EQATA: Equitable access to Quality Antibiotic Therapies in Africa Globally antibiotic treatable infections account for 5.7 million deaths annually where the majority of this mortality burden falls on the populations of least developed low- and middle-income countries (LMICS). This significantly outweighs the 700k deaths, worldwide, currently attributed to antibiotic-resistant infections. However, the increasing threat posed by antimicrobial resistance will further extenuate the disproportionate health burden faced by LMICS. In Africa, deaths attributed to bacterial lower respiratory infections and diarrhoeal diseases together account for nearly 20 percent of all mortality.  Strikingly this outnumbers the combined mortality rate of HIV/AIDS, TB and malaria. These headline figures underline the challenge faced by the health care systems in the least developed and lower middle-income countries of Africa. Here, access to frontline antibiotics is hampered by: i) substandard administration and/or unregulated over-the-counter availability, resulting in misuse and overuse; ii) weak supply chains resulting in chronic shortages; and iii) poor quality drugs and falsified medicines from a reliance on imports from generic API drug manufacturers alongside counterfeit drugs. These factors combined lead to unnecessary loss of human life and ever increasing drug resistance. As an example, multiple studies in hospital settings of Klebisella pneumonie isolates (a common urinary tract infection) from Kenya, Tanzania and Nigeria have shown multiple drug resistance (MDR) in 40-75% of cases; worryingly, this number also included samples showing extensive drug resistance. Combined, these studies demonstrate the problem faced across the three partner countries (Kenya, Tanzania, Nigeria), spanning East to West Africa, in accessing effective antibiotic therapies within the constraints of under developed healthcare systems. These nations do not have sustainable access to effective drugs, which we in the UK and the developed world take for granted.  This proposal will seek to address this unmet and urgent need partnering with Kenyan, Tanzanian and Nigerian institutes to investigate and apply innovative engineering, novel synthetic biological and chemical solutions toward improving health in Africa, by building capacity in these disciplines and providing sustainable solutions to an efficient and local well-stewarded antibiotic pipeline. This highly integrated project, links experts in industrial synthesis, industrial fermentation, engineering, synthetic biology, drug discovery and medicinal chemistry to build a sustainable antibiotic production pipeline. This will equip our African partners with the capability and capacity not only for equitable production of the most needed antibiotics (categorised by WHO as "access antibiotics") but also addressing our partners' dream for capacity building and training in the discovery of new antibiotics from their own natural resources. The Global Challenges Research Fund (GCRF) supports cutting-edge research to address challenges faced by developing countries. The fund addresses the UN sustainable development goals. It aims to maximise the impact of research and innovation to improve lives and opportunity in the developing world.