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.