Slow pandemic: Next global health crisis has already begun with quiet spread of antimicrobial resistance

The next global health crisis is unlikely to arrive with the same unmistakable signature as Covid-19. It may not begin with a novel virus, a dramatic lockdown or daily infection curves dominating headlines. It could emerge more quietly, through drug-resistant infections that no longer respond to routine treatment, as heat, hunger and water stress reshape disease patterns and fragile health systems buckle under pressure they were never designed to absorb.

That is what makes the next crisis so dangerous. It may not look like a single event. It may look like a slow, grinding failure of resilience until the world suddenly realises it is already in the middle of it.

If there is one threat that deserves to be called a slow pandemic, it is antimicrobial resistance. The World Health Organization (WHO) estimates that bacterial antimicrobial resistance was directly responsible for 1.27 million deaths in 2019 and contributed to 4.95 million deaths globally. That is an extraordinary burden, and it is being driven by exactly the kind of complacency that global systems are prone to: the overuse and misuse of antimicrobials in human health, agriculture and food production, along with weak surveillance and uneven stewardship.

In 2025, the WHO warned that antibiotic resistance rose in more than 40% of the pathogen-antibiotic combinations it monitored between 2018 and 2023. In plain language, this means more common infections are becoming harder to treat, and more routine procedures are becoming riskier. A world in which antibiotics fail is not a distant dystopia. It is a world in which childbirth, surgery, cancer care and the treatment of simple wounds become far more dangerous.

The disturbing thing about antimicrobial resistance (AMR) is that it does not trigger the same urgency as an explosive outbreak. It spreads across hospitals, farms, communities and borders without a single dramatic moment of recognition. Yet its cumulative impact could rival or surpass many traditional pandemics.

This is why the United Nations high-level political declaration on AMR in 2024 matters. It marked a growing recognition that this is not just a medical issue. It is a systems issue tied to food, trade, regulation, innovation and public trust. The next crisis may therefore be one the world has already named, but still has not treated with the seriousness it demands.

Climate change is another likely accelerator of the next global health emergency. The WHO estimates that between 2030 and 2050, climate change is expected to cause about 250,000 additional deaths per year, from undernutrition, malaria, diarrhoea and heat stress alone. That figure is almost certainly conservative because it captures only a subset of climate-related health impacts. More than 3.6 billion people already live in areas highly susceptible to climate change.

This matters because warming temperatures, extreme weather, water stress and population displacement alter the geography of disease. Vector-borne illnesses can spread into new areas. Floods can contaminate water systems. Heatwaves can overwhelm elderly and vulnerable populations. Drought can undermine nutrition long before it is recorded as a health statistic.

Food system disruption may be one of the least-appreciated drivers of the next crisis. The latest global food security assessments continue to show that hunger, food insecurity and malnutrition are being intensified by economic shocks, conflict and extreme weather. The 2025 State of Food Security and Nutrition in the World highlights how high food price inflation has weakened access to healthy diets, especially for low-income populations.

Unicef, the WHO and the World Bank have also reported that the world remains off track on child malnutrition targets. A health crisis does not begin only when hospitals fill up. It also begins when children do not get enough nutrition, when immunocompromised populations become more vulnerable, and when communities are forced into impossible choices between food, transport and healthcare.

Perhaps the greatest lesson from Covid-19 is that pathogens exploit weakness, but systems determine the scale of the damage. The real vulnerability is not only biological. It is institutional. The WHO estimates a projected shortfall of 11 million health workers by 2030, mostly in low- and lower-middle income countries. In Africa, the projected shortage is about 6.1 million by 2030.

At the same time, the world is already seeing renewed disruption to essential health services. In 2025, the WHO reported that 70% of its surveyed country offices were experiencing significant health system disruptions as a result of sudden cuts in official development assistance for health. That should concern everyone. A fragile health system does not fail neatly. It fails through staff burnout, delayed diagnoses, medicine shortages, weak laboratories, broken referral pathways and collapsing trust.

In South Africa and across the African continent, these pressures are already being experienced in real time. Health systems are managing a complex burden of communicable and noncommunicable diseases, alongside workforce shortages and infrastructure constraints. This makes the need for resilient, community-based and preventative models of care even more urgent, particularly in underserved communities where access to care remains uneven.

Financing is central to this story. The World Bank has warned that more than half a billion people were pushed, or further pushed, into extreme poverty because they had to pay out of pocket for health services. Populations that cannot afford care delay treatment, present later, suffer more severe disease and place greater strain on already stretched systems.

Technology will complicate this picture in both promising and unsettling ways. Artificial intelligence, genomic surveillance and predictive analytics offer the possibility of earlier detection, faster outbreak mapping and more precise targeting of interventions. The WHO Pandemic Agreement adopted in May 2025 is an important attempt to strengthen international coordination and improve equitable access to vaccines, diagnostics and therapeutics. But technology is never neutral. The same era that allows for faster detection also raises difficult questions about biosecurity, data governance, misinformation, unequal access and dual-use research. Biotechnology and AI can help us see the next crisis sooner, but they can also widen gaps between countries that can act quickly and those that cannot.

Institutions of higher learning also have a critical role to play in preparing for the next global health crisis. The future health workforce must be equipped not only with clinical skills, but with systems thinking, digital literacy and a strong grounding in prevention and community-based care. Strengthening health systems begins with how we train and develop the professionals who will operate within them.

So, what could the next global health crisis be? It could be an antibiotic-resistant bacterial surge. It could be a climate-linked expansion of infectious disease. It could be a food and nutrition shock that deepens vulnerability across whole populations. Most likely, it will be a compound crisis, where these threats overlap and amplify one another. That is the point policymakers, universities, health leaders and governments need to grasp. The future threat is unlikely to be singular. It will be interconnected.

The world will face another global health crisis. The real question is whether we continue to prepare for the last one, or whether we build systems capable of withstanding the next one by investing in public health infrastructure, health worker training, antimicrobial stewardship, climate resilience, food security and ethical technology governance. DM

Dr Rowen Govender is head of the Regenesys School of Health Sciences.