Risk Communication about Antimicrobial Resistance: A Content Analysis of Metaphor Use in Global Public Discourse

<p dir="ltr">Antimicrobial resistance (AMR) poses an existential threat to humanity, yet<br>public awareness remains low. An underexplored tool for AMR risk<br>communication is metaphor. By inviting a comparison between abstract and<br>familiar concepts, metaphors can make complex health information more<br>accessible. However, metaphor use in the context of AMR has been haphazard<br>and remains poorly understood. We address this issue by providing an integrative<br>content analysis of metaphor use in global, English-language, public AMR<br>discourse. Four types of public sources were searched: (1) websites of 71 non-<br>profit organisations, (2) national AMR action plans from 84 countries, (3) 819<br>international newspaper articles and (4) 2,616 social media posts. Across all<br>sources, 2,149 metaphors excerpts were extracted. Qualitative content analysis<br>identified 41 distinct metaphor themes, but 75% of metaphors fell into one of four<br>themes: “War against resistance, infections and microbes,” “Heroes and villains of<br>resistance,” “Post-antibiotic apocalypse and looming crisis of AMR,” and “Silent,<br>creeping threat of AMR.” All key themes are inapt or theoretically problematic by<br>painting a misleading picture of a finite struggle between good and evil, which<br>does not match the ecological reality of a continuously evolving challenge.<br>Furthermore, most existing metaphors are highly conventional and emotive. They<br>aim to raise general awareness about AMR without conferring specific<br>knowledge. Our findings call for an urgent re-framing. Media, policy makers and<br>health officials should choose theoretically informed, apt and novel explanatory<br>metaphors that are specific to the context of AMR and challenge public<br>misunderstandings with the potential to prompt behaviour change.</p>