Climate Change and Antimicrobial ResistanceA Global Review of Emerging Evidence and Public Health Implications

Abstract

Climate change and antimicrobial resistance (AMR) are two of the greatest health challenges of the twenty-first century, yet they have traditionally been studied and governed as two distinct issues. This paper summarizes the growing scientific evidence linking rising temperatures, extreme weather events, and other environmental changes driven by climate change to the emergence, persistence, and spread of antimicrobial-resistant pathogens. Drawing on ecological, clinical, and environmental genomics studies published between 2018 and 2026, the paper summarizes four key mechanistic pathways: the direct effect of temperature on bacterial physiology and horizontal gene transfer; disruption of water, sanitation, and healthcare systems during extreme weather events; climate-related shifts in antimicrobial use; and amplification through agricultural and zoonotic settings. It further extends the review to two closely related domains — tuberculosis control and healthcare-associated infections — to explore how climate stressors exacerbate existing vulnerabilities in infection control and disease programmes. The review identifies converging global evidence that, for priority pathogens, resistance rises with increasing ambient temperature, with this burden distributed unevenly across countries and falling disproportionately on low- and middle-income countries, including South Asia. The paper concludes with a discussion of existing policy gaps, including the insufficient incorporation of climate variables into national AMR action plans and global surveillance systems, and proposes research and governance priorities within a One Health framework.