Journal of Medicine and Health Research

The accelerating rise of multidrug-resistant (MDR) pathogens poses a critical threat to global health, disproportionately affecting low- and middle-income countries (LMICs) where constrained diagnostic capacity limits timely detection and response. Real-time genomic surveillance offers a transformative approach by enabling high-resolution pathogen identification, antimicrobial resistance (AMR) profiling, and transmission mapping within turnaround times of approximately 24–72 hours. Recent innovations—such as portable nanopore sequencing platforms deployed during Ebola and SARS-CoV-2 outbreaks, field-ready sample preparation methods, and cloud-based AI-assisted analytics—are making genomic surveillance increasingly feasible in low-resource environments. However, significant barriers remain, including limited laboratory infrastructure, supply chain instability, shortages of trained bioinformaticians, and fragmented data-governance frameworks. This review synthesizes current technological advances and operational challenges while highlighting practical strategies for strengthening genomic surveillance systems in resource-constrained settings. Key areas of focus include decentralizing sequencing capacity through tiered laboratory networks, adopting low-cost and cold-chain-independent workflows, building sustainable workforce training pathways, and integrating genomic outputs into routine public health decision-making. Additionally, the review emphasizes the importance of ethical and equitable data-sharing practices to ensure that LMICs benefit fully from genomic technologies. By outlining actionable priorities and implementation considerations, this work provides a comprehensive framework to guide policymakers, researchers, and public health practitioners seeking to expand real-time genomic surveillance for MDR pathogens in low-resource settings.