“When these drugs fail or stop working, doctors are left with toxic, expensive alternatives that many patients cannot afford.”
Consider this scenario – not a specific case, but one that plays out in hospitals and homes across Nigeria every day…
A young mother takes her child to a community pharmacy. No doctor examines the child. No test identifies the pathogen. The pharmacist sells amoxicillin over the counter.
What Happens When The Drugs Stop Working?
The mother gives it for three days. The fever subsides, then returns. She buys a stronger antibiotic. The cycle repeats. By the time they reach a teaching hospital, the bacteria have learned to resist every oral antibiotic available.
The child dies from an infection that should have been treatable!!!
This is not a rare tragedy. In 2019 alone, antimicrobial resistance (AMR) killed 64,500 Nigerians directly and contributed to 263,400 deaths.
Nigeria now ranks 19th globally in age-standardised mortality from drug-resistant infections. Among children under five, AMR is a leading contributor to death, robbing thousands of families of their youngest members every year.
The silent pandemic is already here.
The Invisible Enemy
Antimicrobial resistance occurs when bacteria, viruses, and parasites evolve to defeat the drugs designed to kill them. It is not a failure of medicine. It is a failure of stewardship.
The World Health Organisation (WHO) has declared AMR one of the top 10 global public health threats. Yet, in Nigeria, the response remains fragmented, underfunded, and legally inadequate.
Resistance to commonly used antibiotics has reached alarming levels. Third-generation cephalosporins – drugs reserved for serious infections – now face resistance rates, exceeding 80 per cent in some settings. Carbapenems, the last line of defence against multi-drug-resistant bacteria, are increasingly ineffective.
When these drugs fail or stop working, doctors are left with toxic, expensive alternatives that many patients cannot afford.
The economic cost is staggering. AMR currently drains an estimated 2.4 per cent of Nigeria’s GDP. Resistant infections cost 287 per cent more to treat than susceptible ones. Without decisive action, Nigeria could lose 5–7 per cent of its GDP by 2050. The human cost is incalculable.
The Five Deadly Drivers
Why is Nigeria losing this battle? Five interconnected failures explain the catastrophe.
First, unregulated access: A 2019 study found that 72.4 per cent of community pharmacies sell antibiotics without prescription. Patent medicine vendors dispense antibiotics like paracetamol. The law requires a prescription, but enforcement is weak. The result is a marketplace where resistance is manufactured one unnecessary course at a time.
Second, diagnostic darkness: Only 23.4 per cent of secondary health facilities have functional microbiology laboratories. Most doctors prescribe blindly, without knowing which pathogen they are fighting or which drugs it resists. A clinician who cannot identify the enemy cannot choose the right weapon.
Third, agricultural misuse: A 2024 study found that 87.4 per cent of poultry farms use antibiotics as growth promoters – not to treat sick animals, but to fatten them faster for market. These drugs enter the food chain and the environment, creating reservoirs of resistant bacteria that eventually infect humans.
Fourth, patient non-compliance: Many Nigerians stop taking antibiotics once symptoms improve, leaving partially treated infections that breed resistance. Others share prescriptions or self-medicate with leftovers. These behaviours reflect not only ignorance, but systemic failures: the cost of full treatment, the distance to licensed pharmacies, and the absence of patient education.
Fifth, weak legal architecture: Nigeria launched a National Action Plan on AMR in 2017, updated in 2022. But the Plan lacks legislative backing. It is a policy document, not a statute. There is no dedicated AMR law. Without enforceable legal standards for prescription, dispensing, agricultural use, and diagnostic practice, policy remains aspiration.
The Global Moment
In June 2026, Nigeria will host the 5th Global High-Level Ministerial Conference on Antimicrobial Resistance in Abuja – the first such meeting on African soil. Heads of government and health ministers will gather to renew commitments.
This is a pivotal opportunity. But it is also a test. Will Nigeria arrive with credible domestic action, or will it be another conference of promises?
The conference should not be a photo opportunity. It should be a deadline.
The Dignity Imperative
At the centre of this crisis lies a question of human dignity.
Section 33 of the Constitution guarantees the right to life. Section 34 guarantees the dignity of the human person. These impose on the state an obligation to protect citizens from preventable death – including death caused by regulatory failure.
When a child dies because antibiotics were sold like sweets, because no laboratory could identify the pathogen, because agricultural profit was prioritised over public health, the state has failed in its constitutional duty. The death is not merely medical. It is political.
Article 16 of the African Charter on Human and Peoples’ Rights – domesticated in Nigerian law – recognises the right to health, including access to effective treatment. When that treatment is systematically undermined by unregulated commerce, the right becomes illusory.
A constitution that guarantees life while permitting the conditions that make medicine ineffective is not protecting its citizens. It is presiding over their vulnerability.
Towards Meaningful Reform
Addressing AMR requires more than awareness campaigns. It demands legal and institutional transformation.
First, enact a dedicated Antimicrobial Resistance Act. This statute should mandate the prescription-only sale of antibiotics, establish penalties for unauthorised dispensing, require microbiological testing before prescribing broad-spectrum antibiotics, and create a national surveillance system to track resistance patterns in real time.
Second, strengthen diagnostic infrastructure. The Federal Government must invest in microbiology laboratories at secondary and tertiary facilities. Without diagnostic capacity, stewardship is impossible.
Third, regulate agricultural antibiotic use. Ban the use of medically important antibiotics as growth promoters in livestock. Empower NAFDAC and the Federal Ministry of Agriculture to inspect farms and prosecute violations.
Fourth, mandate antibiotic stewardship in healthcare facilities. Every hospital should have an antimicrobial stewardship committee responsible for monitoring prescription patterns and educating clinicians.
Fifth, establish a national AMR compensation fund – though this would require primary legislation, adapting the Employees’ Compensation Act model to AMR-related harm caused by regulatory failure.
Sixth, use the Abuja Ministerial Conference to secure binding commitments. Nigeria should lead by example, announcing concrete legislative timelines and budget allocations before the global audience arrives.
The Bottom Line
A pandemic does not require a virus. It requires only a pathogen that spreads faster than our capacity to stop it.
Antimicrobial resistance is not coming. It is here. It is killing Nigerians in numbers that rival any epidemic. And it is doing so quietly – one unnecessary prescription, one incomplete course, one growth-promoted chicken at a time.
The drugs that saved our grandparents are failing. The drugs that should save our children are being squandered. And the legal framework that should protect the efficacy of medicine remains fragmented, underenforced, and dangerously inadequate.
Nigeria has the data. It has the policy documents. It has the global platform.
What it lacks is the law. And without law, the silent pandemic will only grow louder.
Know Your Rights
Antibiotics are prescription-only medicines. No pharmacy should sell them without a doctor’s prescription. Report violations to the Pharmacists Council of Nigeria (PCN).
Insist on laboratory testing before accepting broad-spectrum antibiotics. A culture and sensitivity test identifies the right drug for the right bug.
Complete every antibiotic course exactly as prescribed. Stopping early breeds resistance.
Do not share antibiotics or use leftover prescriptions. What worked for one infection may not work for another – and may make resistance worse.
Report suspected counterfeit or substandard medicines to NAFDAC through its toll-free lines or mobile app.
•Sanu is a Nigerian lawyer and health law scholar. This column breaks down complex health laws for everyday Nigerians.
