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

Antimicrobial resistance (AMR) poses one of the most urgent global health threats, with Sub-Saharan Africa (SSA) bearing the highest mortality rates of 23.5 deaths per 100,000 population in 2022. Critical drivers of AMR include weak health systems, laboratory constraints, regulatory gaps, in addition to misuse of antimicrobials. Despite extensive policy and clinical discussions, the pivotal role of pharmaceutical supply chains in ensuring quality, rational use, and antimicrobial availability remains underemphasized. This study examines how inefficiencies across SSA’s pharmaceutical supply chain exacerbate AMR and identifies actionable strategies to fortify resilience. This study employed a narrative review and policy analysis approach, synthesizing data from global AMR reports, peer-reviewed literature, WHO TrACSS 2023 survey responses, and case studies to examine the linkages between pharmaceutical supply chain weaknesses and AMR outcomes in SSA. Local production in SSA remains minimal, with most pharmaceutical manufacturers unevenly concentrated in Nigeria, South Africa, Kenya, and Ghana. Most SSA countries depend on imported APIs and medicines. Public supply chains operate via multi-tiered medical stores, but suffer from siloed information, poor inventory management, and donor-driven parallel systems. Private sector distribution is highly fragmented, facilitating counterfeit drugs and volatile pricing. Only 5 of 46 WHO Afro countries regularly monitor national antimicrobial consumption for human use and rational use of antibiotics in a representative sample of health facilities. Sixteen countries use consumption data to inform policy. Chronic shortages of key ‘Access’ group antimicrobials such as benzathine penicillin G and cotrimoxazole force reliance on broad-spectrum alternatives, accelerating resistance and increasing treatment failures and costs. Fragility of the pharmaceutical supply chain in SSA critically compounds the AMR crisis by limiting access to quality antimicrobials, fostering misuse, and limiting surveillance. Strengthening these systems requires harmonizing public, private, and donor-funded vertical supply chains, expanding pooled procurement, digitizing inventory and forecasting platforms, and incentivizing local manufacturing through tax exemptions and subsidies. Bolstering regulatory oversight, embedding supply chain metrics into national AMR action plans, and building workforce are imperative. Future research should evaluate the impact of integrated supply chain interventions on antimicrobial availability and resistance trends, and explore regional manufacturing hubs’ potential to improve equity and supply security.