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

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