- Antibiotics changed everything when they were discovered. But the germs that the antibiotics were designed to kill have been fighting back, changing, adapting, outsmarting the medicines ever since they were first widely used in the 1940s.
- These superbugs are causing infections that are hard, and sometimes impossible, to treat.
- Researchers say they were directly responsible for about 1.27-million global deaths in 2019, and contributed to almost 5-million more that same year. A 2025 WHO report found that nearly one in six infections globally is now caused by bacteria resistant to the most commonly used antibiotics, while in 47 African countries (including South Africa), the figure is closer to one in five.
- Yet superbugs don’t make headlines the way heatwaves, floods or pandemics do. They spread quietly, through rivers, soil, farmyards, dust and even clouds.
- This guide, which is based on a Bhekisisa webinar on superbugs and a warming climate, gives journalists the background, the story ideas and the expert contacts to cover one of the most important and most neglected health stories of our time.
In today’s newsletter, Ida Jooste explains why superbugs are everywhere. Sign up for our newsletter today.
Antibiotics — what Luther King Abia Akebe, an environmental microbiologist at the University of KwaZulu-Natal, calls “the eureka of medicine” — changed everything when they were discovered.
During the Second World War, soldiers who would have died from wound injuries came home because of them. Families got their people back.
But the germs that the antibiotics were designed to kill have been fighting back, changing, adapting, outsmarting the medicines ever since they were first widely used in the 1940s. They’re called superbugs because they’re near impossible to kill with the medicines we’ve relied on for decades. These superbugs cause infections that are hard, and sometimes impossible, to treat. The scientific name for this is antimicrobial resistance (AMR).
The numbers are stark. Superbugs are directly responsible for about 1.27-million global deaths in 2019, and contributed to almost 5-million more that same year.
The World Health Organisation’s 2025 Glass report (WHO Glass), which has the most comprehensive global snapshot of AMR trends, found that nearly one in six infections globally is now caused by bacteria resistant to the most commonly used antibiotics. In the Africa Region (a grouping of 47 countries, including South Africa), the figure is closer to one in five.
Yet superbugs don’t make headlines the way heatwaves, floods or pandemics do. They spread quietly, through rivers, soil, farmyards, dust and even clouds.
This guide, which is based on a Bhekisisa webinar on superbugs and a warming climate, gives journalists the background, the story ideas and the expert contacts to cover one of the most important and most neglected health stories of our time.
Take the quiz
Before diving in, test what you already know. The answers might surprise you.
Simple explanations for tricky terms
To understand superbugs, it’s important to know some basic terminology. Here’s a quick reference guide:
Antibiotic: A medicine used to treat bacterial infections. Antibiotics do not work against viruses — so they cannot treat flu or COVID-19.
Antimicrobial: A medicine used to kill microbes. When germs stop responding to the medicine, we call it resistance.
Antimicrobial resistance (AMR): When bacteria, viruses or fungi develop the ability to resist the medicines designed to kill them. “Superbugs” is the everyday term for the same thing.
MDR-TB (multidrug-resistant TB): TB that no longer responds to the two main medicines used to treat it.
Microbe: A tiny germ — bacterium, virus or fungus — so small it can only be seen with a microscope or other imaging equipment.
NICD: The National Institute for Communicable Diseases — the body that collects South Africa’s resistance data for the World Health Organisation.
One Health: An approach that recognises human health, animal health and environmental health are all connected. Humans, animals and the environment are connected, and germs move freely between them. So when resistance builds in one corner, it doesn’t stay there.
XDR-TB (extensively drug-resistant TB): TB that resists both the main drugs and the key backup drugs — among the hardest infections in the world to treat.
WHO Glass: The main international database tracking AMR trends.
AMR basics
What are superbugs?
Superbugs is a popular term for microbes — like bacteria, viruses or fungi — that have learned how to fight off the medicine, antimicrobial drugs, that used to stop them. These are infections that don’t get better when you take the medicine that’s meant to treat them.
“These germs have become super-powerful, because nothing can kill them,” says King Abia on the Bhekisisa webinar.
As King Abia explained, they can cause untreatable or very difficult-to-treat throat, ear, chest and skin infections, as well as meningitis and cholera, and sexually transmitted infections such as gonorrhoea, syphilis and chlamydia, amongst other diseases.
Superbugs appear when germs change in small ways that help them survive the medicine meant to kill them. Sometimes they even pick up those survival tricks from other germs. When that happens, the usual treatments stop working and the infection can get much harder, or even impossible, to cure. Today, common germs like E. coli, TB and gonorrhoea are developing drug resistance. Ironically, we’re at risk of ending up right where we started: back in a time before antibiotics, when even small infections could be deadly.
The clearest example of antimicrobial resistance in South Africa is drug-resistant TB.
When TB no longer responds to the main medicines used to treat it, it’s called multidrug-resistant TB, or MDR-TB. If the bacteria become resistant to even more drugs, including the backup ones, it is called extensively drug-resistant tuberculosis (XDR-TB). Many people around the world are still not diagnosed or treated for drug-resistant TB. The WHO says many people with drug-resistant TB still aren’t getting the right treatment, and South Africa is one of the ten countries where this gap is largest. TB treatment is hard enough, and even though some new medicines are easier to take, the stronger drugs used for resistant TB are still much tougher on patients. Treating it takes years, the medicines can be toxic, and the side effects are often severe. TB shows, in the most human way, what AMR looks like when it hits home.
Story hook: TB is AMR with a human face. If you want to show readers what drug-resistant infection looks like in practice, start with TB.
How do bugs develop resistance?
Like all living things, disease-causing bacteria try to protect themselves or fight back against threats such as antimicrobial drugs. Over time, some bacteria have changed in ways that let them outsmart the medicines designed to kill them. So, instead of dying out, they multiply. When this happens, AMR is said to have developed.
Over decades of antibiotic use in medicine and agriculture, bacteria have steadily gained resistance. Every time someone takes antibiotics improperly — like not finishing a course or using them for viral infections — or when antibiotics are used too much in animals, bacteria learn to fight back. Studies show that the best way to slow this process is to use antibiotics much more carefully.
Polluted water, soil and air can also help superbugs spread — and that, King Abia says, would be a good story for journalists to follow.
Story hook: Ask local researchers what AMR data exists for your province’s waterways after the last major flood. The answer (or the absence of one) is a story.
Who is hit hardest — and why?
Not everyone faces the same risk. Drug-resistant infections make common illnesses far more dangerous. If the first antibiotics fail, doctors need to turn to stronger, more expensive ones. And sometimes there are none. According to the South African health department’s latest strategy framework for AMR, patients with superbug infections often have to stay in hospital longer and they have more complications.
“More people continue to die from lack of access to effective antibiotics than from overuse, and that’s something we need to bear in mind,” says Esmita Charani, a pharmacist and global health researcher at the University of Cape Town, who also spoke during the Bhekisisa webinar. The population at greatest risk, she says, are the very young, the very old, the severely ill with weakened immunity, and the poor.
AMR hits hardest among babies and older people, because their immune systems are weaker. A global analysis which looked at drug-resistant infections between 1990 and 2021 found that deaths caused by superbugs among people aged 70 and over almost doubled in this time.
An analysis of studies from many parts of sub-Saharan Africa shows that in poorer communities — where water, toilets and healthcare are limited — drug-resistant infections are common.
Story hook: Find a public clinic and a private hospital in the same city and ask each one the same question: what happens when a first-line antibiotic fails? The contrast will tell you something important.
Why can’t we just make new antibiotics?
Developing a new antibiotic is slow, expensive and often not profitable for drug companies. It can take more than a decade and cost more than a billion US dollars — around R16.5-billion — and even then, bacteria often start finding ways around new medicines within a few years.
But even when new antibiotics come out, they’re often just small variations on older drugs, not truly new weapons. That means bacteria can adapt to them more quickly, especially if the drugs are overused.
We also need to protect the drugs we already have by using them wisely, preventing infections in the first place, and tracking how resistance spreads.
Story hook: Ask a pharmacist whether patients in your area can buy antibiotics over the counter without a prescription. If yes, ask what they’re typically buying them for.
What does climate change have to do with it?
More than most people realise. Superbugs don’t make headlines the way heatwaves, floods or pandemics do. But the everyday conditions that help these germs spread are becoming more common: warmer temperatures, damaged water systems, crowded clinics, sewage in floodwater, and clinics and hospitals that are already stretched.
Changes in normal weather patterns and more frequent floods, heavy storms, heatwaves or droughts are signs of climate change. The fallout of these changes can weaken sanitation systems — whether because of infrastructure being damaged or clean running water being scarce — which can cause infections to spread easily. Heat helps bacteria grow and adapt faster. Floods move resistant germs to new areas. Drought pushes people and animals to share limited water sources. Meanwhile, heat and dust storms help drug-resistant bacteria move farther and faster.
“We are surrounded by superbugs,” King Abia says, even inside our cars, if the air conditioning system draws in outside air.
This is why we can’t fight AMR by focusing on hospitals alone. King Abia urges a One Health approach: tackling AMR also involves what’s happening on farms, in rivers, in the air, and in how antibiotics are used in animals and people.
Slowing resistance depends on safe water and sanitation, good farming practices, careful antibiotic use in people and animals, and planning for climate pressures. These systems are connected, so the solutions have to be connected, too.
Story hook: The WHO Glass report received no media coverage in South Africa. That gap is an opportunity: journalists can help bring these findings to life and show what they mean for people on the ground.
Common superbugs
These are the drug-resistant germs most likely to come up in your reporting, and what to call them:
Story ideas — where to start
1.The data gap
Check what AMR data South Africa is collecting and sharing — including contributions to global systems like the WHO Glass database. Check how easy or difficult it is to find, access and interpret the data. Journalists may struggle to locate South Africa’s submissions or to understand what the numbers actually show over time.
Start by contacting the NICD and the health department, which has an AMR Knowledge Hub. Ask for a clear breakdown of available AMR data: what is being tracked, where it’s coming from, and what trends are they seeing? Then go a step further. Work with a data colleague to analyse the figures — look for patterns across provinces, facilities or over time. Are certain infections becoming harder to treat? Are there regional differences?
You can also localise the story. Some metros have epidemiologists or surveillance teams — ask what they’re seeing on the ground. Even if the answers are incomplete, that’s part of the story: gaps in data can mean gaps in response.
Meanwhile, South Africa’s AMR national strategy framework covers 2017 to 2024 and has not yet been updated. Over 70 leading medical professionals and scientists have recently petitioned the health department and Health Minister Aaron Motsoaledi to prioritise this issue, calling for the immediate reinstatement of a scientific advisory body to guide the national response. Find out why — and what the delay means for how the country is responding to the crisis.
2. The COVID-19 question
A global study published in 2024 found that doctors gave antibiotics to about three out of every four patients during 2020–2023, compared to 57% before 2010. Researchers say this jump was likely caused by COVID-19, when many people were given antibiotics “just in case,” even though the virus itself doesn’t respond to them. Ask local doctors and pharmacists if antibiotic use also spiked in South Africa. You can also do a mini-survey among people who had COVID, asking: “Were you given an antibiotic?”
3. A tale of two hospitals
Compare a well-resourced private hospital with an under-resourced public clinic. Ask each: what happens when antibiotics don’t work? Do they have gloves, soap or isolation wards? Do hospitals keep a record of infections that start in their wards? Find out about solutions — an easy, affordable way to keep infections down and avoid giving too many antibiotics.
4. Antibiotics on the farm
Talk to vets or animal-health researchers about what they’re noticing as the weather and climate change. Ask what responsible antibiotic use for farm animals would look like and what the alternatives are. Visiting a poultry or cattle farm can help bring the story to life — you can see first hand how antibiotics are used, how waste is handled, and where it might end up after rain. Describe what you observe: the smell, the runoff, the workers’ routines. Do check with an expert whether your observations are relevant. Don’t call something a superbug if you cannot show or explain the link.
5. The flood and the germ
Look at whether heatwaves or floods in your province are linked to more infections. Ask researchers whether water or soil samples were taken after a major flood in your area. Were resistant bacteria found? Who tested, who reported, and who acted on it?
6. World AMR Awareness Week
18 to 24 November each year is World AMR Awareness Week — a good time to get superbug stories published. Plan ahead and use it as a peg.
Talk to the experts
Dig deeper: Where to learn more
WATCH | Bhekisisa webinar recording: Why a warmer Earth makes superbugs spread faster
Key reports and studies:
– Surveillance for antimicrobial resistance and consumption of antibiotics in South Africa 2018-2022
– Antibiotic resistance increases with local temperature (Nature Climate Change, 2018)
– Antibiotic resistance is a growing threat — is climate change making it worse? (Nature, 2024)
– Climate change and antimicrobial resistance: a scoping review (Environmental Microbiology, 2024)
This resource was produced by the Bhekisisa Centre for Health Journalism as part of the Climate Health Story Project, supported by the Wellcome Trust.
Ida Jooste is a seasoned health and science journalist. She has worked in newsrooms in Durban, Johannesburg and Nairobi, winning more than 20 national and international media awards for her work. An international trainer and speaker, she led a global COVID-19 media initiative and provides journalist mentoring in all areas of health science.
