Comparing the Antimicrobial Resistance Crisis to the COVID-19 Pandemic: A Randomized Public Health Messaging Experiment

BACKGROUND: Antimicrobial resistance (AMR) is an urgent health threat. Effective communication about AMR and avoiding antibiotics for viral infections is a public health priority. Here, we evaluated whether comparing the AMR crisis to the coronavirus disease 2019 (COVID-19) pandemic could enhance public understanding of AMR and reduce intentions to seek unnecessary antibiotics. METHODS: In this randomized online survey (March-April 2024), US adults were randomized to receive 1 of 3 messages: (1) written message describing the AMR crisis (control); (2) written message comparing AMR to the COVID-19 pandemic; or (3) a series of poster-like graphics comparing AMR to the COVID-19 pandemic. Respondents then read a scenario describing a viral respiratory infection (where antibiotics are not clinically indicated) and asked to indicate whether they would (1) respond by visiting a primary care clinician and (2) desire to take antibiotics. RESULTS: The final sample (N = 972, completion = 90%) had a mean age of 42 years and 58% identified as female. No statistically significant differences were found between messages for intention to visit a primary care clinician (P = .625) or desire to take antibiotics (P = .157). Across all respondents, older age and independent/third-party political affiliation were associated with lower antibiotic-seeking intentions, whereas medical maximizing, prior antibiotic use, being vaccinated for COVID-19, and pride in that status were associated with higher intentions. CONCLUSIONS: Comparing the threat of AMR to the COVID-19 pandemic did not reduce antibiotic-seeking intentions, indicating this analogy may not be an effective messaging strategy. Adults with greater care-seeking behaviors and preferences were more likely to report antibiotic-seeking intentions.