The World Health Organization (WHO) has published its first reports highlighting the severe shortage of medicines and diagnostic tools for invasive fungal infections. The findings emphasize the urgent need for research and development (R&D) to bridge these critical gaps.
Fungal infections are becoming an increasing global health threat, with common conditions like Candida—responsible for oral and vaginal thrush—developing greater resistance to existing treatments. These infections pose the highest risk to individuals with weakened immune systems, such as cancer patients undergoing chemotherapy, people living with HIV, and organ transplant recipients.
“Invasive fungal infections put the most vulnerable patients at risk, yet effective treatments remain unavailable in many countries,” said Dr. Yukiko Nakatani, WHO Assistant Director-General for Antimicrobial Resistance ad interim. “Not only is there a lack of new antifungal medicines and diagnostic tools, but many low- and middle-income countries lack basic fungal testing, even in district hospitals. Without proper diagnostics, infections go undetected, preventing patients from receiving appropriate treatment.”
High Mortality Rates and Limited Treatment Options
Fungi categorized as ‘critical priority’ pathogens on WHO’s Fungal Priority Pathogens List (FPPL) are particularly deadly, with mortality rates reaching up to 88%. As medical advancements enable more people to live with immunocompromised conditions, cases of invasive fungal infections are likely to rise. However, tackling this issue remains challenging due to the scarcity of diagnostic tools, limited treatment options, and slow progress in drug development.
Challenges in Developing Antifungal Treatments
According to WHO’s report on antifungal medicines, only four new antifungal drugs have received regulatory approval in the U.S., EU, or China in the past decade. Currently, nine antifungal drugs are undergoing clinical trials for use against the most dangerous fungi on the FPPL. However, only three of these candidates have reached phase 3, the final stage before potential approval, meaning new treatment options will likely remain limited in the coming years. Additionally, 22 drugs are in preclinical development, but given the high dropout rates and risks in early-stage research, this pipeline is insufficient.
Existing antifungal treatments often come with significant drawbacks, including severe side effects, interactions with other medications, limited dosage forms, and prolonged hospital stays. The report stresses the urgent need for safer, more effective antifungal drugs that reduce the need for continuous monitoring. It also calls for broad-spectrum antifungal treatments that can combat multiple life-threatening fungal infections.
Children are particularly underserved, as very few clinical trials focus on pediatric dosing and child-friendly formulations. WHO urges greater investment in global fungal infection surveillance, increased financial incentives for antifungal drug development, and more funding for basic research to identify new fungal targets for treatment. Strengthening immune-based therapies is another promising avenue for future treatments.
Gaps in Diagnostic Tools and Accessibility
The WHO’s diagnostics report reveals that although tests for fungal priority pathogens exist, they depend on well-equipped laboratories and skilled personnel, making them largely inaccessible in low- and middle-income countries. To improve global fungal infection diagnosis, especially in these regions, WHO recommends developing faster, more affordable, and more accessible testing methods, including point-of-care diagnostic tools.
Current fungal diagnostic methods are far from ideal. Many tests detect only a narrow range of fungi, lack accuracy, and take too long to produce results. Furthermore, many health facilities, especially primary and secondary care centers, lack the necessary equipment and a stable electricity supply for such tests.
Another major issue is the limited awareness among healthcare workers regarding fungal infections and the growing threat of antifungal resistance. This knowledge gap further reduces the chances of timely and accurate diagnosis, preventing patients from receiving life-saving treatments.
To strengthen the global fight against invasive fungal infections and antifungal resistance, WHO is working on an implementation blueprint for the FPPL and calling for an improved international response to these health threats.
