Antimicrobial resistance (AMR) has long since moved beyond the boundaries of a purely medical problem and has become one of the most serious global threats to public health, the economy and food security. According to estimates by international researchers, in 2021 bacterial AMR was directly responsible for 1.14 million deaths worldwide and was associated with a total of 4.71 million deaths [1].
It is important to distinguish between two concepts in order to interpret these figures correctly. Deaths attributable to AMR are cases in which a pathogen’s resistance to treatment increased the risk of death compared with an infection caused by a drug-susceptible microorganism. Deaths associated with AMR are a broader measure, covering deaths among people with infections caused by resistant microorganisms compared with what would have happened if they had not had the infection. Thus, the first measure reflects the additional impact of antimicrobial resistance, while the second captures the broader burden of infections involving resistance.
For Central Asian countries, this crisis has a distinctly cross-border dimension and requires immediate, coordinated action. According to country-level estimates from the Institute for Health Metrics and Evaluation (IHME), in 2019 approximately 9,700 deaths across the five countries of the region—Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan—were directly attributable to bacterial AMR, while approximately 37,100 deaths were associated with it [2]. These are modelled estimates based on 2019 data, not counts of laboratory-confirmed cases. The figures should not be added together, as they reflect different approaches to estimating the disease burden.
Microorganisms do not recognize national borders. Intensive trade flows, population migration, shared ecosystems and transboundary waterways all contribute to the spread of resistant strains throughout the region. Resistance arising from the inappropriate use of antimicrobial agents in one country or sector can become a shared threat to its neighbours. The problem affects several areas at once: human medicine, where familiar antibiotics are losing their effectiveness against common infections; agriculture, where antimicrobial agents are used in animal husbandry; and the environment, where drug residues and resistant microorganisms can enter through wastewater and waste.
AMR threatens not only human health but also the economic resilience of the region. Infections caused by resistant microorganisms may require more expensive medicines, additional laboratory tests and longer hospital stays. This increases the burden on healthcare budgets and household expenditure, while complications and prolonged recovery lead to lost working days and reduced productivity.
The economic consequences are already being considered at the global level. According to the Second Quadripartite Biennial Report on the Implementation of the Global Action Plan on AMR, published in 2026, the annual cost of treating bacterial infections involving antimicrobial resistance could reach USD 412 billion. Additional losses associated with reduced workforce productivity are estimated at USD 443 billion over the projected ten-year period. Global livestock production losses could reach as much as USD 953 billion by 2050 [3]. Although these estimates are not specific forecasts for Central Asia, they clearly demonstrate the scale of the threat to economies and food systems.
The issue is particularly important for livestock farming, a major component of Central Asia’s rural economy and food systems. Resistant infections in farm animals can lead to increased morbidity and mortality among herds and flocks, lower productivity, additional veterinary-care costs and restrictions on trade in animal products. In a region where the incomes of many rural households depend on livestock farming, this is also a matter of employment, food availability and people’s well-being.
Brucellosis provides a telling example. It is a zoonotic infection that is widespread in the region and can be transmitted from animals to humans. A study conducted in Kazakhstan and published in 2017 found rifampicin resistance in 26.4% of the 329 clinical isolates of Brucella melitensis examined. A further 21.9% of isolates showed intermediate susceptibility, while 37.4% were fully susceptible to rifampicin [5]. The samples were collected in 11 regions of Kazakhstan between 2008 and 2014. These findings relate to a specific sample and do not represent the current prevalence of resistance across all Central Asian countries.
A more recent systematic review and meta-analysis, published in 2024, brought together the results of 59 studies from 21 countries covering the period 1976–2024. It estimated overall resistance among Brucella species at 4.6% for rifampicin and 3.4% for cotrimoxazole. The authors also noted substantial differences between studies, countries and observation periods [6]. These findings confirm the need for continuous monitoring of pathogen susceptibility to antimicrobial agents; however, they cannot be used as a separate estimate for Central Asia.
The example of brucellosis illustrates how important it is to develop laboratory diagnostics, monitor the susceptibility of pathogens to antimicrobial agents and ensure that treatment is selected on an evidence-based basis. This is particularly relevant to zoonotic infections, in which human health is directly linked to the health of animals.
Global monitoring remains an important tool for assessing the situation. In October 2025, the World Health Organization published its Global antibiotic resistance surveillance report, based on more than 23 million laboratory-confirmed infection cases. The analysis included data from 104 countries for 2023 [4]. The report emphasizes the need to strengthen national epidemiological surveillance systems, laboratory diagnostics and international data sharing.
That is precisely why no single agency can address this threat effectively on its own. A comprehensive One Health approach is needed, bringing together human health professionals, veterinarians and environmental specialists to conduct joint monitoring, share data and coordinate preventive measures.
Practical cooperation between the scientific community and relevant government agencies across the region is an important step in this direction. One notable example of such collaboration is a joint specialized seminar hosted at Nazarbayev University to build capacity in science communication, crisis response and cross-sectoral epidemiological surveillance. Initiatives of this kind enable specialists from different countries and sectors to develop common approaches to antibiotic-resistance surveillance, improve the quality of scientific publications and coordinate action in biological emergencies.
Containing AMR in Central Asia depends on effective interagency mechanisms, harmonized epidemiological and veterinary surveillance standards, the prudent use of antimicrobial agents and transparent public communication. Bringing together the human health, veterinary and environmental sectors not only helps protect people’s health, but also preserves the effectiveness of treatment, the resilience of livestock farming and food security—and, ultimately, the well-being of future generations throughout the region.
References
1. GBD 2021 Antimicrobial Resistance Collaborators. “Global burden of bacterial antimicrobial resistance 1990–2021: a systematic analysis with forecasts to 2050.” The Lancet, 2024. https://doi.org/10.1016/S0140-6736(24)01867-1
2. Institute for Health Metrics and Evaluation (IHME). The burden of antimicrobial resistance (AMR). Country-level estimates for 2019: Kazakhstan; Kyrgyzstan; Tajikistan; Turkmenistan; Uzbekistan.
3. UNEP, WHO, FAO, WOAH. Implementing the Global Action Plan on Antimicrobial Resistance: Second Quadripartite Biennial Report, 2026.
4. World Health Organization. Global antibiotic resistance surveillance report 2025.
5. Shevtsov A. et al. “Antimicrobial susceptibility of Brucella melitensis in Kazakhstan.” Antimicrobial Resistance & Infection Control, 2017, 6:130. https://doi.org/10.1186/s13756-017-0293-x
6. Beig M. et al. “Unravelling the challenge of cotrimoxazole and rifampin resistance in B. melitensis and B. abortus: A systematic review and meta-analysis.” PLOS Neglected Tropical Diseases, 2024, 18(12): e0012630. https://doi.org/10.1371/journal.pntd.0012630
Maral Chommadova
Coordinator for the Development and Implementation of the Regional One Health Action Plan (CAREC) mchommadova@gmail.com
This publication was prepared by the Regional Environmental Centre for Central Asia (CAREC) under the Regional "One Health" Program in Central Asia. The program implemented with financial support from the World Bank and the Pandemic Fund. The he content of this publication is the sole responsibility of the author and does not necessarily reflect the views or official positions of the World Bank or the Pandemic Fund.
For further information:
Oksana Kravtsova – Regional "One Health" Programme Coordinator, CAREC, okravtsova@carececo.org