Exploring the Nexus of Antimicrobial Resistance and Natural Hazards and Associated Disasters: A Scoping Approach

Abstract

Antimicrobial resistance (AMR) and natural hazards and associated disasters both pose significant global threats, with potential for exacerbating intersections. Despite AMR’s growing international priority, the nexus of AMR and hazards/disasters remains underexplored. This thesis aims to provide a comprehensive overview of the nexus to inform future perspectives and highlight further investigation areas. A scoping literature study across Scopus and PubMed was conducted, complemented by semi-structured interviews. Out of 1,234 unique references, 90 were analysed. Most literature focused on human health (60%), followed by environmental (35.6%), but limited animal perspectives. Earthquakes (32.2%), floods (24.4%), and hurricanes (14.4%) were most frequently studied. Mapping revealed diverse AMR occurrence perspectives, relating primarily to infections among disaster-affected patients (36.7%), environmental occurrence and spread (32.2%), gastrointestinal infections (11.1%), and malaria infections (5.6%). Central pathways included infection risks, baseline AMR conditions, and disaster-exacerbated circumstances. Management approaches reflected these pathways, including contextualised infection control and prevention, water, sanitation and hygiene (WASH), and surveillance. Concrete impact evidence remained limited. Interviews with 12 stakeholders largely confirmed the scoping results. While the nexus was perceived as relevant and indirectly addressed through infection prevention and control and WASH, AMR is not prioritised during acute disaster situations and lacks direct integration. Findings emphasise the relevance of a progressive dual-layered perspective, reinforcing long-term besides short-term approaches, alongside foundational measures like infection prevention and control or WASH. Greater interdisciplinary exchange is warranted. Research should deepen analysis across hazards/disasters and One Health sectors and enhance understanding of concrete impacts.

Popular Abstract

Floods, Earthquakes, Storms, and Resistant Microorganisms – A Dangerous Mix?


What happens when antimicrobial resistance (AMR) meets another growing global threat: natural hazards and associated disasters like floods, storms, wildfires, or earthquakes? This thesis explores this silent nexus.

Imagine being prescribed antibiotics for an infection ‒ and they no longer work. This growing threat, known as AMR, relates not only to bacteria but also to viruses, parasites, and fungi. A recent United Nations High-level meeting acknowledged AMR’s urgency, which highlights the relevance of considering its role in different contexts. This thesis focused on the intersection between AMR and natural hazards and associated disasters (in the following referred to as hazards and disasters) through scientific literature and interviews. The research uncovered various ways in which AMR plays a role in disaster contexts, including infections among injured disaster patients, environmental spread of AMR, and diarrhoea-related infections or malaria outbreaks. Although these findings and the interviews underscored the multidimensional relevance of the nexus, AMR is not an immediate priority for disaster response. However, the central role of infection prevention and control measures has been consistently highlighted. This research calls for greater dialogue and investigation into the silent and complex nexus.



AMR is a rising global threat. In 2019 alone, AMR related to bacteria was associated with 4.95 million deaths and directly attributed to 1.27 million (Murray et al., 2022). Although AMR is a natural process, human actions can worsen it, such as the misuse of antibiotics, lack of access to adequate antibiotics, and environmental pollution. This problem not only relates to humans but also to animals and the environment. This is why the One Health approach is important, as it integrates these sectors.

AMR also becomes central in disaster situations, where conditions can intensify the problem, like weakened healthcare or water and sanitation systems. In these situations, it can then, for instance, become harder to treat injuries and infections. This is especially concerning because such events are projected to increase.

This thesis explored the connection between AMR and hazards/disasters. It analysed 90 scientific studies and 12 interviews. The findings show that AMR can play a role across various disasters, from injured earthquake patients suffering from infections caused by resistant bacteria, to the spread of resistant bacteria or other AMR-factors through flooding. Further, the risk for diarrhoea-related infections, and thus also associated resistance, is often increased after disasters. Even the emergency response can play a role, for instance, through the widespread use of medications for malaria prevention and control. These findings highlight that common pathways of AMR in disaster contexts include general infection risk factors and AMR conditions, alongside disasters worsening such conditions. While various impacts are likely, they remain difficult to assess fully. However, key measures were identified, including infection prevention and control practices, surveillance, and informed treatments.

Although the link between AMR and hazards/disasters is recognised as relevant across the literature and interviewees, AMR is not an immediate priority in acute disasters. This is because the focus in emergencies is on saving lives and providing emergency aid. However, interviewees emphasised that basic measures, like infection prevention and control, and improved water and sanitation access, can and should help to address AMR during disasters.

Overall, the study highlights the need to address the problems long before a hazard/disaster occurs. This means implementing long-term prevention and preparedness strategies, such as building stronger health systems and AMR capacities and strengthening vaccination and surveillance activities. In these long-term perspectives and acute disasters, basic steps, like infection prevention and control, and access to safe water and sanitation, are important before further AMR-focused activities.

Ultimately, this thesis provides a valuable foundation for future research on the diverse roles of AMR in natural hazards and associated disasters and in assessing their impacts. In short, it advocates for increased dialogue, collaboration, and exchange across a wide range of stakeholders.

• author: Berger, Finja
• supervisor: Marcus Abrahamsson
• organization: Division of Risk Management and Societal Safety
• course: VBRM15 20251
• year: 2025
• type: H2 - Master's Degree (Two Years)
• subject: Science General
• keywords: Antimicrobial resistance, Disasters, Scoping review, One Health, Disaster risk management, Health systems resilience
• language: English
• id: 9196937
• date added to LUP: 2025-06-11 12:23:48
• date last changed: 2025-06-11 12:23:48