Barriers to accessing newer antibiotics in countries with high burden of bacterial antimicrobial resistant infections-a qualitative study.

Bacterial antimicrobial resistant (AMR) infections pose a significant health threat. Newer antibiotics designed to treat resistant pathogens may offer superior efficacy and fewer side effects compared to older alternatives. However, access to newer antibiotics remains limited in high AMR burden Asian countries. We aimed to explore stakeholder perspectives on barriers and potential solutions to improving access to newer antibiotics across Asia. We conducted a qualitative study using semi-structured interviews with stakeholders across Asia between April 2024 and April 2025. Stakeholder groups included in-depth, multi-stakeholder interviews with Asian policymakers, drug regulators, healthcare professionals, pharmaceutical companies, global health actors, health technology assessors, and patient advocacy groups. We employed maximum variation sampling to understand participants' unique perspectives on antibiotic access challenges. Interviews were audio-recorded, transcribed verbatim, and analysed using a seven-stage framework analysis. We interviewed 40 of 79 (50.6%) invited participants from Cambodia, China, India, Indonesia, Japan, Malaysia, Singapore, Sri Lanka and Thailand. Findings revealed a cascading set of barriers which highlighted deeper structural and political fractures in regional health governance. Firstly, misaligned mindsets were shaped by differing perceptions of AMR urgency between high and low-income countries causing fragmented implementation of solution strategies. These divergent perspectives influenced disjointed and short-term interventions, including reliance on inefficient workaround access mechanisms, and lack of sustained antibiotic stewardship and infection prevention and control policies. Third, systemic underinvestment in infrastructure, clinical trial capacity, regulatory processes, and market-shaping mechanisms further constrained access. Finally, in the absence of coordinated leadership, responsibilities remained siloed across stakeholders, with global health actors unable to fill the governance and accountability gap. Equitable access to newer antibiotics relies on commitments to strengthening health systems' infrastructure and facilitating coherent evidence generation. Improved coordination among key stakeholders including government-private-global health actor partnerships, regulatory harmonisation and pooled procurement could significantly alleviate immediate challenges. This work was supported by the British Academy, National Medical Research Council (NMRC) Singapore and The Good Clinical Trials Collaborative (GCTC).