An integrated framework for antimicrobial resistance: links with climate change and vulnerability

Antimicrobial resistance (AMR) has been extensively studied in clinical settings; however, research on the environmental aspects of AMR is relatively new. Recently, there has been growing interest in the relationship between climate change and AMR, yet evidence linking AMR to climate change and potential environmental transmission is very limited. Even less is understood about how vulnerabilities may exacerbate exposure and associated health risks. This study aims to compile literature on recent research on how climate change exacerbates risks associated with AMR. The study builds a framework based on this review that connects the amplifying effects of climate change to AMR risk using the modified DPSEEA (mDPSEEA) model. Additionally, the framework complements the mDPSEEA context by incorporating the vulnerability concept of the Intergovernmental Panel on Climate Change (IPCC) risk framework, which encompasses susceptibility and limited coping capacity to face exposure and potential health impacts of AMR. The integrated framework facilitates systemic analysis of the combined risk of climate change and AMR in its early stages, particularly within the driver-pressure-state interface. It also helps to identify vulnerable groups most likely to experience severe effects from AMR, such as the older adult(s), children, individuals with pre-existing chronic conditions, those at higher occupational risk of being colonised by antibiotic-resistant bacteria (ARB), and populations living in highly contaminated environments. The framework analysis emphasises that addressing AMR requires more than just isolated interventions; it demands a fundamental rethinking of public health planning and agendas. There is a need to develop strategies that coordinate various policy frameworks, including those about infectious diseases, chronic diseases and environmental hazards. Tackling climate change, pollution, and social inequalities is essential for combating AMR, as their interconnectedness cannot be overlooked.