Fungal Disease Is Rising and Underdiagnosed – Can AI Help Close the Gap?
Key Takeaways:
- Fungal diseases affect more than 300 million people each year and are linked to over 3.75 million deaths annually, yet they remain historically underrecognised, difficult to diagnose and poorly tracked compared with viral and bacterial infections.
- A World Health Organization (WHO) blueprint released in June 2026 sets out a framework for countries to raise awareness, build laboratory and surveillance networks, stimulate research and improve access to diagnosis and treatment.
- Australian researchers are finalising an automated surveillance platform that uses AI to extract evidence of fungal disease from electronic medical records, with the biggest obstacle being the standardisation of clinical annotations rather than the technology itself.
A threat that has grown in the shadows
Fungal disease and antifungal resistance are growing global threats that have long sat at the margins of public health planning. They are difficult to detect, difficult to track and, until recently, have attracted comparatively little policy attention. That is beginning to shift, driven by two parallel developments: a new international policy framework and a set of digital health initiatives designed to make fungal infection visible in routine clinical data.
The scale of the problem is substantial. More than 300 million people are affected by fungal diseases every year, and over 3.75 million people die annually. Among patients who are immunocompromised, invasive fungal infections are the “leading cause of mortality and morbidity”, according to a 2025 WHO report.
In recent years, the number of new infections, and especially antifungal-resistant infections, has doubled. Two environmental drivers are implicated. As the climate warms, fungi are adapting to survive at higher temperatures, narrowing the thermal barrier that has historically protected humans from many environmental fungi. Increased flooding events have also contributed to mould growth, which in turn leads to disease spread. A third driver sits outside the clinical environment altogether: the use of fungicides on agricultural crops is a major cause of antifungal resistance encountered in healthcare settings, because agricultural compounds and clinical antifungals share overlapping mechanisms of action.
Despite rising prevalence, fungal infections are still not as common as viral infections, so far fewer diagnostic tools have been developed to test for them. With relatively fewer resources allocated to fungal disease research, surveillance and response, fungal diseases also lag behind bacterial infections in terms of treatment options. Recent policy developments and digital health initiatives are working to change this.
Why fungal diseases are difficult to diagnose and treat
One of the biggest challenges to fungal disease preparedness is underdiagnosis, which makes research, surveillance and response considerably more difficult. Without a diagnosis, there is no case to count, and without counted cases there is no evidence base to justify investment.
“If we don’t have good diagnostic tests, these diseases don’t exist because we don’t know who has them,” said Tom Chiller, MD, former chief of the Mycotic Diseases Branch at the Centers for Disease Control and Prevention.
Chiller adds that diagnosing fungal disease is inherently difficult because fungal cells look similar to human cells, making it challenging to develop a diagnostic test sensitive enough to tell the difference. Fungi are also everywhere around us, in their billions. Exposure is “near universal”, and it is hard to distinguish the colonies that are causing disease from those that are entirely harmless. A positive result, in other words, does not automatically indicate infection.
That same cellular similarity creates a second problem at the point of treatment. Because fungal cells so closely resemble human cells, it remains very challenging to kill one type of cell without also damaging the other, which makes treatment toxicity a major issue for the patients who most need therapy.
There is also the matter of range. Only three major classes of antifungal drugs are available – azoles, echinocandins and polyenes – so resistance carries disproportionate consequences. When a fungal pathogen becomes resistant, there are simply fewer tools left in the toolbox.
New antifungal agents in development
Encouragingly, several new antifungal drugs are at various stages of development and investigation, and may help to address resistance. Oteseconazole and rezafungin have received US Food and Drug Administration approval in recent years, building on the existing antifungal classes and expanding the available arsenal. Two newer treatments, olorofim and fosmanogepix, represent entirely new classes and will hopefully be approved in the coming years. New classes matter more than new agents within existing classes, because they offer options where cross-resistance is less likely.
A blueprint for improving antifungal care
While millions of fungi exist, only a few hundred can cause disease in humans. Some of the most common and well-known fungal diseases include ringworm, vaginal yeast infections, athlete’s foot, skin infections such as sporotrichosis, and mould infections such as aspergillosis, as well as invasive infections including cryptococcal meningitis and candidiasis.
The most dangerous fungal disease is multidrug-resistant Candida auris, which was first identified in a Japanese hospital in 2009 and has been found fatal in 29% to 62% of cases.
Without surveying when these conditions are diagnosed and treated, there can be no accurate picture of which diseases are most prevalent, or of when they become resistant to available antifungal treatments. Stewardship programmes designed to protect against resistance also remain weak and limited in scope, particularly in underresourced countries.
Recognising this gap, the WHO released a new blueprint in June 2026 to help countries begin to create uniform tools to respond to the growing public health threat of fungal disease and antifungal resistance. The report provides a framework with recommendations to guide implementation across four areas: increasing awareness and strengthening public health initiatives; building laboratory networks and surveillance systems; stimulating research and improving access to diagnosis and treatment; and addressing the factors that contribute to disease and resistance.
It also aims to support countries in their disease response and to make more fungal diseases reportable to public health officials. Across the United States, for example, reporting priorities vary between states, and the only fungal diseases prioritised as legally reportable nationally are coccidioidomycosis (Valley fever) and Candida auris – a small fraction of those that can affect human health.
Chiller said he hopes the report will draw more attention to both the prevalence and the morbidity of these infections in order to improve available funding. Increased resources would be particularly useful for investing in new treatments to stave off antifungal resistance.
A digital platform for fungal disease and antifungal resistance surveillance
Alongside the policy work, Australian researchers are in the final stages of launching an automated fungal infection surveillance platform that will digitally survey fungal disease across the continent.
The digital platform, called the Design Thinking Framework, was built from a review of multiple sources of clinical information across a wide array of healthcare settings in Melbourne. It extracts information from electronic medical records (EMRs) using AI trained to detect episodes of fungal disease even when the diagnosis is not explicitly recorded. The tool will also provide a web-based platform accessible to physicians so that they can properly report future episodes of fungal disease and resistance.
Vlada Rozova, PhD, a senior lecturer in AI in Health at Monash University, who originally led the project at the University of Melbourne, said the Design Thinking Framework will be helpful in monitoring what is being prescribed for fungal diseases across a range of hospitals, in order to understand when prescribing leads to resistance and what can be done to reduce it, while also identifying which treatments are most effective for patients.
“It will help clinicians to better evaluate the therapies that they’re providing their patients to know what’s necessary and in what particular types of patients certain antifungal agents are most effective,” said Rozova.
Why the hardest problem is human, not technical
The biggest challenge for Rozova and her colleagues has not been the algorithm. It has been standardising clinical annotations to ensure that reports are consistent across the platform. Getting clinicians to agree on which notes within EMRs indicate fungal disease, and which indicate resistance, has been and will continue to be a complex task, because humans, unlike machines, are not standardised.
“If we can’t get humans to agree on what a fungal disease is, we can’t train a machine to look for it,” said Rozova.
This is a familiar theme across clinical AI. Tools that read free-text records depend on consistent human documentation and shared definitions, which is why clinicians increasingly need a working understanding of how these systems are built, what they can reasonably infer and where they are likely to fail. Practitioners looking to develop that grounding often begin with structured CPD, such as the College of Contemporary Health’s AI Essentials for Primary Care short course, which introduces how AI-driven tools are being applied in clinical practice and how to appraise them critically.
Looking ahead
Increased awareness will hopefully bring increased agreement. With guidance from global bodies such as the WHO, and with new digital surveillance platforms of the kind being finalised in Australia, the global response to fungal infections and antifungal resistance stands to be meaningfully strengthened – provided the diagnostic, documentation and funding gaps are addressed in parallel.
CCH insight
Digital surveillance tools are only as reliable as the clinical documentation that feeds them, and clinicians are increasingly being asked to work alongside AI systems rather than simply receive their outputs. Our CPD-accredited short course AI Essentials for Primary Care is designed for healthcare professionals who want a practical, jargon-free grounding in how these technologies work and how to evaluate them in day-to-day practice.
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Source: JMIR Publications
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WHO Warns of Severe Global Shortages of GLP-1 Obesity Medicines as Demand Surges
Key Takeaways:
- Fewer than one in ten people worldwide who could benefit from GLP-1 medicines such as Wegovy and Mounjaro are currently able to access them, due to major limitations in production, affordability, and health system readiness.
- The World Health Organization has issued its first formal guidance on the clinical use of GLP-1 therapies, describing them as “a new chapter” in the treatment of obesity, but emphasising the need for equitable access and comprehensive lifestyle support.
- Without urgent action, global obesity prevalence is projected to double to two billion people by 2030, with associated economic costs reaching three trillion US dollars.
WHO Issues first guidance on GLP-1 medicines amid severe supply constraints
The World Health Organization has warned that fewer than one in ten people globally who could benefit from modern GLP-1 obesity medicines are currently able to obtain them, despite the scale of the obesity epidemic and the transformative clinical potential of drugs such as Wegovy and Mounjaro.
With more than one billion people worldwide now living with obesity, the WHO has called for far more widespread, affordable, and equitable access to GLP-1 therapies. Projections indicate that more than two billion people will be living with obesity by 2030 unless governments implement decisive action. The economic burden is expected to rise steeply, with global costs anticipated to reach three trillion US dollars by the same date.
Dr Tedros Adhanom Ghebreyesus, WHO Director-General, stressed that modern pharmacological treatments must be understood as part of a long-term care approach. He stated: “Our new guidance recognises that obesity is a chronic disease that can be treated with comprehensive and lifelong care. While medication alone will not solve this global health crisis, GLP-1 therapies can help millions overcome obesity and reduce its associated harms.”
The WHO has already added GLP-1 medicines to its essential medicines list for people who are overweight and living with diabetes, signalling that countries are advised to provide access to them. The organisation’s new guidance, described as a “special communication” aimed at clinicians, sets out for the first time its formal position on the value, limitations, and safe use of these drugs.
A new chapter in obesity treatment
The WHO notes that GLP-1 therapies represent “more than a scientific breakthrough”. They mark a decisive shift in how obesity is conceptualised, moving away from viewing it solely as a “lifestyle condition” and towards recognising it as a complex, preventable, and treatable chronic disease. The statement published in the Journal of the American Medical Association asserted: “GLP-1 therapies … have emerged as an important innovation in addressing the global obesity challenge. The advent of these medications represents a tipping point in the treatment of obesity, its complications and related co-morbidities.”
The WHO highlighted increasing evidence that GLP-1 therapies may also reduce the risk of several serious conditions, including heart attacks, strokes, type 2 diabetes, high blood pressure, elevated cholesterol, sleep apnoea, and kidney and arterial disease.
However, the organisation emphasised that these medicines must always be paired with holistic support. Individuals prescribed GLP-1s should receive advice on nutrition, physical activity, and behavioural counselling to maintain weight loss and improve long-term health outcomes. The WHO also reiterated that pregnant women should not use GLP-1 therapies.
Global access limited by production, affordability, and system capacity
Despite rising demand, global production capacity remains a major barrier. The WHO estimates that even under the most optimistic forecasts, manufacturers could produce enough GLP-1 medicines for only about 100 million people. This represents less than 10 per cent of the more than one billion who could benefit.
High prices, limited manufacturing capability, and supply chain constraints all significantly restrict access. The WHO has urged pharmaceutical companies to expand production rapidly and to reduce the prices of medications such as Mounjaro and Ozempic to prevent people in low-income countries from being excluded.
The guideline calls for measures such as voluntary licensing, through which patent-holding companies allow other manufacturers to produce low-cost generic versions. This pathway may soon become more viable as key patents expire. The patent on semaglutide, the active ingredient in Novo Nordisk’s Wegovy, is due to expire in several countries in 2026. Once this occurs, manufacturers in India, Canada, China, Brazil, Turkey, and other jurisdictions will be able to develop and sell more affordable versions.
The WHO also underscored three persistent barriers that must be addressed to achieve global access:
- Limited production capacity, availability, and affordability.
- Health system readiness to prescribe and monitor the medicines.
- Universal access to healthcare services.
Dr Tedros stressed the organisation’s “greatest concern is equitable access”.
Calls for national action on prevention and supportive environments
While pharmacotherapy can assist individuals living with obesity, the WHO stated that countries must continue to prioritise prevention and create healthier environments. This includes promoting physical activity, improving food systems, and ensuring that population-level interventions accompany advances in medical treatment.
How GLP-1 obesity medicines work
GLP-1 medicines work by mimicking a natural hormone that slows digestion, suppresses appetite, and increases feelings of fullness. This results in people eating less and typically losing weight within a few weeks of starting treatment.
In the United Kingdom, GLP-1 medicines are prescription-only and can only be supplied following clinical assessment by a healthcare professional. Some formulations are available through the NHS, although many are obtained privately. A black market for these medicines exists, and the WHO and UK regulators warn that people should avoid unregulated sources such as beauty salons or social media sellers.
Research suggests that people often regain much of the weight within a year after stopping GLP-1 therapy, as physiological hunger cues return. This further reinforces the need for comprehensive, long-term behavioural support.
Global obesity burden and associated risks
Obesity affects people in every country and was associated with 3.7 million deaths worldwide in 2024, according to the WHO. Being overweight or living with obesity increases the risk of numerous serious health conditions, including type 2 diabetes, cardiovascular disease, stroke, and several cancers. The WHO’s statement highlights the immense public health implications if access to effective interventions continues to lag far behind global need.
Expert commentary
The WHO statement was authored by senior clinicians Francesca Celletti, Luz De Regil, and Jeremy Farrar, the organisation’s Assistant Director for Health Promotion and Disease Prevention and Control. Dr Farrar formerly served as WHO Chief Scientist and Director of the Wellcome Trust in London.
Katherine Jenner, Executive Director of the United Kingdom’s Obesity Health Alliance, emphasised that medicines are only part of the solution. She stated: “Weight loss drugs have an important role to play, but they are not a silver bullet. In the United Kingdom right now, access is still limited, supply is fragile, and NHS use is tightly targeted. These powerful medicines can help individuals with chronic obesity, but they are not suitable for everyone and must be accompanied by comprehensive support to be used safely and effectively. Evidence shows that most people regain weight once they stop taking these drugs, and we cannot medicate two-thirds of the population indefinitely.”
CCH insight:
The limited supply of GLP-1 medicines globally is of course frustrating, but until new drugs come to market, and just liraglutide, semaglutide and tirzepatide available, this is likely to continue. All three of these drugs are polypeptides, delivered via injection ‘pens’ and must be refrigerated, so they are expensive and complicated to produce. However, new GLP-1 medications are in development which should improve access and reduce costs, such as orforglipron – a small molecule which is easier to produce and can be taken orally in pill form.
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WHO Issues First Global Guideline on GLP-1 Therapies for Treating Obesity
Key Takeaways:
- WHO has released its first global guideline on the use of GLP-1 therapies for treating obesity as a chronic, relapsing disease, offering conditional recommendations for adults.
- While the medicines show meaningful benefits, WHO stresses that medication alone will not reverse the obesity crisis and that person-centred, lifelong care is essential.
- Concerns remain about long-term safety data, affordability, availability, and the potential for widening global health disparities without deliberate policy action.
Introduction: A new milestone in global obesity care
The World Health Organization (WHO) has issued its first global guideline on the use of Glucagon-Like Peptide-1 (GLP-1) therapies for treating obesity, a chronic and relapsing disease affecting more than one billion people worldwide. Obesity contributes to 3.7 million deaths globally each year, and without urgent action the number of people living with obesity is projected to double by 2030.
The new guideline follows the decision made in September 2025 to add GLP-1 therapies to the WHO Essential Medicines List for managing type 2 diabetes in individuals at high risk. With this new document, WHO provides its first formal, conditional recommendations on the use of GLP-1 therapies specifically for obesity as part of a comprehensive treatment approach that includes healthy diets, regular physical activity, and professional health support.
“Obesity is a major global health challenge that WHO is committed to addressing by supporting countries and people worldwide to control it, effectively and equitably. Our new guidance recognises that obesity is a chronic disease that can be treated with comprehensive and lifelong care,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “While medication alone won’t solve this global health crisis, GLP-1 therapies can help millions overcome obesity and reduce its associated harms.”
The global and economic burden of obesity
Obesity is a complex, chronic disease and a major driver of noncommunicable conditions including cardiovascular diseases, type 2 diabetes, and some cancers. It also worsens outcomes for people who develop infectious diseases.
The global economic burden is profound. The worldwide cost of obesity is projected to reach US$ 3 trillion every year by 2030 due to increased healthcare demands and the rising costs of managing obesity-related complications. WHO hopes that clear guidance on the use of GLP-1 therapies will support efforts to reduce escalating healthcare expenditure while improving outcomes for people affected by obesity.
A landmark policy shift: WHO’s conditional recommendations
WHO’s new guideline sets out two key conditional recommendations based on currently available evidence.
1. Use of GLP-1 therapies in adults living with obesity
WHO states that GLP-1 therapies may be considered for long-term treatment in adults, excluding pregnant women. The medicines have demonstrated clear efficacy in supporting weight loss and improving metabolic outcomes. However, the recommendation remains conditional due to several concerns:
- Limited long-term data on safety, durability, maintenance, and outcomes following discontinuation
- High costs of treatment
- Insufficient readiness of health systems to support widespread use
- Possible negative effects on health equity
2. Combining GLP-1 therapies with intensive behavioural interventions
WHO also recommends that adults living with obesity and prescribed GLP-1 therapies may be offered structured behavioural interventions, including support for dietary changes and increased physical activity. This recommendation reflects low-certainty evidence suggesting that combining medication with lifestyle interventions may yield better outcomes.
Medication alone will not reverse the obesity crisis
Although GLP-1 therapies represent the first highly effective pharmacological treatment for adults living with obesity, WHO emphasises that medication on its own is insufficient. Obesity must be addressed as both an individual and societal challenge. The guideline calls for a fundamental shift toward comprehensive strategies built on three pillars:
- Creating healthier environments through population-level policies that promote health and prevent obesity.
- Protecting people at high risk by using targeted screening and structured early interventions.
- Ensuring person-centred, lifelong care for people living with obesity, recognising the chronic nature of the disease.
Implementing the guideline: Equity, system readiness and global access
WHO notes that fair access to GLP-1 therapies must be prioritised. Without deliberate policies, these medicines could deepen existing global health inequalities. System readiness, affordability, and supply capacity are major concerns.
Even with rapid increases in manufacturing, GLP-1 therapies are expected to reach fewer than 10 percent of people who could benefit from them by 2030. WHO urges global leaders to consider approaches that expand access, such as:
- Tiered pricing
- Pooled procurement mechanisms
- Voluntary licensing arrangements
These measures could help prevent widening disparities as demand expands.
Development of the guideline
The guideline was developed in direct response to requests from WHO Member States seeking actionable direction on obesity care. The process involved:
- Extensive assessment of available scientific evidence
- Input from global stakeholders
- Engagement with people who have lived experience of obesity
This document forms a core component of the WHO acceleration plan to stop obesity and will be updated regularly as new evidence emerges.
During 2026, WHO intends to work with partners to create a transparent and equitable prioritisation framework to ensure that individuals with the greatest medical need receive treatment first.
Notes to editors
About GLP-1 therapies for obesity
WHO defines obesity in adults as having a Body Mass Index (BMI) of 30 or above. GLP-1 receptor agonists help lower blood glucose, support weight loss, reduce cardiovascular and renal risks, and can reduce early mortality in people with type 2 diabetes.
This guideline provides recommendations for three GLP-1 agents used in the long-term treatment of obesity in adults:
- Liraglutide
- Semaglutide
- Tirzepatide
Falsified and substandard products
The surge in global demand has contributed to the spread of falsified and substandard GLP-1 products. WHO stresses that safe access requires:
- Prescription and distribution through regulated, qualified healthcare providers
- Strong oversight and monitoring
- Patient education
- International cooperation to safeguard public health
The organisation warns that falsified or substandard medicines threaten both patient safety and public trust.
CCH insight:
This new guideline is very welcome. The World Health Organisation has been a little slow in recognising obesity as a chronic relapsing disease and the importance of GLP-1 medications as a very important development in obesity treatment. However, these guidelines are comprehensive, consistent with treatment of obesity as a chronic relapsing disease, and recognise the challenges of delivering safe, sustainable, equitable obesity care.
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