Leveraging a people-centred approach to combat antimicrobial resistance in Africa.

Antimicrobial resistance (AMR) poses a severe and growing threat to public health in Africa, disproportionately affecting marginalised and vulnerable populations across communities and health systems. Current responses often prioritise technical measures, such as stewardship programmes and surveillance systems, with insufficient attention to the socioeconomic and cultural realities that drive resistance. AMR cannot be addressed in isolation, as its emergence and spread are closely linked to poverty, inadequate education, gender inequality, poor governance, limited access to healthcare, clean water, sanitation, and diagnostics, as well as weak supply chains for essential medicines. This commentary advocates for a people-centred approach to AMR that addresses the social determinants of health and fosters inclusive, community-driven solutions. Strengthening primary healthcare systems and improving access to affordable, quality-assured antimicrobials and diagnostics must be prioritised to empower both healthcare providers and patients. Local stakeholders are essential for raising awareness, promoting behaviour change, and ensuring cultural relevance through meaningful community engagement. Marginalised populations, including those in underserved regions or disproportionately exposed to infection due to displacement, disability, or comorbidities, should be central to the co-creation of AMR strategies. Embedding AMR initiatives within universal health coverage reforms, expanding preventive measures, such as vaccination, and tackling systemic challenges are also crucial for reducing antibiotic dependence and building equitable health systems. A coordinated, multisectoral response that connects human, animal, and environmental health, grounded in equity, community ownership, and interdisciplinary collaboration, is essential for sustainable AMR control efforts that leave no one behind.