Beyond antibiotics: Vaccines as catalysts for one health solutions to antimicrobial resistance

Abstract

Antimicrobial resistance (AMR) is a leading global health threat, with drug-resistant infections contributing to 4.95 million deaths in 2019 and projections of up to 10 million annual deaths by 2050. AMR undermines the effectiveness of antimicrobials across human, animal, and environmental domains, demanding integrated One Health solutions. This study positions vaccines as central tools in mitigating AMR by synthesizing interdisciplinary evidence from peer-reviewed literature and global policy briefs. Evidence was synthesized through a structured narrative review using PubMed, Scopus, Web of Science, and Google Scholar. Gray literature from the World Health Organization, Food and Agriculture Organization, World Organization for Animal Health, and United Nations Environment Programme was included. Thematic analysis mapped vaccine impacts to antimicrobial use reduction, transmission control, and One Health integration. In contrast to antibiotics, which act therapeutically and exert strong selective pressure on pathogens, vaccines act prophylactically, inducing polyclonal and multi-epitope immune responses that minimize opportunities for resistance emergence. Evidence demonstrates that pneumococcal conjugate vaccination reduced multidrug-resistant infections by over 80%, while influenza vaccination lowered antibiotic prescriptions by 50% in clinical trials and by 64% in population-level analyses. In livestock, vaccines against pathogens such as Lawsonia intracellularis , Salmonella, and avian pathogenic Escherichia coli significantly reduced antibiotic use, thereby limiting residues and resistant microbes entering food chains. Aquaculture vaccines, including nano-formulated and recombinant platforms, achieved protective efficacy above 80%, reducing reliance on prophylactic antibiotics. Environmental integration through wastewater AMR surveillance and soil microbiome monitoring further strengthens vaccine-based strategies. Embedding vaccines within national antimicrobial stewardship programs and One Health action plans offers cost-effective, equitable, and sustainable reductions in AMR burden, particularly in low- and middle-income countries, where vaccine coverage remains sub-optimal. Limitations such as vaccine hesitancy, cold-chain fragility, and pathogen variability must be addressed through innovation, regulatory strengthening, and equitable access. In conclusion, vaccines represent durable, cross-sectoral interventions that protect Health holistically beyond antibiotics, making them indispensable catalysts for One Health solutions to AMR.