In 2024, a 25-month-old boy arrived at a hospital in Banjul, Gambia, with fever, seizures, and a bloodstream infection caused by Enterobacter cloacae, a bacterium that in previous generations might have been beaten with the standard antibiotics. This strain was multidrug-resistant, impervious to at least one agent in nine different antimicrobial groups. Laboratory testing identified two antibiotics that could have been effective and saved him. Neither was available. He died nine days after admission.

As distressing as this story is, it’s not just a distant tragedy. Children account for one in five antimicrobial resistance (AMR) deaths globally. Another telling statistic: every year, over 700,000 children under the age of five die from pneumonia, a disease that antibiotics should be able to treat. However, critical antibiotics that should cure sick children are unavailable, untested, or don’t exist for the youngest patients. This is a failure of incentive, as children are complex to study and chronically deprioritized by the global policies that govern their supply. The AMR crisis in children is thus, at its core, a policy crisis. A crisis that could very well be worsening, moreover. 

Antibiotic shortage and AMR amplify each other

Antibiotic shortage and antimicrobial resistance do not simply coexist; they amplify each other. When the right antibiotic is unavailable, clinicians are forced to prescribe second-line alternatives that are less targeted. This is not just suboptimal care, it accelerates the selective pressure that drives resistance. The case of the 25-month-old boy could be dismissed as a distant tragedy, but the crisis is not confined to rural Africa. A systematic review from 2025 found that shortages are increasingly prevalent, even in high-income countries, routinely producing treatment failure, prolonged hospital stays, and inferior substitute prescribing. Children who receive the wrong drug can die, but they may also carry and spread a more resistant strain. A shortage is thus not just a supply problem with potentially fatal consequences for children; it can also accelerate AMR.

Even when antibiotics exist, they are frequently unavailable to children in any meaningful clinical sense. A few months ago, The Lancet Regional Health Western Pacific uncovered a shocking gap in children’s medicine in the Oceania region. Of the 12 antibiotics recommended by WHO for serious drug-resistant bloodstream infections, only six were licensed for children under 12, while merely three were for infants. Researchers describe it as “the decade long delay” –  the average between approving a new antibiotic for adults and finally studying it properly for children. During that window, pediatricians are left guessing. They prescribe off-label, estimating doses from adult data for bodies that metabolize drugs in an entirely different way.

Upcoming World Health Assembly: a window of opportunity?

In May 2026, the World Health Assembly will consider an updated Global Action Plan on AMR. The current draft contains robust language on surveillance and innovation but lacks a dedicated focus on children and newborns. Without child-specific targets, member states face no accountability to disaggregate AMR data by age, prioritize pediatric formulations or close licensing gaps on a defined timeline. Let’s not mince words: a plan that does not name children does not protect them. The political will to change this exists, different frameworks for mandatory pediatric licensing timelines have been outlined. What is still missing is the global governance architecture to push for them.

The child in Banjul did not die because no one knew how to treat him. He died because the system failed to ensure the medicine that existed was approved for his age, and was on the shelf when he needed it. This is a policy failure, and policy failures can be fixed. The World Health Assembly’s updated Global Action Plan is an opportunity to do exactly that: to mandate child-specific AMR data and research, set time-bound licensing requirements, and build supply chain accountability frameworks that hold member states responsible for keeping essential pediatric antibiotics in supply while resourcing those who cannot supply their own. Because this crisis does not begin and end at a nation’s income level. It begins when children’s health and rights are not prioritized in the first place.