A structured look at the complex, poorly understood intersections between climate change, antimicrobial resistance, and the most vulnerable communities.
More than a medical problem
While antibiotics have saved hundreds of millions of lives, their extensive misuse over decades is rapidly undermining their clinical effectiveness. This decline is compounded by a lack of attention addressing the structural inequalities that dictate who suffer most from the risks of antimicrobial resistance (AMR).
This research does not present a single breakthrough. Instead, it brings together existing evidence to show how climate change and social inequalities are intensifying a threat that biomedical alone cannot solve.
Why does this matter?
AMR is often treated as a clinical issue. This research shows it is much more than that.It reveals how environmental change and social conditions shape who is exposed to resistant bacteria — and who is most at risk. By connecting these factors, the work helps identify where action can make the biggest difference, from infrastructure and environmental management to public health planning.
Ultimately, it supports more targeted, fair, and effective responses to a growing global challenge.
At a glance
- 4.71 million deaths linked to antibiotic resistance in 2021
- 10 million projected annual deaths by 2050 — more than cancer
- 70–80% of antibiotics are excreted into the environment
The climate connection
Climate change is accelerating the spread of antimicrobial resistance.
- Rising temperatures are linked to higher rates of drug-resistant infections at European and international levels.
- Heat stress triggers survival mechanisms in bacteria that also help them withstand antibiotics.
- Heavier rainfall and flooding increase sewage overflows, spreading resistant bacteria and genes into rivers and coastal waters.
Climate action is also AMR action.
The framework
Researchers at the Basque Centre for Climate Change a partner in the BlueAdapt project, reviewed 68 studies to build a structured synthesis of existing knowledge.
They combine:
- A public health model linking global drivers (e.g. fossil fuels, agriculture) to health outcomes
- The IPCC concept of vulnerability, which considers exposure, sensitivity, and capacity to cope
This approach highlights not just the biological threat, but how risk is distributed across populations.
Who is most at risk?
- Older adults — higher exposure through healthcare and weakened immunity
- Young children — particularly in low-income settings, where impacts are severe
- People with chronic illness — increased antibiotic use and weakened overall health
- Swimmers & surfers — repeated exposure through water contact
- Farm & wastewater workers — high occupational exposure
- Low-income communities — limited access to clean water, healthcare, and infrastructure
What needs to change
Addressing AMR requires action beyond healthcare.
- Invest in water and sanitation infrastructure
- Strengthen environmental and agricultural management
- Improve access to healthcare and diagnostics
- Address underlying social and health inequalities
The research also highlights a key challenge: some climate adaptation strategies — such as wastewater reuse — may unintentionally contribute to AMR if not carefully managed.
A more integrated approach is needed — one that brings together climate policy, public health, and social equity.
Research
To read the paper, visit our publications page and click on: An integrated framework for antimicrobial resistance: links with climate change and vulnerability.
