Targeted Action and Financing the Fight Against Antimicrobial Resistance in Asia 2025

Unsustainable agriculture and aquaculture practices Agricultural practices are another significant driver of AMR in Asia. Pressure to meet rising food demand Asia accounts for around 43% of global meat production and more than 86% of aquaculture.67 As the region catches up with rising demand, the use of antibiotics will continue to escalate, in turn exacerbating AMR. To meet demand, intensive livestock production models are increasingly being used, causing a build-up of antibiotics in the food chain as farmers overuse and misuse antibiotics to prevent disease and promote growth.68 A lack of regulation around proper agricultural practices further compounds this problem – veterinarians are in short supply in many parts of the world, with 73% of Asian countries reporting a shortfall of vets in a survey conducted by WOAH.69 It is observed that in South-East Asia, multi-drug resistance has been found in chickens, ducks and pigs, including resistance to classes of antibiotics used to treat humans.70 The European Union has taken a strong stance on the misuse of antibiotics in livestock – it has banned the use of antibiotics for growth promotion since 2006 and the preventive use of antibiotics in certain groups of animals since 2022.71 While Thailand and Viet Nam are forerunners to ban or restrict the use of antibiotics for growth promotion in livestock, regulations on the use of antibiotics remain generally less enforced in Asia. Although it is projected that global animal antimicrobial consumption could reduce by 80%72 through efforts such as regulatory caps and price increases of veterinary antibiotics, a lack of data on antimicrobial use and the absence of a global veterinary antimicrobial sales database casts doubt on this estimate.73 Contamination of waterways from improper aquaculture practices Asia dominates global aquaculture production, contributing nearly 92% of the world’s supply, which amounts to close to 120 million tonnes.74 Rising sea temperatures have increased mortality among cultured aquatic animals, prompting farmers to increase the prophylactic use of antimicrobials. Additionally, farmers may use antimicrobials to protect their fish from the inputs and diseases that are transmitted from neighbouring countries through shared water bodies. Antibiotic-resistant bacteria and multiple antibiotic-resistance genes (ARGs) have been found at fish farms and transect sites in Singapore.75 Similarly, ARGs have been found in aquaculture farms in Malaysia’s Johor Strait, raising the risk of transmission to nearby aquaculture facilities.76 Indoor fish farming, using an independent water circulation system, could be a direct solution to this problem. However, many fish farms in Asia cannot afford this alternative due to the high cost of investing in the necessary infrastructure and technology.77 Emergence of resistant fungal pathogens Unsustainable agricultural practices in Asia are contributing to the rise of antifungal- resistant pathogens. The widespread use of fungicides in crop protection across Asian countries contributes to the development of more resistant strains of fungi in the environment. For example, when Aspergillus (a fungus that causes pigmentation, rotting, development of off-odours and off-flavours in crops)78 is exposed to fungicides, it can develop resistance to the anti-fungal medicines used to treat infections in humans.79 Invasive aspergillosis (infection of Aspergillus) is the most frequently reported fungal infection in immunocompromised individuals in the Asia-Pacific.80 Inadequate clean water and sanitation AMR is further exacerbated by lack of access to clean water and proper water, sanitation and hygiene (WASH) infrastructure. It is estimated that AMR- related mortality in LMICs could be reduced by 5.7% through water and sanitation improvements.81 Lack of access to WASH facilities and availability of clean water Three-quarters of the Asian population faces water insecurity, with up to 84% of water sources in the South-East Asia region identified as contaminated.82 In addition, fewer than four in 10 healthcare facilities in LMICs are estimated to have even rudimentary WASH amenities.83 Further, climate-driven disasters, particularly storms and floods, risk damaging this fragile infrastructure. Interventions such as universal access to WASH services could prevent nearly 247,800 deaths annually. Where clean water is scarce and expensive, families are often forced to prioritize higher- quality water only for drinking. This creates fertile conditions for bacteria and other pathogens to spread through water used for other purposes, such as cooking and personal hygiene.84 The use of contaminated water for non-drinking purposes can lead to higher incidence of waterborne diseases such as cholera, which can also become resistant as the bug continues to evolve amid a lack of sanitation. For example, while endemic cholera is already causing 100,000 cases in Bangladesh annually, a resistant strain could double caseloads as untreated infections are prolonged and secondary infections extended. AMR-related mortality in LMICs could be reduced by 5.7% through water and sanitation improvements. Targeted Action and Financing the Fight Against Antimicrobial Resistance in Asia 17