Harnessing One Earth-One Health: A Unified Framework Against Antimicrobial Resistance

In an era where antimicrobial resistance (AMR) threatens public health on a global scale, the One Earth–One Health concept offers a unifying framework for coordinating multidisciplinary efforts against this persistent threat.

Context-setting: AMR does not arise within a vacuum; it reflects pressures across people, animals, and environments. The One Earth–One Health approach, as described in a recent analysis that explores integrative human–animal–environment links, underscores integrating human, animal, and environmental health perspectives. This collaborative methodology enhances global strategies against AMR by leveraging dynamic ecological feedbacks—interactions among humans, animals, and environments that can dampen the spread of resistance—and by reinforcing connections between health sectors.

Human health intersects with other systems in tangible ways. As emphasized by the One Earth–One Health model, managing AMR effectively requires understanding and acting on dynamic ecological feedbacks—reciprocal interactions across human, animal, and environmental domains that influence resistance patterns. Framing AMR through these feedbacks supports prevention, stewardship, and surveillance strategies that link clinical decision-making with environmental and veterinary practices.

The power of this lens is clearest in specific challenges such as carbapenem-resistant urinary tract infections (UTIs). As illustrated by a cohort analysis of carbapenem-resistant urinary pathogens, these infections often involve multidrug-resistant organisms such as Enterobacterales. Such pathogens can compromise the efficacy of last-line antibiotics, necessitating a deeper understanding of resistance mechanisms and therapeutic alternatives; notably, some newer β-lactam/β-lactamase inhibitor combinations have activity against many carbapenem-resistant strains, though resistance can still emerge.

The complexity of carbapenem-resistant UTIs showcases the need for innovative solutions within the One Earth–One Health framework. Cross-sector examples include targeted antibiotic stewardship in livestock to reduce environmental reservoirs that may feed back into human exposure, and wastewater surveillance that detects resistance trends early so hospitals can adjust empiric therapy and stewardship priorities before outbreaks occur.

Clinicians face greater risks of morbidity—and in some settings mortality—when options are limited, particularly in complicated or bacteremic cases, with care further hampered by diagnostic difficulties and the emergence of resistance during treatment. Practical responses include rapidly updating local antibiograms with inputs from community, hospital, veterinary, and environmental sampling; prioritizing source control and timely culture-directed therapy; and embedding pharmacist-led stewardship consults for complex cases.

Building on this mechanism-first view, the One Earth–One Health approach not only highlights the interconnectedness of health sectors but also offers a strategic pathway for addressing AMR comprehensively. This interdisciplinary approach provides a framework that not only joins human, animal, and environmental health but also supports policy coordination, for example through national action plans that align surveillance and stewardship across sectors. Translating strategy into action means better aligning incentives—such as tying procurement to stewardship metrics and harmonizing reporting so data flow between clinical, veterinary, and environmental agencies.

Real-world progress hinges on interoperable data systems and shared governance. Using the dynamic ecological feedbacks model, programs can prioritize upstream prevention (e.g., vaccination and infection prevention), midstream stewardship (right drug, dose, duration), and downstream containment (isolation, decontamination, and environmental management). Each tier draws on the same cross-sector information to anticipate where resistance is likely to emerge and to intervene earlier.

As resistance continues to evolve, training and workforce development must keep pace. Interdisciplinary education that brings together clinicians, veterinarians, environmental scientists, and data analysts builds shared mental models around dynamic ecological feedbacks and accelerates the translation of evidence into practice. Continuous quality improvement—supported by routine audit-and-feedback loops—helps systems adapt as local resistance patterns shift.

Key Takeaways:

• Anchor AMR strategy in dynamic ecological feedbacks: use integrated human–animal–environment data to anticipate where resistance will emerge and to target prevention, stewardship, and containment.
• Translate mechanisms into care: for carbapenem-resistant UTIs, pair rapid diagnostics and source control with updated local antibiograms and pharmacist-led stewardship, especially in complicated or bacteremic cases.
• Design systems for coordination: align policy levers—such as national action plans and shared reporting standards—so surveillance, stewardship, and procurement reinforce each other across sectors.
• Invest for equity: expand access to diagnostics, effective antimicrobials, and WASH infrastructure so stewardship guidance is feasible and clinically impactful in all settings.
• Build the workforce: interdisciplinary training and continuous audit-and-feedback speed the adoption of evidence-based practices as resistance patterns evolve.