Editorial: New Target Product Profiles From the WHO as Climate Change, Global Population Migration, and Conflict Drive Antimicrobial Resistance

Climate change, population migration, and conflict have driven antimicrobial resistance (AMR) globally, and at a time when there remains a need for a reliable pipeline of affordable, accessible, and innovative antimicrobial agents that can be made available to all. In 2023, the World Health Organization (WHO) estimated that in 2019, bacterial AMR directly caused 1.27 million deaths and contributed to 4.95 million deaths worldwide [1]. Misuse of antibiotics, including over-prescribing, incorrect prescribing, and non-compliance with full courses of antibiotics, was previously the main driver of drug-resistant microbial pathogens [1]. Also in 2019, the Antimicrobial Resistance Collaborators estimated mortality and disability-adjusted life-years (DALYs) directly due to and associated with bacterial AMR using 471 million records from 204 countries and territories and evaluated 23 bacterial pathogens and 88 drug combinations [2]. Predictive statistical modelling estimated that in 2019, 4·95 million deaths were associated with bacterial AMR, with the highest rates in western sub-Saharan Africa, and the lowest in Australasia [2]. Worldwide, lower respiratory tract infections were the most common association with AMR [2]. The leading causes of mortality were due to infections with resistant Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa [2]. The main pathogen-drug combinations associated with high mortality rates were methicillin-resistant Staphylococcus aureus (MRSA), multidrug-resistant tuberculosis, third-generation cephalosporin-resistant and fluoroquinolone-resistant Escherichia coli, carbapenem-resistant Acinetobacter baumannii, and carbapenem-resistant and third-generation cephalosporin-resistant Klebsiella pneumoniae [2]. In 2024, the WHO published its list of bacterial priority pathogens and their associated antimicrobial resistance, including medium, high, and critical groups (Table 1) [3,4].

In 2025, the WHO identified more than 90 new antibacterial agents in preclinical studies or in clinical development but highlighted the lack of innovative agents that treat or prevent current priority pathogens [5]. On March 11, 2026, the WHO published three new Target Product Profiles (TPPs) for antibacterial agents to address AMR in bacteria that cause sepsis, urinary tract infections, pneumonia, and meningitis worldwide (Table 2) [6]. The WHO TPP initiative is part of a joint initiative between the WHO and the European Commission’s Health Emergency Preparedness Authority (HERA), established in 2021, which aims to address AMR under the EU4Health program [7]. The first 2026 WHO TPP group includes the Gram-negative carbapenem-resistant Enterobacteria, Acinetobacter baumannii, and Pseudomonas aeruginosa, which can cause sepsis, hospital-acquired infections, and ventilator-associated bacterial pneumonia (Table 2) [6]. This first group of bacteria has a high mortality rate, leading to prolonged hospital stays and admissions to intensive care units (ICUs), with an impact on healthcare services and the economy [6]. The second TPP group includes severe Gram-positive infections in vulnerable immunosuppressed patients and critically ill patients, and mainly includes vancomycin-resistant Enterococcus faecium, which can be associated with fatal sepsis (Table 2) [6]. The third TPP group includes bacterial meningitis, including penicillin- and cephalosporin-resistant community-acquired infections, and health care-associated meningitis (Table 2) [6]. Bacterial meningitis has a high mortality rate, and patients who survive can have long-term sequelae that include epilepsy, loss of hearing, or cognitive decline, which makes AMR in bacterial meningitis a serious concern that requires urgent innovations in prevention, diagnosis, and treatment [6].

In 2023, the WHO recognized the crisis in access to antibiotics and in the research and development pipeline and highlighted the urgent need to ensure equitable access to antimicrobials, vaccines, infection diagnostics, and medicines [1,8]. Although AMR is a problem across regions, countries, and income levels, the effects are exacerbated by inequality and poverty, which explains why low- and middle-income countries have been most affected [1,8]. In low- and middle-income countries, poorly regulated antibiotic markets and over-the-counter availability drive inappropriate antimicrobial use, accelerating AMR [9]. Therefore, improving healthcare systems to improve health awareness and ensure prescription-only policies, and expanding access to basic diagnostics have been suggested as approaches to control AMR in these countries [9].

AMR is not only associated with morbidity and mortality but also has significant economic outcomes [10]. A World Bank analysis report in 2017 estimated that AMR could result in between US$ 1–3.4 trillion in gross domestic product (GDP) losses per year by 2030 and US$ 1 trillion in additional healthcare costs by 2050 [10]. In 2023, the WHO recommended that AMR be recognized as a global healthcare priority, to be addressed through improved diagnostics and infection prevention, expanded access to prevention measures, information, and appropriate treatment, and research and development of novel diagnostics, vaccines, and antimicrobials [1].

International travel is a mechanism for the transmission of resistant organisms among travellers with infected wounds or lung infections [11]. In addition to international travel, climate change, natural disasters, and conflicts are factors that increasingly drive the development and spread of antimicrobial-resistant organisms [12]. The 21st century has been marked by an increase in armed conflict and the displacement of populations, exacerbated by natural disasters and climate change, which prevent infection diagnosis, prevention, and AMR surveillance, and impact sanitation and water supplies [12]. Conflict is a major contributor to AMR due to the lack of adequate healthcare and injuries that occur during conflict, and also because displaced persons from war zones may have limited or inappropriate access to healthcare and are susceptible to infection [13]. Conflict also drives AMR by damaging healthcare systems, disrupting water, sanitation, and diagnostic testing, limiting treatment and vaccine availability, and causing trauma and contaminating wounds with environmental organisms [12,13]. The United Nations High Commissioner for Refugees (UNHCR) Global Trends Report for 2022 estimated that from a global population of 8.3 billion, 110 million people, or 1.4% the global population, had been forcibly displaced either within their country of origin or to neighbouring countries [13,14]. This was a 19 million-person increase compared to 2021, the largest single increase since UNHCR records began in 1992 [13,14]. More recent global data from the UNHCR shows that at the end of June 2025, due to persecution, conflict, or violence, there were 17.3 million people displaced across borders, 42.5 million refugees, 67.8 million people displaced within their own national borders, 8.42 million asylum-seekers, and 4.4 million stateless people [14]. This means that globally, in June 2025, 1 in 70 people were at increased risk of AMR infection due to violence, persecution, or conflict [14].

Conclusions

This is a critical time for the world as climate change, population migration, and conflict have driven AMR. It is hoped that the 2026 WHO priority TPP recommendations can highlight these concerns and provide a framework for research and development and investment to control what seems to be an inexorable rise in AMR in bacterial infections, including community- and hospital-acquired infections in all demographic regions, age groups, and healthcare settings.