What comes to your mind when you hear the term “antimicrobial resistance”? Is it a petri dish or perhaps a vague health-related image? For many of us, the term might not evoke any clear picture at all.

Few people know that antimicrobial resistance describes one of the biggest health threats of the 21^st century. It refers to a process whereby germs such as bacteria become stronger over time so that existing medicines such as antibiotics no longer kill them. This means that common infections like pneumonia may become impossible to treat. After being hospitalised with severe pneumonia earlier this year, I certainly understand the importance of effective antibiotics.

Yet, the outlook is bleak. In 2019, 4.95 million people died because of antimicrobial resistance—an eye-watering number that overshadows the 3.3 million COVID-19 death toll a year later. Furthermore, with antimicrobial resistance on a constant rise, experts predict it will overtake cancer as a leading cause of death over the next 25 years.

The importance of behaviour change

Given these alarming statistics, it's puzzling why many continue to overlook the threat of antimicrobial resistance. After all, everybody knows about the threat of cancer. As soon as a doctor mentions the “Big C”, patients brace themselves and hope for the best. Being aware of cancer risks may even motivate people to embrace lifestyle changes like quitting smoking or reducing alcohol intake. Why isn’t this the case for antimicrobial resistance?

Even though the process of antimicrobial resistance can’t be stopped completely, it can be slowed through simple actions like using antibiotic medicines more sparingly and only when absolutely necessary. We can also help to prevent infections from occurring in the first place—for example by getting vaccinated and washing our hands more frequently. If people adapt their behaviour to prevent cancer, why don’t they do the same for antimicrobial resistance?

Problematic terminology

Recent research suggests that antimicrobial resistance has a language problem. We need effective terminology to communicate the threat it poses. This terminology is necessary for making sure that people remember the issue, take it seriously and consequently adapt their behaviour. Yet, the current language associated with antimicrobial resistance is inadequate to say the least. Firstly, many different names are used interchangeably to describe the same phenomenon. In addition to “antimicrobial resistance”, scientists and media alike use synonym terms such as “antibiotic resistance”, “bacterial resistance”, “superbugs”, “drug-resistant infections” or the acronym “AMR”. Such inconsistency leads to confusion..

Furthermore, none of the many existing names actually appear to be effective as shown in our recent two-part study published in Communications Medicine. We tested how well members of the US and UK general population remembered different names referring to the issue of antimicrobial resistance. We also investigated how much risk they associated with these terms. Finally, we asked participants to score the different names of antimicrobial resistance on linguistic dimensions such as “pronounceability” and “familiarity”.

As expected, memory for the different names of antimicrobial resistance was much poorer compared with names of other health and illness terms such as “cancer”, “Ebola”, “HIV” and “heart disease”. Participants also didn’t seem to think that “antimicrobial resistance” sounded like a big threat. Finally, they generally rated the associated names as harder to pronounce and less familiar. Out of the different terms associated with antimicrobial resistance, some fared slightly better than others. For instance, memorability for the name “antibiotic resistance” was higher than for the other names and the name “drug-resistant infections” appeared to signal the greatest risk. Overall, however, none of the existing terminology was as effective as names referring to other major illnesses and health threats.

What can we do?

Our research indicates a pressing need for clearer language to convey the risks of antimicrobial resistance and inspire essential behavioural change. Scientists, politicians and key stakeholders will have to get their act together and come up with a new name that is effective for risk communication and can be used consistently moving forwards. A term that's easy to pronounce and familiar will likely be more effective. The re-naming of health threats has worked in the past, for example when re-naming “gay-related immune deficiency” as “HIV/Aids” or “Wuhan novel coronavirus” as “COVID-19”. We need to learn from those past successes and apply lessons learned to the case of antimicrobial resistance.

Meanwhile, we all can play a part in raising awareness about antimicrobial resistance. To obtain more background information about the issue, existing information leaflets or factsheets may help. Additionally, why not make a personal pledge to become an antibiotic guardian and make a contribution towards preservation of antibiotics? If you decide to take this step, please don’t forget to share your pledge online!