Is the Silent War Too Silent? A Qualitative Study on How Risk and Crisis Managers in Sweden Perceive Antibiotic Resistance in Times of War

Abstract

Introduction: In 2022, the war between Russia and Ukraine began. War has been proven to be a catalyst for antibiotic resistance (AR). AR is among the largest health threats in the world and by 2050 it’s expected to cause 10 million annual deaths. Sweden is facing the threat of war, but no evidence suggests that Swedish authorities preparing the nation for war are concerned about this threat. Aim: The study aims to examine how local Risk and Crisis Managers in Sweden perceive the risk of a war-related increase in AR if war extends to Sweden. Methods: This qualitative study used purposive sampling to target Risk and Crisis Managers at municipal, regional or county level in various parts of Sweden. The data was collected through six semi-structured interviews and analyzed by manifest content analysis. Results: Three themes each for municipalities and counties (MAC) and regions were identified that reflects key aspects related to the aim. Insights into how war-related AR is unheard of and unaddressed is gained. The two first themes also present the participants' elaborations prior to the subject of AR being brought up, reflecting about the perception of it in relation to other war-related risks. Conclusions: The participants perceived AR in war as severe but still saw the need to prioritize other risks instead, which this thesis discusses in the light of the risk prioritization paradox. None of the six authorities have prepared for a specific war-related increase in AR, which suggested by the public health program work theory might be due to a systematic failure.