By Davida Spaine-Solomon

Freetown, 25th August 2025 – At dawn, Freetown bursts awake with the call of traders and the rumble of ‘poda-podas’, Sierra Leone’s iconic minibuses. From the narrow alleys to the busy heart of Sani Abacha Street, vendors line the roadsides, offering everything from shoes to syrups and in between, a quiet trade in pills. Antibiotics, painkillers, malaria drugs all within easy reach, no prescription required.

Among the crowd is Ibrahim, a young hawker balancing a wooden tray stacked with colorful packets of medicine. “Panadol, Ampiclox, Doxcycline,  they cure all types of infection,  original!” he calls out, trying to outshout the traffic.

When asked why he sells antibiotics without a prescription, Ibrahim offers a simple truth:

“People want quick cure. Hospital is far,  theres no time. If I dont sell them, another person will sell,” he says. “And hospitals have long procedures,” he adds ,

This daily hustle hides a slow-moving catastrophe: antimicrobial resistance (AMR). Once curable infections are becoming harder to treat as bacteria, viruses, and other microbes adapt to survive the drugs meant to kill them. And Sierra Leone, like many countries, is sitting on a ticking time bomb.

What is AMR?

AMR happens when bacteria, viruses, fungi, and parasites develop the ability to defeat the medicines designed to kill them. In simple terms, the drugs stop working. The infections they once treated become harder or even impossible to cure.

Why It Matters

Globally, AMR kills more people than HIV/AIDS or malaria, claiming an estimated 6 million lives every year. Experts fear that by 2050, the death toll could reach 19 million annually, with the global economy losing up to $100 trillion. What’s worse? Africa especially West Africa  is among the hardest hit.

The World Health Organization (WHO) has called AMR a top global health threat. In Sierra Leone, the signs are already here. Ordinary infections linger longer, treatments fail, and hospital bills rise. What was once a routine illness could soon become a death sentence.

The danger isn’t just on the streets. Even hospitals seen as safe havens are part of the problem. Dr. Moses Batema, Chief Pharmacist at the Pharmacy Board of Sierra Leone, admitted during a recent awareness session:

“Sadly, even in hospitals, some doctors prescribe two different antibiotics that are not needed for a patient,” he revealed.

A Global Point Prevalence Survey at Connaught and Ola During hospitals confirmed widespread misuse of antibiotics.

“We have trained Antimicrobial Stewardship Champions. Now it’s time to deploy them,” Dr. Batema emphasized.

At the 68th World Health Assembly in 2015, AMR was declared a critical global threat. That warning has only grown louder.

According to a 2021–2023 Structured Operational Research and Training Initiative (SORT-IT) report, 5 million deaths in 2021 were linked to AMR, with 1.2 million caused directly by resistant bacteria many in sub-Saharan Africa.

WHO Sierra Leone Representative, Dr. Innocent Nuwagira, is blunt:

“Yesterday was a missed opportunity. Tomorrow will be too late. Now is the time to act so we can combat AMR in Sierra Leone,” he said.

Back on Sani Abacha Street, Ibrahim sells antibiotics to a woman complaining of fever. No doctor. No prescription. Just a guess.

This over-the-counter culture, born from poverty, distance, and mistrust in health systems, adds fuel to the AMR fire. But the truth is, people like Ibrahim are not the root cause they are a symptom of a bigger problem: weak regulation, poor public education, and a health system stretched thin. “People just want medicine. If I tell them to  go  to the hospital, they will get  angry ,” Ibrahim says, tucking away his earnings as dusk falls. For him, this is survival. For Sierra Leone, it is a slow moving disaster

Experts call for stronger laws on drug sales, tighter hospital prescribing guidelines, and massive public awareness campaigns. Without these, the dream of modern medicine may vanish replaced by a nightmare where simple infections kill again.

For now, the streets of Freetown hum with life, and the trade in antibiotics continues. But somewhere in that hum lies a silent enemy, growing stronger every day.