A new study explores the role of climate change and socioeconomic factors in antimicrobial resistance around the world, and how sustainable development programmes will be key to tackling growing antimicrobial resistance.

Antimicrobial resistance (AMR) is a major threat to global health, responsible for 1.14 million deaths worldwide as of 2021. This is projected to increase to nearly 2 million deaths by 2050, disproportionately affecting low- and middle-income countries (LMICs).

Growth in AMR is most commonly analysed as a healthcare problem, such as the overuse and misuse of antibiotics. But AMR has also been linked to a range of other socioeconomic factors and climate change. To better understand the role of environmental and socioeconomic factors in AMR, researchers at the London School of Hygiene & Tropical Medicine and several institutes in China collected AMR surveillance data from 101 countries. As well as analysing how environmental and socioeconomic factors contribute to AMR, these data modelled future changes to global AMR levels based on several scenarios.

Published in Nature Medicine, the results highlighted a range of issues not just in healthcare, but also socioeconomic and environmental factors, contributing to the growth of AMR.

The authors identified the overuse and misuse of antibiotics as a major contributor. This was linked, in part, to weak regulations protecting against unnecessary prescriptions, showing how healthcare problems are connected to socioeconomic factors. Additional socioeconomic factors driving AMR included higher population density, humans carrying resistant bacteria in international travel, and problems with health infrastructure. The authors also noted the role of economic factors leading to increased out-of-pocket costs and lower health spending from governments.

Their analysis also highlights several environmental factors that helps spread antimicrobial resistant infections. This includes factors linked to climate change like extreme weather events (e.g. heavy rainfall, flooding), air pollution, increasing temperatures that helps some bacteria maintain antimicrobial resistant genes, as well changes to habitats from agriculture and urbanisation.

Following from this analysis, future scenarios were modelled to determine the best approaches for reducing AMR in the future. Their results found that sustainable development programmes were the most successful approaches for reducing AMR. These would go beyond standard research programmes with broader investments in: healthcare infrastructure and vaccination programmes, improving access to clean water & sanitation, and policy to reduce patient costs in accessing healthcare alongside programmes to combat climate change. The authors hope that these findings can guide policy efforts to tackle AMR, particularly in LMICs.

Dr Shanquan Chen, Assistant Professor at LSHTM, said: “Our findings highlight that antimicrobial resistance is not just a matter of antibiotic misuse. It is deeply embedded in the way we build health systems, respond to climate change, and support social development.

“Sustainable development strategies – such as expanding immunisation, improving water and sanitation, and reducing out-of-pocket healthcare costs – are not only equitable but also among the most effective tools we have to curb the global rise of AMR, especially in low- and middle-income countries.”

The paper emphasis on a multi-sectoral approaches aligns with the United Nations General Assembly 2024 declaration to reduce antimicrobial resistance via a ‘One Health’ approach, co-ordinating action across the human health, environmental and agricultural sectors.

The paper was co-led by Weibin Li at San Yat-sen University in China and Tingting Huang at Chinese Academy of Sciences, with corresponding author Lianping Yang affiliated at both Sun Yat-sen and Peking Universities. Additional collaborators include authors based at universities in China, Hong Kong, Australia, the USA, and LSHTM.

Publication

Read the full paper: Li W, Huang T, Liu C, et al. Changing climate and socioeconomic factors contribute to global antimicrobial resistance. Nature Medicine, 2025. DOI: https://doi.org/10.1038/s41591-025-03629-3