Antimicrobial Resistance: An In-depth Explainer For Journalists

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In a 2022 study by the Infectious Diseases Society of America, Timothy Monk, a medical student in the United States, was hospitalized one month into his rotation with extreme abdominal pain. When he was admitted to the hospital, doctors discovered an abscess, revealing an infection caused by extended-spectrum beta-lactamase (ESBL) positive Escherichia coli, commonly known as E. coli.

E. coli is most commonly contracted through drinking water contaminated with the bacteria. Common antibiotics, such as cephalosporin and penicillin are typically used to treat ESBL infections. But Monk's particular strain, however, has grown highly resistant to a wide variety of antibiotics, making these infections especially difficult to treat.

Due to the resistant nature of the bacteria, Monk was placed in isolation in the hospital, so that he did not spread the drug-resistant bacteria to other people. Fortunately, he survived. You can read more about his story here. But many people who have an encounter with a drug-resistant infection aren’t so lucky.

Antimicrobial resistance (AMR) occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to antibiotics or other classes of antimicrobials. According to a UC Davis case study, the “impacts of AMR often hit low-and middle-income countries the hardest, as AMR can spread easily in humans and agricultural settings due to variations in healthcare infection-control practices, high rates of infectious diseases, high population densities and suboptimal agricultural regulations in place for biosecurity and the use of veterinary antimicrobials.”

According to the U.S Center for Disease Control and Prevention U.S Center for Disease Control(CDC), AMR is an urgent global public health threat — it has played a role in nearly five million deaths worldwide, with around 1.27 million deaths in 2019.

The World Health Organization (WHO) says that antimicrobial resistant infections may become the leading cause of death globally by 2050.

From an economic perspective, the rapid uptick of AMR will blow a financial hole in national economies and their health systems, as prolonged hospital stays and the need for more expensive and intensive care increases.

Global GDP will end up 1.4% smaller by 2030, purely due to the steady increase of resistant bacteria, according to the Review on Antimicrobial Resistance. By 2050, it has been predicted that AMR will cost the global economy US$100 trillion by 2050, if urgent collective action is not taken.

Despite this looming threat, some studies have revealed a lack of general knowledge regarding the issue. Environmental, health and science journalists can play a pivotal role in improving awareness and understanding of antibiotic resistance through effective communication, and education about existing and potential solutions to tackle this crisis.

Throughout this tipsheet, you’ll learn about the basics of AMR and how to get started on reporting on this growing threat in your own community — from scientific underpinnings, story examples and ideas to case studies and further reading.

Some story ideas to get you started:

• What new diseases and infections are becoming resistant in your country or community? How do factors like education and sanitation play into antibiotic use?
• What new antibiotics are being developed for use? What diseases do they target?  
• What collaborative efforts has your country made in fighting the spread of AMR? Have they been successful?
• Does your country use surveillance tools or programs to track the spread of AMR?
• The risk of vertical transmission (mother-to-child transmission) of multi-drug resistant pathogens to neonates – what awareness-raising strategies are present in your setting?
• AMR control measures/lessons learnt from veterinarians for human health: often vets have overlooked expertise in this field and they would make for "fresh" new interviewees. This story could work as an interview/profile with a vet.
• A human or community story outlining community engagement (e.g. farmer education) strategies present in an area which has experienced or is at risk of agriculture and food production-based AMR.
• Antimicrobial drugs should not be taken without a doctor's prescription. Are they available over the counter in your country or community? If a pharmacist does dispense antibiotics sans prescription, does she sell the full course of an antibiotic with instructions to complete the regimen?
• Multiple Drug Resistant TB is an emerging problem in many countries. Considering that anti-TB treatment regimens last six months or more, how does the private health sector ensure that patients stay on treatment to completion?
• What do pediatricians in your community or country commonly prescribe for children with the common cold?
• What sorts of disease control practices are deployed by poultry or livestock farmers in your community?
• Are there cultural practices that you may be aware of that can potentially increase the spread of drug resistant bacteria and may need to be revisited or made safer? 
   

• Check out this blog from the Health Journalism Network on finding creative story angles on animal health and food safety.

Antimicrobial resistance and the One Health approach

The One Health framework emphasizes the interconnection between animals, humans and our environment, and the need for practitioners working in these areas to collaborate in order to better understand and address the many factors involved in not only AMR, but zoonotic disease transmission too.

• Read EJN’s tipsheet: A Journalists Guide to Covering and Implementing the One Health Approach in Reporting.
   

The One Health approach has been adopted by the WHO, which works closely with the World Organization for Animal Health (OIE) to promote multi-sectoral responses to public health threats originating in the animal-human-environment interface. In the context of AMR, only solutions that address environmental, animal and human health holistically will be able to solve this crisis. As this global threat of AMR increases, there is a vital need for integrated reporting on the socio-economic, social, scientific and behavioral factors that are contributing to the rise of AMR. Environmental journalists, health journalists, farmers, veterinarians, public health officials must take integrated and collaborative approaches to understanding and educating the public on the intersections of human, environmental and animal health, and the many malpractices that can lead to the spread of drug-resistant bacteria.

In addition to consumers of antibiotics, it is important to target audiences in human health, animal health and agricultural practice on the appropriate use of antibiotics and the spread of AMR. Given the high risk of AMR infection in hospitals, journalists must hold policymakers and hospital administrators accountable to ensure that sanitation plans and procedures are effective and observed.

When reporting on AMR, it is also important to consider the climate and environment angle. There is a broad consensus that warmer temperatures promote bacterial growth. A number of bacteria, like Methicillin-resistant Staphylococcus aureus (MRSA, or Staphylococcus aureus), thrive in temperatures between 40 and 140 degrees Fahrenheit (4-60 degrees Celsius). As global temperatures continue to rise, bacteria are expected to reproduce at a faster rate, increasing both mutation and transmission. This 2018 Nature study estimates that a 10-degree Celsius (18 degrees Fahrenheit) increase in average minimum temperatures across the U.S. could result in a 2.2% increase in S. aureus antibiotic resistance. When reporting on AMR through a climate angle, consider the human and animal health aspects that play into climate change to produce well-rounded and holistic stories with a One Health lens.

What is an antimicrobial?

The WHO defines an antimicrobial as any substance of natural, semisynthetic or synthetic origin that kills or inhibits the growth of microorganisms such as bacteria, viruses and fungi. Put simply, antimicrobials — including antibiotics, antivirals, antifungals and antiparasitic — are medicines used to prevent and treat infections in humans, animals and plants. You’ve probably taken them dozens of times — antibiotics, the most common antimicrobial, treat a host of common bacterial infections including earaches, urinary tract infections, strep throat, sexually transmitted diseases, staph infections and more.

What is a superbug?

In layman’s language, bacteria or fungi that have developed the ability to resist antibiotics are often referred to as” superbugs.” Superbugs occur when the bacteria that causes a certain disease (in Timothy Monk's example, E. coli), becomes more powerful than the antibiotics available to treat it.

Unfortunately, once an infection has become resistant to an antibiotic, a longer or stronger course of that type of antibiotics won’t help.

The COVID-19 pandemic caused a surge in antibiotic-resistant superbug infections in hospitals, pushing back years of progress made combating antimicrobial resistance, according to an analysis by the CDC.

The analysis highlighted seven different pathogens, including a 78% increase in a type of bacteria that can cause infections of the blood, urinary tract, lungs and wounds. But in 2020, there was a significant increase in antimicrobial use, and difficulty in following infection prevention guidance as hospitals and health systems were pushed to their breaking points. This resulted in an increase in healthcare-associated superbugs in hospitals.

• Look for the most recent stories on AMR in your region. What did they do well? What did they miss? Were they fearmongering and sensationalist? Did they rely too much on technical jargon? Identifying gaps and weaknesses in coverage could yield your next story idea.
   

Story ideas:

• What are some of the most common superbugs in your region?
• What regulations are in place to limit access to antibiotics and discourage doctors and pharmacists to give them out easily in your region?

How does AMR occur?

AMR occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to antimicrobial drugs. Antibiotics are essential to treat serious bacterial infections, such as bacterial meningitis, pneumonia and sepsis, but they are frequently misused, or used to treat mild illnesses, such as coughs, earache and sore throats. In the case of agriculture, animals are frequently given antibiotics to promote growth, rather than to fight an infection. This can lead to drug-resistant bacteria developing in the animal  — when animals are slaughtered and processed for food, bacteria can contaminate meat or other animal products, for example, by spreading from contaminated processing equipment or from humans practicing poor hygiene after contact with animals.

It can also spread through the environment, through contamination of water bodies and soil, meaning that AMR can amplify beyond direct animal exposure or human consumption — we’ll get to that soon.

How resistance happens

Some bacteria, such as Clostridium difficile, are naturally equipped with a chemical that destroys the antibiotic molecule, by changing some of their proteins so that the antibiotic can’t touch the outside of the cell bodies. But the bodies also have good bacteria, which protect us from infection. When a person takes antibiotics, the drugs kill both types of bacteria — the good, and the bad. This allows the drug resistant bacteria to grow and take over. As bacteria multiplies and mutates, there is a higher chance that this drug-resistant gene can spread to other bacteria.

The illustration below depicts how AMR can mutate and grow on a cellular level.

The spread of antibiotic resistance is a vicious cycle that involves not only humans and medicines, but plants, animals and food.

All over the world, over half a million individuals are prescribed antibiotics every day. In most cases, these antibiotics are prescribed by a physician to treat an infection. But some common antibiotics can be purchased over the counter, which can quickly lead to incorrect use, or taking the antibiotics when they are not necessary.  A study on the use of antibiotics purchased through retail pharmacies conducted in Hanoi, Vietnam found that of purchasers visit a pharmacy when they found that those who felt they needed antibiotics had minor symptoms such as cough (34.1%), sore throat (32.5%), stomach upsets (10.0%). Misusing antibiotics can lead  drug resistant bacteria to develop in the patient’s body. If the patient needs to go to the doctor, or hospital, poor hygiene practices (for example, staff or visitors not washing their hands) can help spread those drug resistant germs to other people, and into the general public.

Let’s look at a typical example of human-to-human AMR spread:

Person X is being treated for Multiple Drug Resistant Tuberculosis (MDR-TB). The bacteria that causes TB is called Mycobacterium tuberculosis.  All over the world, M. tuberculosis is growing increasingly resistant to first line drugs - the best most effective combination of 4 antibiotics that are widely used against it (Isoniazid, Rifampicin, Pyrazinamide and Ethambutol).First line treatment of TB usually lasts only six months. Someone with TB Bacilli that resist treatment with Rifampicin and Isoniazid, the two most effective TB drugs is diagnosed as having MDR TB.

Most cases of TB are of the pulmonary variety. The TB germs spread from person to person through droplet infection, while coughing and sneezing. Before going to the hospital and getting diagnosed with MDR TB, person X exposed three members of her household to the drug resistant bacteria in her lungs by not covering her mouth when she coughed.

The antibiotics that Person X is now given to treat her MDR-TB are expensive, less effective and have more side effects than first line anti-TB drugs and they need to be taken for 2 years. And if her household members have contracted the disease from her, they too will, after getting diagnosed with MDR-TB, need to take anti-TB treatment for 2 years.

This does not only happen with TB, but also during the transmission of any disease or infection that contains bacteria resistant to drugs. For example, if Person X had E. coli, the drug resistant bacteria in their stool could be passed onto other individuals who might have come into contact with that bacteria (for instance, drinking water that had been contaminated with the person’s stool, or shaking hands with the person and touching the mouth or eyes with contaminated hands).

But, human-to-human is not the only route of transmission. Drug resistant bacteria can circulate between animals and the environment, as well. As a result, food safety is particularly important, given it’s role in agriculture and animal production.

Antibiotics are commonly used in industrial agriculture to fight off infection, and they are also used to promote faster growth in animals such as farmed fish, chickens, pigs and cattle. Similarly to humans, animals can also develop drug resistant bacteria in their gut, and consequently, in their feces. The public may come into contact with this drug-resistant bacteria by consuming animal products such as meat, eggs and dairy. A good example is the use of fluoroquinolone, a common antibiotic used to treat infections in poultry.

But it’s not only our animal product consumption that is exposing us to antimicrobial resistance — anthropogenic contact with animals in the form of agriculture, bushmeat consumption, habitat encroachment or poaching can also expose us to drug-resistant bacteria.

AMR can also impact wildlife. In this PubMed study, fecal samples were collected from herring gulls, black-headed gulls, lesser black-back gulls and hybrid deer species. E. coli was detected in the feces of some of the samples and were tested for AMR encoding genes. In total, 5.4% of the E. coli positive samples exhibited drug-resistant bacteria, indicating that wild birds and mammals may function as host reservoirs and potential vectors for the spread of resistant bacteria. It is critical for journalists, and by default, the public, to be aware of the risks of AMR in settings where humans and wildlife coexist.

Drug resistant bacteria can also be spread to people and animals through the environment. This could be the water we drink, the soil that grows our vegetables, or the air we breathe.

According to the CDC, “Antibiotic-resistant pathogens and their genes have been found in streams, rivers, lakes, and oceans. They can often be traced back to discharge flowing from hospitals, farms, or sewage systems. Even properly functioning wastewater treatment systems may not fully remove resistant pathogens and their genes.”

Story ideas:

• How do people use water in your community? Do those waterways in your community pose as a threat for the spread of AMR?
• Have wildlife populations in your region been tested for AMR encoding genes? What were the findings?
• Is smuggling of wildlife an issue in your country? Are there laws that prevent this and / or campaigns that educate the public on the perils of keeping wild animals in domestic settings?
   

Most active pharmaceutical ingredients are manufactured in India and China, where residents are exposed to excessively high concentrations of pharmaceuticals in the air that they breathe. This concept is known as pharmaceutical pollution. Air pollutants that are commonly found in pharmaceutical laboratories are bio-aerosols and microbes. The typical air pollutants emitted by pharmaceutical industries are different types of particulate matter, volatile organic compounds and carbon monoxide, which is known as the “silent killer.”

According to Dr. Adela Maghear, Pharmaceuticals Policy Officer at Health Care Without Harm (HCWH) Europe, “The production of both APIs (antibiotic pharmaceutical ingredients) and finished dose antibiotics is concentrated in specific locations so the resulting point-source pollution is in incredibly high concentrations and encourages the development of drug resistance. This practice has a detrimental impact on vulnerable populations living near manufacturing facilities and wastewater treatment plants in these countries. In India, an estimated 58,000 newborns die from multidrug-resistant infections every year.”

• Has pharmaceutical pollution been covered in your local media outlets?

• Compile a contact list of experts and affected people in your own locality that you can consult for regular and ongoing AMR stories.
   

The illustration below depicts how bacteria with acquired resistance can spread from their environment (a lake) to humans and agriculture.

Where does AMR spread?

According to the International Centre for Antimicrobial Resistance Solutions, AMR hotspots tend to be in point-sources such as hospitals, nursing homes, domestic households, the pharmaceutical industry, slaughterhouses and urban wastewater treatment plants (WWWTPs). The effluents from AMR hotspots are usually discharged into the public sewage system, which can transport harmful drug resistant bacteria.

AMR tends to be more prevalent in hospitals. This is because every day, thousands of individuals arrive and depart from hospitals, each carrying different types of bacteria. If clear policies to help keep spaces clean aren’t adhered to, bacteria will travel more easily, which can support the development and spread of AMR. Patients in the hospital also tend to lack the usual defenses and immunity that protect us from infections. Their immune systems may be weaker, or they may have wounds from procedures that allow bacteria to enter the body easily. As noted, low and middle-income countries also tend to be disproportionally affected by the spread of AMR, partly due to the high burden of communicable diseases and poor healthcare infrastructure. As a result, what are now benign, simple infections will become harder or impossible to treat with the medicines we currently have on hand, which can lead to increased disease spread, severe illness and even increased mortality rates.
 

Case study: AMR at the intersection of urban and rural settlements in Nepal

Dr. Cristin Young, MPH, and recent One Health Institute PhD graduate in Infectious Disease Epidemiology, worked on the USAID-funded PREDICT pilot study of AMR in the community of Jadibuti, in southeastern Nepal. USAID describes the region as, “an ideal representation for studying how AMR might occur in informal settlements worldwide.”

Jadibuti exists at the crux of urban and rural settings within Kathmandu, bordered by an international airport on one side, and an agricultural setting on the other, where people, livestock and wildlife share habitat. Though regional and international travel by residents is fairly common, sanitation infrastructure is limited to tube wells and pit latrines. The findings of the pilot study showed widespread AMR genes among humans, domestic animals, water sources, and wild small mammals, strengthening the need for public health improvements to sanitation and hygiene to slow the spread of AMR.

 Overall, the study found a wide range of antimicrobial resistance genes that were widely distributed across humans, animals, and water sources. This case study, in particular, illustrates the deeply interconnected relationship between humans, animals and the environment we share, and those inherent dangers when it comes to AMR.

• As a journalist reporting on AMR, it is important to look outside of just the infection itself . What are some of the socioeconomic or cultural factors that contribute to humans and animals sharing habitats?

• Are there case studies you could learn more about from your region? How would you highlight the inequitable burden of AMR risk faced by different genders or more marginalized sectors of society?

• Check out this story written by a former Health Journalism Network Ambassador in Ghana: Antibiotic Use Very Alarming in Rural Communities. Can you find out what percentage of people in your community misuse, or have misused antibiotics?

The rise and fall of antibiotics: A brief history

When antibiotics were first industrially produced after World War II, the quality and longevity of human life changed enormously. In fact, between 1944 and 1972, human life expectancy jumped by eight years, which was largely credited to the development, production and widespread use of antibiotics to treat infection — a time colloquially referred to as ‘the golden age of antibiotics.’

But as early as 1947 some of the earliest resistances to antibiotics were being recorded, such as a type of bacteria, staphylococci, that became resistant to penicillin, a common antibiotic.

According to Infection Control and Hospital Epidemiology, today, Escherichia coli, Staphylococcus aureus and Klebsiella are some of the most common current antibiotic-resistant pathogens.

Since the late 1940s, over-prescription, misuse in animal agriculture, lack of education and awareness and improper hygiene in hospital settings have all contributed to the AMR issue that public health officials, decision-makers and veterinarians face now.

“Antibiotics are uniquely societal drugs,” Dr. Stuart Levy, President of the Alliance for the Prudent Use of Antibiotics famously said, “because individual use affects others in the community and in the environment.”

For common bacterial infections, high rates of resistance against antibiotics frequently used have been observed world-wide, indicating that we are rapidly running out of effective antibiotics. For example, the rate of resistance to ciprofloxacin, an antibiotic commonly used to treat urinary tract infections, varied from 8.4% to 92.9% for E.coli, a common gastrointestinal infection resulting from consuming contaminated food or water in countries reporting to the Global Antimicrobial Resistance and Use Surveillance System (GLASS).

Why can't we just develop new antibiotics?

In short, researchers are working on it. But developing new medications can take years, or even decades. In fact, MIT researchers used a machine-learning algorithm to identify a drug called halicin that kills many strains of bacteria. Halicin prevented the development of antibiotic resistance in E. coli. Using a machine-learning algorithm, MIT researchers have identified a powerful new antibiotic compound. But, like any other medications available for prescription use, the drug must go through extensive clinical trials before it is determined safe for use.

That being said, many pharmaceutical companies that are manufacturing new versions of antibiotics are going out of business — and many hospitals have been hesitant or unwilling to pay large prices for new drugs and therapies.

“The companies have invested billions to develop the drugs have not found a way to make money selling them,” said Andrew Jacobs in his article for the New York Times, ‘Crisis Looms in Antibiotics as Drug Makers Go Bankrupt.’

You might be wondering: So why was the COVID-19 vaccine developed and authorized for use within only 12 months of the virus being discovered?

Before COVID-19 was discovered, scientists had actually spent many years building new types of vaccine technologies that could quickly be adapted to new emerging viruses (often called ‘Disease X’). When COVID-19 hit, researchers at Oxford University were able to tweak the vaccine (commercially known as AstraZeneca) to target COVID-19. Scientists also credit speedy collaboration across sectors and countries (for example, getting the virus' genetic code from China in January 2020) that expedited the use of the vaccine. The success of the COVID-19 production and rollout demonstrates the value of global collaboration and collective action in urgent circumstances.

Click here to read about new antibiotics that are currently in global clinical development.

• Do some research on current antibiotics in development in your region. How much government funding is being spent on antibiotic development, vs. more lucrative drugs?
   

Alliances look to curb the treat of AMR

We may be entering a post-antibiotic era where treating previously simple bacterial infections with the medicines we have on hand will no longer be possible. The consequences of this are staggering.

According to a 2019 Nature study, AMR  caused more deaths than both Human Immunodeficiency Virus (HIV) and malaria in 2019.

Public health officials have been mobilizing to curb this threat. Launched by the WHO in 2015, the develop of GLASS was the first global collaborative effort to standardize AMR surveillance. The tool is used to inform policies to prevent infection and control responses, and it is the cornerstone for assessing the spread of AMR and monitoring the impact of local, national and global strategies.

According to the WHO, GLASS provides a standardized approach to the collection, analysis, interpretation and sharing of data between countries. It incorporates data from surveillance of AMR in humans (monitoring of resistance and the use of antimicrobial medicines), as well as in the food chain and in the environment.

GLASS can be a useful source for journalists producing data stories on the spread of AMR and it’s connection between human, environmental and animal health. Click here to read their annual reports, surveillance activities and data collection.

The Food and Agriculture Organization of the United Nations (FAO), the OIE, and the WHO) have been working together for decades to address risks at the human, animal, plant, and environment interface. Since 2018, the three agencies joined forces as a Tripartite to strengthen their long-standing partnership, with a renewed focus on tackling AMR from a One Health approach.

The engagement of the United Nations Environment Programme (UNEP) in this work is also essential to support governments, civil society, and the private sector in addressing AMR risks related to the environmental sector. In 2022, the Tripartite became formally the Quadripartite as it welcomed UNEP in the alliance to accelerate coordinated strategy on human, animal and ecosystem health.

The One Health approach requires strong cross-sectoral coordination for strengthening systems to prevent, detect and respond to infectious diseases, and by default, antimicrobial resistance. While the Quadripartite aims to lead in contributing to achieving its goals and objectives (including “curbing the silent pandemic of antimicrobial resistance (AMR)” they cannot realize them alone. A coordinated One Health response is needed at global, regional, and national levels to help all sectors and stakeholders design and implement evidence-informed responses to AMR.

At the policy level, it is critical to ensure a robust international action plan, including improving surveillance of antibiotic-resistant infections and strengthening policies, programs and implementation of infection prevention and control measures. Journalists have both the power and responsibility to drive change at the policy level by holding decision-makers accountable, and to drive change at the local level by informing individuals about evidence-based solutions and best practices.

• How has your government responded to the threat of AMR? Which agencies are involved in their response? Is it a One Health approach?

• Look into how the Quadripartite Alliance and GLASS is active in your region.

•  Check out this story written by a past EJN grantee on the One Health approach in Fiji. What did the journalist do well? How could the story be stronger?

Solutions: What's next?

Every individual has a role to play in stopping the spread of AMR — from policymakers to healthcare workers, to the agricultural sector. Reporting through a community-based, One Health framework that addresses all sectors involved with human, animal and environmental health is critical in halting the spread of AMR. To prevent and control the spread of antibiotic resistance, the WHO recommends the following guidelines for individuals, policymakers, healthcare workers. There may be more context-specific guidelines that apply to your region.

• Prevent infections by regularly washing hands, preparing food hygienically, avoiding close contact with sick people, practicing safe sex, and keeping vaccinations up to date.
• Preparing food hygienically, following the WHO Five Keys to Safer Food (keep clean, separate raw and cooked, cook thoroughly, keep food at safe temperatures, use safe water and raw materials) and choose foods that have been produced without the use of antibiotics for growth promotion or disease prevention in healthy animals.
• To prevent the spread at the healthcare level, it is critical to only prescribe and dispense antibiotics when they are needed, as well as communicating with patients about how to take antibiotics correctly, antibiotic resistance, and the dangers of misuse.
• Within the agricultural sector, the WHO recommends farmers and agricultural workers must only give antibiotics to animals under veterinary supervision, as well as improve biodiversity on farms and prevent infections through improved hygiene and animal welfare.
• Is there a preparedness plan in place for a disease outbreak that cannot be contained with standard antibiotics in both animal and human populations (surveillance, mitigation, etc.)

Addressing and closing regulatory holes where pharmacies dispense antibiotics without requiring a prescription is critical in fighting AMR, but it also reflects as a failure on the part of governments, antibiotic producers and health officials just as much as pharmacies and physicians. Though clamping down on regulatory framework at the government and pharmaceutical level could theoretically help diminish the AMR crisis, it is highly dependent on the country, pathogen and drug. Exposing these regulatory gaps and holes, how a lack of regulation in the pharmaceutical sector can lead to monumental public health problems, is an important responsibility that journalists and media outlets hold.

Examples of robust reporting on AMR

• Scientific American: Antimicrobial resistance is growing because of COVID-19
• National Geographic: How we’ll tackle diseases that are becoming untreatable
• Mongabay: Sundarbans mangroves harbour antibiotic resistant bacteria
• The Guardian: GM bacteria could combat antibiotic resistance, study suggests
• The Guardian: McDonald’s and Walmart beef suppliers criticised for ‘reckless’ antibiotics use
• Financial Times: Antibiotic Resistance in Africa: ‘A Pandemic that is Already Here’
• The New York Times: A Deadlier Pandemic Could Soon Be Here

"Animal caretakers are often the first victims of spillover. The same goes with AMR. [It is important to] focus on animal welfare and ensure that a preparedness plan is in place if there is an outbreak among animals who are being raised and cared for in a farm setting," said Bea Spadacini, Health Manager, Internews' Health Journalism Network. 
 

Resources

• The Global AMR Hub, which aims to improve and enhance R&D activities and policies across the One Health spectrum by bridging between human and animal health and the agriculture sector at international level and across public and private sectors. The Global AMR Hub provides an evidence-based picture of global AMR R&D activities and resources. Currently, it presents data from human and animal health and will be completed with the addition of plant and environment health data in March 2021.
• The Global Health Network has many useful resources for journalists including tackling AMR with a One Health approach and helpful webinars on AMR surveillance efforts.
• The United States Center for Disease Control (CDC) offers free resources featuring antimicrobial resistance including fact sheets, social media graphics, illustrations and videos.
• Earth Journalism Network’s tipsheets, A Journalists Guide to Covering Zoonotic Diseases and A Journalists Guide to Covering and Implementing the One Health Approach in Reporting.
• The Global Action Plan on Antimicrobial Resistance, World Health Organization
• Pulling Together to Beat Superbugs, World Bank 
• Bracing for Superbugs: Strengthening environmental action in the One Health response to antimicrobial resistance
• In-depth: After UN report, new focus on antimicrobial resistance in the environment

This tipsheet was produced by Signi Livingstone-Peters with input from Bea Spadacini, Ida Jooste, Jaya Shreedhar, Sam Schramski and Amrita Gupta. ​

Banner image: We may be entering a post-antibiotic era / Credit: Hal Gatewood / Unsplash.