Antimicrobial resistance (AMR) is one of the most pressing global health challenges facing modern medicine. As bacteria, viruses and other pathogens evolve resistance to existing treatments, the need for innovative research and effective global partnerships has never been greater.

To explore the future of AMR research, Student Ambassador  Adam Harmon spoke with Dr Dirk Lamprecht, Chief Investigator of AMR Biology at the Holistic Drug Discovery and Development Centre (H3D) at the University of Cape Town, South Africa. With nearly two decades of experience spanning tuberculosis (TB) research, pharmaceutical drug discovery and antimicrobial resistance, Dr Lamprecht shared his insights on conducting research in endemic regions, the role of artificial intelligence in drug discovery, and the future direction of AMR innovation.

Could you tell us a little about how you came to work in AMR research at H3D?

I began my scientific career with a PhD in organic chemistry, where I was attempting to synthesise small-molecule inhibitors for an enzyme in Mycobacterium tuberculosis. As many researchers know, PhD projects do not always go according to plan, and afterwards, I decided not to continue in chemistry.

I completed a postdoctoral fellowship at the Africa Health Research Institute (AHRI) in Durban, where I investigated how respiratory inhibitors affect the metabolism and bioenergetics of M. tuberculosis. Through this work, I connected with researchers at Johnson & Johnson and eventually joined the company.

I spent seven years there leading small-molecule discovery programmes for tuberculosis and managing biology teams supporting those programmes from both in vitro and in vivo perspectives. In 2025, I returned to South Africa and joined H3D. While H3D is very different from a large pharmaceutical company, my role has expanded beyond TB to antimicrobial resistance more broadly.

Do you think it is important for research into infectious diseases to be carried out within endemic areas?

Absolutely.

There is a saying that “the drugs are where the diseases are not, and the diseases are where the drugs are not.” Many infectious diseases remain concentrated in low- and middle-income countries, while much of the drug development infrastructure exists elsewhere.

Even if countries cannot immediately replicate the infrastructure available in Europe, the United Kingdom or the United States, it is essential that scientists from endemic regions are involved in research and development. They bring perspectives that are often missing from global discussions.

A pharmaceutical company may believe it has developed a solution that could transform TB treatment, but clinicians working in endemic regions may point out practical challenges, such as limited healthcare infrastructure, difficulties administering treatment, or supply-chain constraints. Those conversations are crucial.

Researchers working in endemic settings are often motivated by personal experiences and a deep understanding of the diseases affecting their communities. For many, it is more than a job—it is a mission.

Does having an AMR centre influence public engagement and science communication within South Africa?

I think we can do better.

There are efforts from both H3D and the University of Cape Town to educate people about antimicrobial resistance and drug resistance, but there is still room for improvement. Organisations such as Eh!woza are doing important work by engaging directly with communities affected by TB and HIV and providing educational support in those settings.

Public awareness is a critical part of tackling AMR, and expanding these outreach efforts remains important.

Do you think more progress in developing new treatments for AMR will come from research institutes or pharmaceutical companies?

The reality is that both sectors are essential.

COVID-19 provides a useful example. Much of the foundational work behind vaccine development occurred in academic institutions supported by public funding. However, pharmaceutical companies were needed to manufacture, commercialise and distribute those innovations at scale.

I believe antimicrobial resistance will increasingly rely on public–private partnerships. Academic institutions and non-profit organisations often generate the initial innovative science, while pharmaceutical companies provide the expertise needed to turn promising discoveries into medicines that can reach patients.

That does not mean innovation only occurs in academia. Pharmaceutical companies continue to contribute significantly through formulation science, toxicology, optimisation and clinical development. These advances can dramatically improve how effectively treatments work and how safely they can be delivered.

What aspects of antimicrobial resistance research do you think are currently overlooked?

One area is our failure to learn enough from neighbouring fields of infectious disease research.

For example, long-acting injectable therapies have transformed HIV treatment. Rather than requiring patients to take medication every day, a single injection can provide protection or treatment for months. Similar approaches are now being explored for tuberculosis and malaria, but much more could be done.

Treatment adherence remains one of the biggest challenges in infectious disease management. Long-acting formulations could reduce pill burden, improve compliance and potentially decrease the emergence of resistance.

Another lesson comes from combination therapy. HIV researchers quickly recognised that using a single drug often led to resistance, which is why multi-drug treatment became standard practice. Tuberculosis treatment also relies heavily on combination regimens.

We should be asking whether similar approaches could be applied more systematically in other bacterial infections.

What role do you think artificial intelligence could play in AMR research?

I think it would be awesome if we could ask ChatGPT how to cure TB or eradicate Gram-negative infections. I suspect that's never really going to be the case.

However, AI has a very important role to play, especially in low- and middle-income countries where resources are limited. AI and machine-learning algorithms can help prioritise experiments or identify which molecules should be synthesised first, rather than requiring researchers to make hundreds of compounds to find one that works.

At H3D, we use these approaches extensively. We also work closely with a non-profit organisation in Spain called Ersilia, which is building open-source AI models to support drug discovery in low- and middle-income countries.

Is it better to focus on well-characterised targets or on entirely new targets and pathways?

Both approaches have value, but novel targets are particularly attractive because they may not yet have established resistance mechanisms.

For existing targets, researchers often understand how resistance develops and can design strategies to overcome those mechanisms. For example, scientists are developing new RNA polymerase inhibitors for TB that bind differently from rifampicin and may remain effective against rifampicin-resistant strains.

However, identifying entirely new targets offers the possibility of staying ahead of resistance before it emerges.

What do you see as the major priorities for future drug development?

Apart from all the science that can happen in the laboratory, there needs to be closer collaboration with clinicians.

We can make all the medications in the world, but if those medications are not taken up into public healthcare programmes, it is useless. Understanding what clinicians and patients actually need should play a much larger role in guiding research priorities.

We also need to learn more from other infectious disease fields and avoid conducting research in isolation. Those are two of the major opportunities moving forward.

AI, rational drug design and increasingly sophisticated technologies will continue to play an important role. The tools are getting smarter, and hopefully that will make it easier to identify safe and effective drugs more quickly.