The social burden of antimicrobial resistance: what is it, how can we measure it, and why does it matter?

Antimicrobial resistance (AMR) is a growing global health threat, which is increasingly quantified in terms of its human health and economic burden. In this article, we highlight that for policy and planning purposes the social burden of AMR is as important to attend to as health and economic burdens, requiring systematic consideration and measurement of multiple dimensions. We provide a conceptual and empirical overview of four dimensions of the social burden of AMR: the distribution of AMR among and between populations; the lived experiences of AMR by patients and carers; how and by whom AMR interventions are shouldered; and how AMR can change society. We illustrate these dimensions through five case studies drawn from research projects in the UK, East Africa, Thailand and Brazil. Drawing on these insights, we discuss challenges and opportunities for documentation and measurement of AMR's social burden going forward. Taking this seriously aligns with the consensus observation that to address AMR requires moving away from pathogen-based and siloed disciplinary perspectives and means embracing different forms of data and evidence from around the world. We propose an interdisciplinary engagement across researchers, policy makers and community stakeholders to arrive at agreed principles and metrics for future monitoring of the social burden. We need to tackle invisibility through lack of data by considering the social burden in design of AMR surveillance and research, includes mainstreaming social science data, and incorporating arts-based approaches to understanding AMR. Recognition, documentation and measurement of the social burdens of AMR will advance AMR approaches and help develop equitable solutions.