Catalyzing Change: Entrepreneurs from the Global South Leading the Fight against Antimicrobial Resistance.

Antimicrobial resistance (AMR) is rapidly emerging as one of the greatest threats to global health, with projections estimating 10 million deaths annually by 2050. The departure of major pharmaceutical companies from antibiotic research─driven by a combination of scientific complexity, low profitability, and complex regulatory hurdles─has left a serious innovation gap in the development of new antibiotics. This gap is being filled by entrepreneurial ventures in the Global South, particularly in India, South Africa, Brazil, and China, where small and medium enterprises (SMEs) now drive 80% of late-stage antibiotic development. The convergence of abundant scientific talent, cost-effective research capabilities, access to seed funding, and real-world experience with high-burden pathogens is fueling the discovery of innovative solutions to address multidrug-resistant infections. This perspective examines how these vibrant ecosystems are overcoming traditional barriers to innovation by leveraging scientific advancements, tapping into local talent, forming strategic partnerships, and developing novel business models to enable equitable access, thereby realigning public health obligations with commercial viability. This entrepreneurial endeavor in the Global South not only provides sustainable solutions to local health challenges but also contributes to the creation of a resilient global antibiotic ecosystem.