Averting Antimicrobial Resistance Through One Health Policy Solutions
The same drugs that save lives and enable one of the largest food production industries are now at risk of undermining their own effectiveness. Antimicrobial drugs are a cornerstone of modern economies. Antibiotics, a subset of antimicrobials that treat bacterial infections, are essential to modern medicine and have been widely used to facilitate large-scale animal agriculture. Yet their widespread use carries significant costs; the rapid growth of antibiotic use and consumption in recent years has resulted in stark increases in overuse and misuse across these sectors.
Despite its critical function in these sectors, a fundamental challenge in antibiotic use is that bacteria and other microorganisms naturally adapt over time, meaning that widespread use inevitably promotes pathways to resistance. Studies show that the selection pressures generated by continuous antibiotic use result in antimicrobial resistance (AMR) not only to the specific drugs administered but also to other antibiotics from the same class. This is particularly acute in clinical settings, especially since broad-spectrum antibiotics are often prescribed empirically to combat community-onset infections.
Unconstrained antibiotic use may result in a tragedy of the commons, where AMR decreases the effective total supply of medically important antibiotics. Balancing the utilization of these critical drugs through policy action requires an interdisciplinary approach that integrates economics with One Health—a unifying conceptual framework that aims to sustainably balance the health of animals, people and ecosystems. The threat of AMR, if neglected, may result in a global public health crisis—affecting all nations regardless of economic status.
Antimicrobial Resistance Affects the Global Economy
Antibiotics have been critical in greatly reducing the risks of infectious diseases that once plagued entire nations. As illustrated in Figure 1, larger countries such as the United States and China, that have larger livestock sectors given the higher demand for animal-based foods, consume the largest quantities of antibiotics in the world. Brazil and Australia also produce a substantial share of the global supply of livestock and are among the world’s top consumers of veterinary antibiotics. Other countries exhibit relatively low levels of antibiotic use, indicating that livestock sector size is a key determinant in global antibiotic consumption.
Figure 1. Distribution of Antibiotic Use Among Food-Producing Animals (in thousands of kilograms) Across 10 Countries, 2020
Source: Chart generated in RStudio using data from Mulchandani et al., 2023
According to a 2023 economic assessment based on data from the Food and Agriculture Organization (FAO), the global market value of livestock was estimated to be $3.3 trillion USD in 2018, reflecting the primary outputs (meat, eggs, milk) and the asset value of food-producing animals. By contrast, the global economic burden of AMR reached nearly $700 billion in 2019 in hospital costs and productivity losses alone, revealing the immense externalized costs associated with this lucrative sector.
Policy inaction will exacerbate AMR-associated and attributable deaths, which are expected to increase significantly by 2050 (Figure 2).
Figure 2. Current and Projected AMR-Associated and Attributable Deaths Globally, 2050
Source: Global Burden of Disease 2021 Antimicrobial Resistance Collaborators
Note: AMR-associated deaths are estimated using a counterfactual in which no infection occurs, capturing all deaths that involve drug-resistant infections. AMR-attributable deaths represent the subset of deaths caused by drug resistance itself, estimated using a counterfactual in which resistant infections are replaced with drug-susceptible infections.
The AMR crisis will result in substantial economic losses. A 2025 working paper published by the Center for Global Development asserts that global GDP could decline by $1.67 trillion by 2050 under a scenario where AMR accelerates. An immediate, integrated policy solution is required that acknowledges the biophysical systems governing coordinated economic activity, starting with adopting regenerative agricultural practices that focus on soil health.
Antibiotic Use in Agriculture
Over 70 percent of the global supply of medically important antibiotics was used in agriculture in 2017. Within the sector, antibiotics are commonly administered to food-producing animals as a prophylactic and for growth-promotion purposes. As livestock production has intensified in recent years, so has the global demand for veterinary antibiotics—which is estimated to increase further over the next few decades (Figure 3).
Figure 3. Historical and Projected Quantities of Global Antimicrobial Usage Across Primary Food-Producing Animal Species between 2000 – 2040
Source: Acosta et al., 2025
Note: Antimicrobial use quantity (AMUQ) measured in metric tons (1,000 kilograms).
Intensive animal agriculture creates hotspots for antibiotic use due to unsanitary conditions, close living quarters, and immunological deficiencies present within concentrated animal feeding operations (CAFOs). In the US, for instance, cattle and swine (which are largely produced in CAFOs) account for the largest share of sales for medically important antibiotics among primary food-producing animals (Table 1).
Table 1. Medically Important Antimicrobial Drugs Approved for Use in US Food-Producing Animals Actively Marketed in 2024
Source: Food and Drug Administration (FDA), 2025
Note: Includes antimicrobial drug applications that are approved and labeled for use in both food-producing animals (cattle and swine) and nonfood-producing animals (dogs and horses).
According to the US Department of Agriculture (2025), the US is the third largest producer of pork globally while ranking first in beef production. Cattle and swine comprise approximately 84 percent of all domestic livestock antibiotic use. At the same time, these food-producing animals currently make up the single largest share of domestic agricultural cash receipts by commodity category.
Livestock manure contains high concentrations of antibiotic resistance genes (ARGs), which may pollute the environment through runoff into waterways or through land application of manure to soils. It is now empirically recognized that agricultural soils utilizing animal manure for fertilizer are hotspots for ARGs. This widespread proliferation creates numerous exposure pathways, increasing the risk of antibiotic-resistant infections in people (Figure 4).
Adapted from:Trinchera et al., 2025
Note: Livestock antibiotic use drives the dissemination of antibiotic resistance genes (ARGs) across animal, environmental, and human systems, amplifying the global burden of antimicrobial resistance (AMR) through interconnected One Health pathways.
Consumption of ARGs via animal food ingestion and exposure through soil residue can destabilize the human microbial resistome, including within the gut microbiome. (The resistome refers to the distribution of ARGs across microbiomes, ranging from the gut to the skin for humans and animals.) Given that the gut harbors a disproportionate share of the body’s microorganisms, such exposure to ARGs has important implications for health. Antibiotic-induced gut dysbiosis—a state of microbial disequilibrium caused by reduced species diversity and richness—can impair digestion, reduce immune system functioning and influence the progression of chronic disease.
The Chicken Conundrum
Although domestic antibiotic consumption among broiler chickens seems relatively low at four percent (Table 1), these animals disproportionately contribute to the spread of AMR throughout the food system. Broilers are the most consumed animal in the US currently, exacerbating the risk of foodborne illnesses caused by chicken-associated pathogens (Figure 5).
Figure 5. Trends in Poultry Antibiotic Use and Resistant Bacterial Strains, 2010 – 2024
Adapted from: Abou-Jaoudeh et al., 2024
Bacterial species commonly found in poultry—such as Salmonella enterica, Campylobacter spp. and Staphylococcus aureus—have become increasingly resistant to antibiotics due to the widespread use of antimicrobial drug in broilers.
Poultry production also substantially increases the risk of zoonotic diseases, infectious diseases transmitted between animals and humans. In fact, poultry is a major source of foodborne bacterial infections in the US, particularly Salmonella spp. and Campylobacter spp. Recent US estimates show that non-typhoidal Salmonella spp. imposes the highest economic burden of any foodborne pathogen, with mean annual costs of approximately $17.1 billion (in 2023 dollars), while Campylobacter spp. ranks second at $11.3 billion (Table 2).
Table 2. Estimated Economic Burden of Major Foodborne Pathogens in the US (in 2023 dollars)
Source: USDA ERS, 2025; calculated using estimates from Hoffman et al., 2025
In treating these foodborne infections, health providers typically prescribe antibiotics, further reinforcing the positive feedback loop of AMR throughout global economies (especially for methicillin-resistant S. aureus, which often requires stronger antibiotics to treat).
Moving Toward One Health Policy Solutions
Addressing the crisis of AMR emergence requires a paradigm shift in international policy, one that accounts for the economic and ecological contexts in which antibiotics are used. Limiting the industrial production of animals and employing antibiotic stewardship demands a reformulated approach, one that could have broad-ranging health, environmental and economic co-benefits.
The modern food system is a major driver of global land degradation, biodiversity loss, and the erosion of healthy soil—reducing its capacity to regulate microbial ecosystems and help address AMR. As nations such as the US continue to scale up monocropping systems and animal agriculture in lieu of diverse cropping and rotational grazing systems, planetary boundaries will continue to be transgressed. Hence, market-oriented policy solutions that simply prioritize economic growth are ineffective to resolve the AMR crisis.
The One Health framework, defined as the interconnectivity of health across a spectrum of three domains—environmental, animal, and human—provides a perspective that bridges disciplines without losing scientific integrity. One Health allows for the interpolation of insights from various disciplines—biology, ecology, public health—to help explain the interconnectedness of economic choices. When viewed from this holistic perspective, the structural problems inherent to AMR connect to other market failures such as non-communicable disease proliferation and climate change exacerbated by the current global food system. Hence, One Health offers a compelling foundation for improved government policy.
The World Health Organization (WHO) asserts that to effectively reduce the risks of AMR and attenuate future costs, countries must substantially reduce the use of medically important antibiotic drugs in agricultural settings—primarily the sub-therapeutic use in animals such as growth-promotion. By limiting the expansion of CAFOs and increasing public investment in soil health-oriented policies, antibiotic use can be reduced and the discovery of antimicrobial compounds can be supported.
A 2024 report from the National Academies of Science, Engineering and Medicine found that only about 5 percent of the myriad antimicrobial compounds in soil ecosystems have been formally characterized. Thus, diverse microbial communities in soil ecosystems represent an untapped reservoir for new antibiotic drugs while simultaneously acting as a barrier to the accumulation of ARGs.
Shifting from CAFOs to regenerative practices such as rotational grazing would decrease the need for antibiotic inputs, thereby limiting the dissemination of ARGs into the environment. Rotational grazing, or adaptive multi-paddock systems, are those that move grazing animals (ruminants such as cattle and sheep) to different areas of pastures over short periods. This practice has been demonstrated to improve soil health and metrics of biodiversity as opposed to continuous grazing, which exhibits comparatively less spatial heterogeneity for cattle over longer periods.
Investing in rotational grazing instead of feedlots would enhance soil microbial diversity, suppress the emergence of pathogens, and enhance the advent of antimicrobial compounds. Within a One Health framework, such a transition would constrain the total supply of meat and rebalance agricultural production with externalized public health and environmental costs. For example, the gut resistome of animals could return to a homeostatic state in the process of naturally supporting soil ecosystem resilience, ultimately strengthening all three One Health domains by curbing environmental ARG proliferation throughout the food system.
A concomitant shift in the demand for animal-based food also supports AMR mitigation strategies. A comprehensive global report (2025) by the EAT-Lancet Commission outlines how the planetary health diet simultaneously improves food system sustainability, enhances public health outcomes, and lowers excessive antibiotic use. This dietary regime is characterized by a diverse consumption of whole, minimally processed plant foods, with only moderate amounts of fish, dairy and meat. Such a transition would substantially reduce the spread of ARGs while providing multiple benefits to national economies, including:
1) Reduce the global burden of AMR-associated and attributable deaths and diseases by limiting the dissemination of ARGs in the environment. Also, high-fiber-containing diets can enhance gut microbial diversity, resulting in less accumulation of ARGs in the gut resistome.
2) Increase the robustness of soil microbial ecosystems. Diverse soil microbiomes accumulate less ARGs, promote crop growth through enhanced nutrient acquisition, produce novel antibiotic compounds and sequester atmospheric carbon.
3) Curb the exacerbation of agriculture-induced environmental damage by lowering greenhouse gas (GHG) emissions (methane, nitrous oxide, etc.), land degradation and biodiversity loss.
4) Reduce the global burden of diet-attributable chronic non-communicable diseases such as cardiovascular disease, cancer, and type II diabetes.
Figure 6. Interconnected pathways linking regenerative agriculture and plant-based diets to human and planetary health
Source: Ramkumar et al., 2024
Note: The authors acknowledge that each pathway shown here is more complex and nuanced than shown. The main thematic principles of the diagram are largely accurate.
Fiscal policy can be leveraged to shift from intensive animal agriculture toward regenerative practices and to encourage changes in eating habits aligned with the planetary health diet. This can be achieved through pricing in the externalized costs of animal food production. For instance, levying fees on medically important veterinary antibiotics could encourage greater stewardship of this public good, helping to mitigate the AMR crisis while marginally increasing the price of CAFO-produced meat. Ultimately, no single policy can fully solve the problem, as AMR is rooted in structural inefficiencies rather than misaligned individual behaviors. Applying contextual frameworks like One Health to agricultural system optimization is an essential step toward advancing economic policies and practices that effectively address AMR.