17025 accreditation for the National Veterinary Laboratory, alongside upgrades of 13 microbiology laboratories to Biosafety Level 2 standards. The project also revived a previously non-functional microbiology laboratory in Gilgit-Baltistan and established Pakistan’s first biorepository inventory management system for AMR sample management.
The initiative additionally introduced advanced diagnostic technologies including blood culture systems, genomic sequencing capacity and antimicrobial susceptibility analysis tools designed to strengthen real-time surveillance and improve understanding of resistance patterns.
Whole Genome Sequencing capabilities developed at Pakistan’s National Institute of Health now allow researchers to analyze transmission pathways and resistance evolution more accurately. Digital AMR dashboards have also been established in several provinces to improve access to surveillance data for policymakers, researchers, and healthcare professionals.
The increasing use of genomic surveillance and digital health platforms mirrors broader changes underway in global health security systems following the COVID-19 pandemic. Governments and development institutions are placing greater emphasis on real-time disease intelligence systems capable of identifying emerging threats earlier and supporting more targeted interventions.
For African economies, investment in AMR surveillance infrastructure may carry broader economic implications beyond public health. Resistant infections increase healthcare costs, reduce labour productivity, and place additional pressure on already constrained public health budgets. According to the World Bank, unchecked antimicrobial resistance could significantly reduce global economic output over coming decades, with developing economies expected to bear disproportionate impacts due to weaker health systems and higher infectious disease burdens.
Pakistan’s programme also expanded antimicrobial stewardship initiatives aimed at reducing unnecessary antibiotic use. Working with the Drug Regulatory Authority of Pakistan, the project helped develop an IT-based antimicrobial track-and-trace system covering both human and animal health sectors to monitor antimicrobial production, distribution and usage.
At the clinical level, stewardship programmes developed through Shifa International Hospital contributed to the establishment of a Centre of Excellence for Antimicrobial Stewardship and standardized antibiogram protocols used to guide treatment decisions and monitor resistance trends.
The programme’s emphasis on data generation and local research also highlights the growing importance of evidence-based policymaking in managing complex health risks. Studies supported under the initiative include assessments of the economic burden of AMR, antimicrobial use among pregnant women and hospital-acquired infections associated with resistant pathogens.
For Africa, where healthcare systems continue to face funding constraints and rising disease burdens, the Pakistan experience illustrates how integrated surveillance systems, laboratory investment and cross-sector coordination can strengthen long-term health resilience. Several African countries, including South Africa, Rwanda and Ghana, have already expanded national AMR action plans with support from international partners and multilateral health institutions.
The Fleming Fund initiative also underscores how health security is increasingly intersecting with broader development priorities including agricultural productivity, environmental governance, workforce stability and economic resilience. As antimicrobial resistance intensifies globally, countries with stronger surveillance systems and laboratory capacity are likely to be better positioned to manage outbreaks, maintain healthcare effectiveness and reduce long-term fiscal risks associated with resistant infections.
While Pakistan’s programme remains ongoing, the infrastructure and governance systems established through the initiative may provide a framework for broader regional cooperation on antimicrobial resistance surveillance and public health preparedness. For developing economies across Africa and Asia, the expansion of integrated One Health systems is increasingly being viewed not only as a healthcare priority but as a strategic economic and institutional investment in long-term resilience.
