First blind spot: Overemphasis on high-income nations: While AMR is a global problem, most research and policy efforts are focused on high-income countries. Yet, low- and middle-income countries (LMICs) face the most significant challenges, with higher rates of infectious diseases and widespread antibiotic misuse. AMR strategies found to be effective in high-income settings may not be appropriate for LMICs due to differences in resources, infrastructure, and sociocultural factors.
The way forward – Invest: Increased investment in LMICs, focusing on improving water, sanitation, and hygiene (WASH), expanding vaccines, and creating solutions that fit local needs.

Second blind spot: Neglecting primary care providers: Most AMR efforts focus on hospitals, but over 85% of antibiotics are used in communities. These are often prescribed by private doctors, pharmacists, and informal practitioners. In many rural and underserved areas of LMICs, these providers are the first point of contact for healthcare.
The way forward – Involve: Extending antibiotic stewardship programs to include primary care and community-based providers is crucial in reducing unnecessary antibiotic prescriptions and dispensing.

Third blind spot: Antibiotic overuse in livestock and agriculture: A significant but often ignored cause of AMR is the use of antibiotics in livestock and agriculture, where usage far exceeds that in humans. This is especially true in LMICs, where regulations are poorly regulated, and antibiotics are commonly used to promote animal growth.
The way forward – Intervene: Strengthening collaboration between the health and agriculture sectors is essential, and more robust policies to reduce the use of antibiotics in animals are required.

Fourth blind spot: Lack of accessible diagnostics: Antibiotics are often prescribed in many settings without a clear diagnosis because access to affordable diagnostic tools is limited. Reliance on empirical treatment, particularly in LMICs, significantly drives antibiotic misuse. Rapid point-of-care tests can help reduce unnecessary antibiotic prescriptions by providing quick and accurate diagnoses.
The way forward – Innovate: Increased investment is needed to develop low-cost, robust diagnostic tools that work well in resource-limited areas.

Fifth blind spot: Overlooked informal sector: In many LMICs, informal healthcare providers (IPs), who often have little to no medical training, are key sources of antibiotics. These providers are valued and trusted by their communities
and offer accessibility and affordability services, but they have been reported to contribute to antibiotic overuse.
The way forward – Integrate: To effectively address AMR, IPs must be included in antibiotic stewardship efforts through training, regulation, and pragmatic strategies suitable for local settings.

To make progress in the fight against AMR, we stress the importance of recognizing and addressing these five blind spots. We must shift our focus to LMICs, primary care providers, and informal healthcare sectors. In addition, we need to reduce antibiotic use in livestock and invest in affordable diagnostic tools. By tackling these challenges, we can create a more robust and effective global strategy to fight AMR.