Disclaimer: This post is for academic purposes only. Please read the original document if you intend to use them for clinical purposes.
This document summarises the 2026 WHO guidance for Strengthening Responses to Fungal Disease and Antifungal Resistance (AFR). Fungal diseases represent a profound yet underestimated threat to global health, affecting over 300 million people and causing millions of deaths annually. Though publication of the World Health Organization (WHO) Fungal Priority Pathogens List (FPPL) in 2022 had established a foundation for research and action, however a critical gap still persists between recognition and implementation. This blueprint outlines a comprehensive implementation guidance designed to strengthen national and regional responses to fungal threats.
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I) Global Challenge:
Fungal disease and AFR remain under-recognized and under-resourced, with the true burden likely exceeding current estimates due to poor data quality and limited diagnostic capacity in low-resource settings.
a. Impact:
- Invasive Infections: Diseases such as aspergillosis, candidiasis, cryptococcosis, and mucormycosis carry high case-fatality rates, even when advanced care is available.
- Chronic Morbidity: Non-fatal conditions like chronic pulmonary aspergillosis, fungal mycetoma, and multidrug-resistant dermatophytosis lead to permanent disfigurement, disability, and social stigma.
- Vulnerable Populations: The burden falls disproportionately on marginalized populations and those with compromised immune systems, though diagnostic delays and AFR are increasingly affecting immunocompetent individuals.
b. AFR:
AFR limits treatment options and complicates clinical management. The threat is characterized by:
- Intrinsic and Acquired Resistance: Some fungi are naturally resistant, while others, such as Candidozyma auris (Candida auris) and azole-resistant Aspergillus fumigatus, have acquired resistance.
- Environmental Drivers: The regulated yet widespread application of azole fungicides in agriculture creates selective pressure, leading to cross-resistance in human pathogens.
- Climate Change: Rising temperatures alter fungal ecology, facilitating the spread of thermotolerant and resistant species into new geographic ranges.
II) Barriers:
The global response is currently hindered by entrenched systemic barriers across several sectors:
| Category: | Barriers: |
| Governance | Limited political priority; fragmented responses siloed in disconnected programs (AMR, HIV, TB); exclusion from global burden metrics. |
| Workforce | Mycology is under-represented in medical curricula; critical gaps in basic and clinical research capacity. |
| Diagnostics/Access | Lack of affordable point-of-care tools; high costs and regulatory barriers for new medicines; supply chain fragility leading to stockouts. |
| Health Systems | Infection Prevention and Control (IPC) protocols often lack fungal considerations; stewardship programs (AFS) are under-resourced. |
| One Health | Inadequate monitoring of environmental risk factors and agricultural fungicide residues. |
III) The 4 Domain framework:
The guidance organizes priority actions into 4 inter-connected domains to support a coordinated national response:
1. Public Health Interventions:
Integrating fungal disease management into routine health services and ensuring equitable access:
- Awareness: Develop public awareness strategies and integrate mycology into healthcare professional education.
- Clinical Management: Institutionalize national IPC and case management guidance informed by local epidemiology.
- Stewardship: Integrate Antifungal Stewardship (AFS) into national AMR, HIV, and TB programs.
- Equitable Access: Include priority antifungals and diagnostics in national Essential Medicines/Diagnostics Lists (EML/EDL).
2. Therapies and Innovation:
Align innovation with the FPPL and shorten the timeline from research to patient access:
- Research Prioritization: Align investments with the WHO FPPL and support agents that meet WHO innovation criteria (e.g., new chemical classes or modes of action).
- Clinical Trials: Expand multinational trial networks with meaningful inclusion of low- and middle-income countries (LMICs).
- Market Shaping: Establish push and pull incentive mechanisms and public-private partnerships with enforceable affordability provisions.
3. Laboratory and Surveillance systems:
Building the data infrastructure required for evidence-informed policy:
- Tiered Networks: Establish laboratory capacity at reference and sentinel sites with defined roles for confirmatory testing.
- Integrated Surveillance: Incorporate fungal pathogens into national AMR platforms and report data to the WHO Global Antimicrobial Resistance and Use Surveillance System (GLASS).
- Outbreak Readiness: Develop standardized response protocols, particularly for emerging threats like Candidozyma auris.
4. One Health drivers:
Address the upstream determinants of disease and resistance:
- Risk Reduction: Integrate fungal risk considerations into housing standards, workplace safety, and humanitarian response frameworks.
- Cross-Sectoral Governance: Strengthen collaboration between health, agricultural, and environmental authorities to address the dual-use compound challenge.
- Climate Resilience: Incorporate fungal disease risks into disaster preparedness and climate-informed health planning.
IV) Implementation:
Successful implementation moves from aligning inputs to achieving long-term health impacts through a results-based monitoring structure.
a. The 12 accelerators:
12 accelerators are identified to help countries generate early momentum:
- Integrate AFS within national AMR programs.
- Include priority antifungals in national EMLs.
- Include fungal diagnostics in national EDLs.
- Integrate fungal IPC into primary healthcare platforms.
- Align national research priorities with the FPPL.
- Strengthen regulatory reliance mechanisms for product evaluation.
- Promote LMIC participation in clinical trials.
- Establish innovation financing with embedded access safeguards.
- Report fungal AMR data to GLASS.
- Expand tiered laboratory capacity.
- Integrate fungal considerations into climate-informed health planning.
- Strengthen cross-sectoral One Health coordination.
b. The 3 Phases:
- I (Short-term): High-feasibility, high-impact actions using existing systems (e.g. awareness campaigns, national priority setting).
- II (Medium-term): Actions requiring moderate investment or policy alignment (e.g. lab tiering, procurement strengthening).
- III (Long-term): Structural or multisectoral reforms requiring sustained resource commitment (e.g. built environment resilience, environmental surveillance).
V) Future:
To close persistent evidence gaps, the guidance identifies several critical research areas:
- Disease Burden: Refining global estimates to accurately reflect incidence and mortality across diverse populations.
- Diagnostics: Advancing patient-centered, near-patient tools and adapting next-generation sequencing or AI for LMIC contexts.
- Prevention: Developing innovative vaccine strategies and immune-based therapies for high-risk populations.
- Transmission: Understanding how resistance spreads across human, animal, and environmental reservoirs to interrupt transmission pathways.
Citation: Blueprint for strengthening responses to fungal disease and antifungal resistance: implementation guidance. Geneva: World Health Organization; 2026. Licence: CC BY-NC-SA 3.0 IGO.
