CAPE TOWN – More than 70 infectious disease experts, scientists, and public health professionals have sounded the alarm over what they describe as a “silent pandemic” — the rise of antimicrobial resistance (AMR) — and are urging the Department of Health and Minister Aaron Motsoaledi to urgently reintroduce a national action plan to address it.
In an open letter, the group warns that antibiotic resistance is escalating into a critical public health crisis in South Africa and threatens the country’s vision of universal health coverage, especially through the National Health Insurance (NHI) framework.
“AMR is a current pandemic which is wreaking havoc, is not being attended to properly and not being taken seriously enough in South Africa,” said Professor Marc Mendelson, a renowned infectious disease specialist at Groote Schuur Hospital. Mendelson has long been a vocal advocate for stronger national AMR policies.
The letter criticises the expiration of the 2018–2024 South African Antimicrobial Resistance National Strategy Framework, saying the country now lacks a coordinated national response to this growing health threat. The framework, which recognised AMR as a “serious and growing global health security risk,” lapsed without a replacement or clear extension plan.
Global health data further supports their warning:
Over 1 million people die annually from drug-resistant infections.
Nearly 5 million people die with antibiotic-resistant infections each year.
Projections estimate that 40 million deaths could occur over the next 25 years if action is not taken.
The letter also calls for the reinstatement of a Ministerial Advisory Committee on AMR, which was disbanded in November 2023. Experts argue that without such a scientific advisory body, the government lacks the capacity to make evidence-based decisions on antimicrobial resistance.
“The lack of a robust scientific advisory body limits the government’s capacity to develop and implement data-driven policies,” the letter states. It goes on to say that a national scientific body would “empower the government to make strategic, data-driven decisions to combat this pressing health threat effectively.”
Mendelson noted that South Africa’s healthcare system is seeing an increase in patients with highly resistant bacterial infections, which are harder to treat, lead to longer hospital stays, increase mortality rates, and escalate treatment costs. He stressed that common medical procedures — including surgery, chemotherapy, and childbirth — become significantly riskier when antibiotics stop working.
“Without antibiotics, modern medicine collapses,” Mendelson said. “We are already seeing warning signs.”
While some hospitals in South Africa have antibiotic stewardship programs, the lack of a centralised, funded national response means efforts are fragmented and largely dependent on individual institutions. In rural and under-resourced healthcare settings, the situation is reportedly far worse.
The experts’ plea also raises concern about the socio-economic impact of AMR, highlighting how resistant infections lead to extended periods of illness, loss of productivity, and increased burden on healthcare resources. These consequences disproportionately affect low-income communities, where access to timely and appropriate care is already limited.
The Department of Health, through its spokesperson Foster Mohale, said it will only respond to the letter once it is formally presented, expected to happen at 5pm on Thursday.
The delay in national-level action comes as other countries ramp up their own AMR strategies. The World Health Organization (WHO) has repeatedly warned that AMR is one of the top 10 global health threats, and has called on all governments to treat it with the same urgency as climate change and pandemic preparedness.
South Africa was once considered a leader on the continent for its AMR initiatives, especially following the launch of the first National AMR Strategy Framework in 2014. However, the momentum appears to have stalled, with no successor strategy or updated action plan currently in place.
Public health activists have now called on civil society to support the push for a renewed AMR strategy, warning that inaction today could lead to a future where routine infections become untreatable.
