The supply chain lens of the burden of antimicrobial resistance in Sub-Saharan Africa

Antimicrobial resistance (AMR) is a critical global health challenge, with Sub-Saharan Africa (SSA) experiencing the highest mortality rates due to weak health systems, regulatory gaps, and widespread misuse of antimicrobials. While policy and clinical responses have been extensive, the role of pharmaceutical supply chains in exacerbating AMR remains underexplored. This study, using a narrative review and policy analysis, reveals that SSA’s pharmaceutical supply chains suffer from minimal local production, heavy reliance on imports, fragmented private distribution, and poor inventory management, leading to shortages of essential antimicrobials and increased use of broad-spectrum alternatives. These inefficiencies hinder rational use, enable counterfeit drugs, and limit surveillance. Strengthening supply chains through harmonized systems, pooled procurement, digital platforms, local manufacturing incentives, and robust regulatory oversight is vital to improving antimicrobial access and combating AMR in SSA.