The World Health Organization (WHO) has raised the alarm over the shrinking pipeline of new antibacterials and diagnostics, urging greater investment in R&D to tackle the growing threat of antimicrobial resistance (AMR).

 In its latest reports, WHO assessed antibacterial agents in clinical and preclinical development, alongside diagnostics designed to detect priority bacteria listed in the WHO bacterial priority pathogens list (BPPL).

According to this new analysis, the number of antibacterials in clinical development has fallen from 97 in 2023 to 90 in 2025. Of these, 50 are traditional antibacterial agents and 40 are non-traditional approaches such as bacteriophages, antibodies, and microbiome-modulating agents.

The report noted that the pipeline faces a dual crisis of scarcity and lack of innovation. Only 15 of the 90 antibacterials qualify as innovative, and just five are effective against at least one of the WHO “critical” bacteria.

The report also highlighted ongoing gaps in paediatric formulations, oral treatments for outpatient use, and combination strategies involving non-traditional agents. Since 2017, 17 new antibacterial agents have received marketing authorisation, but only two represent a new chemical class.

The preclinical pipeline remains active, with 232 programmes managed by 148 groups worldwide. However, 90 percent of these companies are small firms with fewer than 50 employees, underscoring the fragility of the global R&D ecosystem.

WHO has urged developers to publish antibacterial activity data to encourage collaboration, attract investment, and accelerate innovation.

Diagnostics are equally critical to AMR control, especially in low- and middle-income countries. WHO’s report on diagnostics highlights persistent gaps, including the absence of multiplex platforms suitable for use in intermediate referral (level II) laboratories to identify bloodstream infections directly from whole blood without culture.

Additionally, the report highlighted insufficient access to biomarker tests (such as C-reactive protein and procalcitonin) to distinguish bacterial from viral infections, and a shortage of simple, point-of-care diagnostic tools for primary and secondary care facilities.

“These limitations disproportionately affect patients in low-resource settings, where most people first present at primary health-care facilities,” WHO said, stressing the urgent need for “affordable, robust, and easy-to-use diagnostic platforms.”

“Antimicrobial resistance is escalating, but the pipeline of new treatments and diagnostics is insufficient to tackle the spread of drug-resistant bacterial infections,” said Dr Yukiko Nakatani, WHO Assistant Director-General for Health Systems.

“Without more investment in R&D, together with dedicated efforts to ensure that new and existing products reach the people who most need them, drug-resistant infections will continue to spread,” she added.

The organisation specifically calls for greater investment in tools designed for resource-limited settings, including those that eliminate the need for culture and simplify diagnostic platforms for primary and secondary care use.