Climate Change, Health System Resilience, and Antimicrobial Resistance: An Integrated Risk Assessment and Mitigation Framework

Background: Climate change functions as a threat multiplier, intensifying health system vulnerabilities and accelerating antimicrobial resistance (AMR). Despite growing recognition of both crises, their interconnections particularly within Low- and Middle-Income Countries (LMICs) remain inadequately characterized. The aim of this study is to synthesize existing evidence on the interplay between climate-driven stressors and AMR proliferation, and to assess how climate change undermines health system resilience using the WHO Building Blocks and One Health frameworks. Methods: A scoping synthesis of high-impact peer-reviewed literature was conducted, examining both acute shocks (e.g., extreme weather events) and chronic environmental shifts (e.g., rising temperatures, water scarcity). Studies were mapped to health system domains – service delivery, workforce, information systems, access to medicines, financing, and governance – to evaluate climate-related disruptions and their implications for AMR emergence and spread. Results: Climate stressors were found to degrade health system performance by damaging infrastructure, overburdening resources, and promoting inappropriate antimicrobial use during crises. Elevated temperatures and hydrological instability were shown to enhance the environmental dissemination of antibiotic resistance genes (ARGs), creating a self-reinforcing feedback loop that amplifies AMR risks. These effects are most pronounced in LMICs, where adaptive capacity and surveillance systems are limited. Conclusion: The convergence of climate instability and AMR escalation represents a systemic and escalating global health threat. Our study proposes an integrated risk assessment framework linking climate adaptation and AMR mitigation, emphasizing the need for cross-sectoral, One Health–aligned policies. Strengthening health system resilience through sustainable, climate-informed interventions is essential to curb the dual burden of climate change and antimicrobial resistance.