Biological mechanisms and social determinants of antimicrobial resistance

Bacterial antimicrobial resistance (AMR) is a defining global health crisis, projected to cause 1.91 million annual deaths globally by 2050. These alarming statistics call for a holistic, dual-lens approach that examines the molecular strategies bacteria use to develop antibiotic resistance, as well as the socio-economic drivers and structural inequities that remain critically overlooked in AMR governance. This review delves into two seemingly unrelated but critical aspects of bacterial AMR: biological mechanisms of bacterial resistance and the social norms and structural inequities that play significant roles in the development and spread of antibiotic resistance. Bacterial resistance mechanisms operate at the genotypic and phenotypic levels, inducing inheritable changes or temporary structural adaptations. A deeper understanding of these diverse mechanisms can help identify new drug targets and develop new antibiotics. We advocate that while discovering new classes of antibiotics and averting resistance mechanisms is paramount, prioritising technical solutions without a socially informed framework cannot yield the results required. Examining how occupational exposures, economic equities and gendered roles drive informal antibiotic usage and increase exposure to resistant pathogens is equally crucial. Hence, by combining the biological mechanisms of resistance with the social norms that facilitate its occurrence and spread, a comprehensive roadmap for socially grounded interventions should be developed.