A One Health framework to assess the economic returns on investment in livestock antimicrobial stewardship

Abstract

Antimicrobial use (AMU) in livestock plays a critical role in sustaining animal health and productivity, yet its overuse and misuse accelerates the emergence of antimicrobial resistance (AMR), posing systemic threats to public health, economic resilience, and global food security. While existing economic analyses have examined discrete sectoral impacts, they often overlook the complex interconnections between farm-level decision-making, governance structures, and broader macroeconomic dynamics. This perspective presents a One Health economic framework for evaluating the returns on investment (ROI) in livestock antimicrobial stewardship. Drawing on interdisciplinary literature from economics, public health, and veterinary science, we map the pathways through which policy environments, market incentives, and production systems shape AMU and influence its downstream economic consequences. By integrating microeconomic, governance, and macroeconomic perspectives, the framework offers a structured basis for evaluating trade-offs between short-term productivity gains and the longer-term costs of AMR, while identifying cross-sectoral synergies that strengthen public health and economic resilience. Designed for future application in computable general equilibrium (CGE) models, the framework offers a conceptual foundation for integrating antimicrobial stewardship into national development strategies within a One Health approach.

1. Introduction

Antimicrobials have long played a critical role in livestock production by reducing disease incidence, maintaining productivity and meeting the growing global demand for animal protein [1]. However, their overuse and misuse accelerate the development of AMR, posing significant risks for public health, animal health and economic stability [2]. Without targeted interventions, global livestock AMU is projected to rise by nearly 30 % by 2040 [3], yet the long-term economic, health and environmental consequences of this trajectory remain insufficiently accounted for in decision-making. The World Bank estimates that AMR could lead to livestock output losses ranging from 2 % in high-income countries to 11 % in low-income countries [4]. In 2019 alone, AMR was associated with an estimated 4.95 million deaths globally, including 1.27 million directly attributable to bacterial AMR [5]. This challenge exemplifies the classic tragedy of the commons, whereby individual producers benefit from short-term productivity gains through AMU, while the resulting societal costs are diffuse, persistent and global in scope [6].

In response, a One Health perspective has gained traction as a holistic approach that recognizes the interconnected nature of human, animal and environmental health [7]. Applying this lens to livestock AMU reveals that decisions at the farm level influence microeconomic factors, which shape governance, and ultimately generate macroeconomic outcomes [8]. AMR, in turn, imposes indirect costs on healthcare systems, disrupts trade and creates regulatory pressures that can alter production incentives [9]. Although these interlinkages are critical to understanding the full economic consequences of AMU and AMR, most livestock analyses have remained narrowly focused, either on the productivity impacts within the sector or on isolated animal health costs. This sectoral orientation limits the ability of decision-makers to appreciate the full range of economic interdependencies and to evaluate the potential ROI from integrated stewardship strategies [10,11].

This perspective proposes a One Health economic framework to evaluate the ROI of livestock antimicrobial stewardship. The framework synthesizes literature from economics, public health and veterinary science, and links microeconomic decision-making with governance structures and macroeconomic dynamics. It identifies three interdependent economic domains that shape AMU outcomes: (i) microeconomic factors, including on-farm behavior influenced by cost structures, risk preferences and access to animal health services; (ii) governance structures, encompassing institutional capacity, regulatory enforcement, surveillance systems and public investment; and (iii) macroeconomic conditions, including market integration, trade competitiveness and national economic resilience. These domains interact dynamically and can amplify or offset each other depending on policy context and structural conditions.

By integrating these dimensions into a unified analytical framework, we advance the theoretical foundations for ROI assessment of AMR-mitigation measures within a One Health approach. As a first step in economic modeling, the framework identifies and structures the pathways linking farm-level AMU decisions to these three domains, providing a structured basis for analyzing trade-offs between short-term productivity gains and long-term societal costs, and for identifying cross-sectoral synergies across livestock, public health and economic policy. Designed for application in CGE models, such as the Livestock Policy Simulation Model (LPSM), the framework provides a conceptual foundation to embed antimicrobial stewardship in economic models and to mainstream it across sectoral strategies, investment planning and decision-making.

2. Integrating microeconomic, governance, and macroeconomic dimensions of livestock AMU

AMU in livestock generates complex, interrelated effects that extend across production systems, governance structures, and macroeconomic performance. Understanding these connections is essential for designing interventions that sustain productivity while safeguarding long-term societal welfare. Fig. 1 presents an integrated framework showing how microeconomic factors, governance structures, and macroeconomic conditions interact to shape the incentives and constraints influencing AMU in the livestock sector.

Fig. 1.

One Health economic framework linking livestock AMU to the wider economy for assessing ROI.

At the core of this framework are microeconomic factors, including farm-level production systems, household decision-making, and resource allocation. These shape how producers weigh the short-term benefits of AMU against the potential long-term risks of AMR and the costs of adopting alternative practices. Governance structures mediate these choices through market incentives, policy instruments, and institutional arrangements. They establish regulatory, surveillance, and service-delivery environments that can encourage responsible AMU or reinforce unsustainable practices. Macroeconomic conditions capture the broader impacts of AMU on national output, employment, trade competitiveness, and market integration. These outcomes depend on how well countries balance productivity with compliance to evolving international standards and resilience to supply and market shocks.

3. Microeconomic drivers of livestock AMU

Microeconomic drivers, encompassing production factors, household decision-making, and production systems, shape AMU in ways that affect farm performance and contribute to the longer-term risk of AMR. Within a One Health perspective, these choices generate externalities that extend beyond the farm, influencing both animal health and public health, as well as wider economic outcomes. Recognizing these dynamics is central to assessing the potential ROI in antimicrobial stewardship, since the feasibility and effectiveness of alternatives to AMU depend on how producers allocate resources, manage risks, and respond to market incentives.

3.1. Factors of production

AMU functions as an input that enhances the productivity of the classical factors of production, namely capital, labor and land, by sustaining animal health and stabilizing output under diverse production conditions. The extent to which producers rely on AMU depends on the availability and quality of these factors, which shape both the feasibility of adopting sustainable alternatives and the opportunity costs of substituting antimicrobials for other inputs.

Capital availability is a central determinant of AMU. Many non-pharmaceutical interventions, such as improved housing, climate control systems, and advanced biosecurity, require significant upfront resources. When expected returns on such investments are uncertain, delayed, or perceived as lower than the immediate benefits of AMU, producers are less likely to commit to them. High interest rates, limited credit access, and underdeveloped lending systems, particularly in low- and middle-income countries, further constrain financing options [12]. In such contexts, antimicrobials often substitute for capital-intensive upgrades. Large-scale producers with stronger capital bases can afford targeted veterinary care and infrastructure improvements, thereby reducing reliance on AMU [13]. By contrast, smaller-scale operations with limited financial resources frequently turn to antimicrobials as an inexpensive means to prevent disease and maintain yields [14].

Labor availability and quality also strongly shape AMU practices. Management practices such as improved housing, stricter hygiene, and continuous monitoring demand sustained labor inputs. Where labor is scarce or costly, producers may substitute antimicrobials as a less labor-intensive option. The presence of skilled workers is equally critical. Veterinarians and trained farm staff are essential for accurate diagnoses, proper dosing, and adherence to treatment protocols, all of which reduce misuse and help slow the development of resistance [15]. In areas where veterinary services are limited or costly, farmers often self-medicate or rely on broad-spectrum antimicrobials, increasing the likelihood of inappropriate use. In high-risk environments without insurance coverage, risk-averse farmers may adopt prophylactic AMU as a form of risk management. Prescribing practices can also be distorted where veterinarians derive income from antimicrobial sales, since financial incentives may encourage higher usage [8,12].

Land availability and the cost of housing infrastructure influence AMU primarily through their effects on animal density and disease pressure. High-density housing systems for cattle, pigs, and poultry concentrate animals in limited space, which elevates exposure risks and typically requires stronger disease control measures, often increasing reliance on antimicrobials. By contrast, systems that allow greater space or lower crowding reduce infection pressure and therefore the need for routine AMU. Where land is scarce or adequate infrastructure is prohibitively expensive, crowding intensifies and prophylactic use becomes more common as a preventive strategy. These dynamics are particularly relevant in rapidly intensifying production systems, where pressure to maximize output per area often leads to management trade-offs that favor antimicrobial reliance. Conversely, where land and infrastructure resources permit lower stocking densities, investments in animal health can be more readily aligned with reduced AMU, as infection risks are naturally mitigated.

3.2. Households

At the household level, AMU functions as a safety net input that helps protect livestock assets by reducing the risk of disease outbreaks that would otherwise undermine milk yields, weight gains, or egg production. Such stability is particularly important for smallholder families who depend on livestock not only for income but also for food, manure, and cultural practices [16,17]. Yet, overuse raises the risk of resistance [18], potentially increasing production costs and inflating prices of essential animal products. Given their relative affordability and immediate effectiveness, antimicrobials are often the most accessible disease prevention tool for resource-constrained households. However, this reliance can ultimately undermine livelihoods, including food security, and exacerbate vulnerability among certain groups [19].

Farmer characteristics strongly influence AMU practices. Risk aversion, education level, and disease detection skills can predispose households to specific patterns of use [20]. Beyond formal education, managerial capacity in areas such as record-keeping and disease monitoring affects a household's ability to adopt prudent AMU practices. Risk-averse households, particularly those close to subsistence, may adopt prophylactic AMU to avoid the economic shock of livestock loss even when such use is inefficient. In many low-income settings, limited access to vaccination programs or veterinary services reinforces this behavior and makes antimicrobials the default strategy [21]. Information asymmetry further contributes to misuse, since farmers often lack reliable guidance on dosages, timing, and withdrawal periods, leading to practices such as partial treatments or routine prophylactic dosing that accelerate resistance [1].

Financial constraints add another layer of complexity. Households with limited access to savings or credit must weigh AMU against competing priorities such as food, education, or healthcare. Because antimicrobials are relatively inexpensive and provide immediate protection, they are often favored over preventive measures such as vaccination or improved housing, which require higher upfront investments and deliver benefits only in the longer term. These opportunity cost trade-offs explain why households may continue to prioritize AMU despite its long-term risks. In sum, household AMU behavior reflects a balance of affordability, access, risk management, and knowledge, all of which vary widely across contexts and shape the aggregate burden of AMR.

3.3. Production systems

Production systems strongly shape patterns of AMU. High-density operations create greater disease pressure, leading producers to rely more heavily on prophylactic or growth-promoting antimicrobials to sustain productivity. Since the mid-twentieth century, such practices have enabled the rapid intensification of livestock production, allowing industrial-scale operations to meet rising demand for meat, dairy, and eggs at relatively low unit costs [22]. Yet, these same conditions amplify the risk of overuse, reinforcing a cycle in which antimicrobials are increasingly used as a form of insurance against disease losses [23]. Easy access to antimicrobials, especially where regulatory oversight is weak, further lowers the barriers to frequent and preventive use.

The economic advantages of intensification can obscure the opportunity costs of overreliance on antimicrobials. Investments that could strengthen resilience through vaccination, improved housing, or biosecurity are often diverted toward preventive or metaphylactic antimicrobial regimens [24]. Market competition also incentivizes cost-cutting strategies, including continued use of growth promoters despite resistance concerns. At the same time, global shifts in consumer preferences toward antibiotic-free or sustainably produced animal products are placing new pressures on producers, particularly those engaged in export markets, to adjust their AMU practices. Smaller-scale farms with limited margins often resort to cheaper antimicrobials, while larger farms with greater resources may adopt more selective usage [25]. Fluctuations in antimicrobial prices or supply can further destabilize decisions, creating difficult trade-offs in animal health management.

Over time, this reliance on pharmaceutical interventions enhances short-term efficiency but also raises the long-term risk of AMR in both animal and human populations [26,27]. The very factors that drive productivity gains, such as high density, rapid growth, and reduced mortality, simultaneously increase infection risk and expand the demand for AMU. Production system choices are therefore shaped not only by immediate efficiency goals but also by regulation, market incentives, and consumer preferences, all of which determine the balance between short-term gains and long-term risks.

4. Governance dimensions of antimicrobial stewardship

Governance structures are central to shaping AMU in livestock, setting the “rules of the game” through market incentives, public-sector interventions, and institutional frameworks. The quality of governance strongly influences the ROI in stewardship, since it determines the relative attractiveness of preventive measures compared with routine AMU. At the same time, AMU decisions feed back into governance by creating new market demands, regulatory pressures, and institutional mandates. This section examines how markets, governments, and institutions interact to influence AMU and shape the economic viability of stewardship strategies.

4.1. Markets

Market forces profoundly influence how antimicrobials are accessed, prescribed, and used, shaping both on-farm decisions and broader supply-chain dynamics. In many livestock systems, vertically integrated operations and contract farming arrangements set de facto standards for veterinary protocols, sometimes mandating routine use of medicated feed to maintain consistent outputs [28,29]. Larger, better-capitalized firms often have the resources to employ diagnostics, veterinary oversight, and data-driven usage protocols, whereas smaller producers with narrower profit margins tend to rely on prophylactic antimicrobials as a low-cost buffer against disease risk. These differences create fragmented usage patterns even within the same supply chain, complicating efforts to coordinate or standardize responsible AMU practices [8].

The pricing of antimicrobials, shaped by patent protections, generic drug availability, and regulatory policies, directly affects usage decisions. Where antimicrobials are inexpensive or widely available without oversight, farmers may favor prophylactic or metaphylactic use as a seemingly cost-effective substitute for labor- or capital-intensive interventions [30]. In some contexts, government subsidies or weak enforcement of prescription-only rules further lower prices, reinforcing habitual AMU and reducing incentives for preventive health measures. Low prices can also encourage overuse and the entry of substandard or counterfeit products, exacerbating the risk of treatment failures and resistance [26,31].

Access is also mediated by supply chain logistics. In areas with dense veterinary networks or informal drug markets, antimicrobials are more readily available and more frequently used. Conversely, when antimicrobial prices rise due to market forces or policy measures such as taxes or user fees, producers may shift toward alternatives such as biosecurity, vaccinations, or improved husbandry, re-evaluating the cost–benefit calculus of routine AMU [32]. Supply disruptions from trade restrictions, production issues, or regulatory changes can also create shortages, pushing producers toward lower-quality or unregulated alternatives and complicating disease management.

Beyond farm-level decisions, downstream actors increasingly shape AMU standards. Retailers, food processors, and brand owners are responding to consumer demand for “antibiotic-free” or sustainably produced animal-source foods [33]. These private standards often require traceability systems and third-party certifications that restrict routine AMU. Producers unable to comply risk exclusion from high value markets, highlighting how private governance can reward prudent AMU while penalizing unsustainable practices. At the same time, strong global demand for low-cost protein sustains incentives for intensive, high-volume production reliant on antimicrobials. Competitive pressures, particularly in export-oriented or low-margin markets, can therefore reinforce dependence on AMU even as regulatory and consumer expectations push toward reduction.

In this way, market dynamics are inherently two-sided. On one hand, they can accelerate responsible AMU adoption through premiums, certifications, and reputational benefits; on the other, they can perpetuate cost-minimizing strategies that amplify AMR risks. Since trade policies, consumer preferences, and technological innovations shift rapidly, governance strategies must remain adaptive to ensure that stewardship interventions internalize social costs, realign incentives, and improve the ROI of responsible AMU practices [34,35].

4.2. Governments

Public-sector interventions play an indispensable role in steering AMU toward outcomes more closely aligned with societal and One Health objectives. Excessive or improper use of antimicrobials in livestock exemplifies a classic economic externality, in which the private benefits accruing to producers lead to collective drawbacks, including the spread of resistant pathogens and escalating healthcare costs [1,8]. As standard market forces do not internalize these widespread risks, government action is essential to correct market failures, protect public health, and ensure the long-term efficacy of existing antimicrobial options.

Regulatory frameworks range from stringent requirements, such as mandated veterinary prescriptions and restricted over-the-counter sales, to more holistic strategies targeting per capita antimicrobial consumption in the livestock sector [2,36]. Such command-and-control policies can curtail some of the most harmful usage practices, but they often demand robust enforcement capacity and political resolve. Their effectiveness depends on well-resourced regulatory institutions capable of monitoring compliance, imposing penalties, and coordinating across sectors. Additionally, compliance costs may weigh heavily on smaller-scale producers, necessitating parallel investments in extension services, veterinary infrastructure, and access to affordable alternatives such as vaccines or biosecurity measures [37].

Economic instruments offer another policy lever to influence producers' cost–benefit calculations. Taxes on antimicrobials, for example, can discourage unwarranted use while generating revenue to support surveillance systems, research on novel treatments, and programs that promote responsible AMU [32]. Likewise, subsidies or targeted grants can facilitate the adoption of sustainable disease management practices such as vaccination, improved housing, or precision livestock farming technologies. These approaches require careful calibration to avoid placing disproportionate burdens on lower-income producers, but when well designed, they can accelerate the shift away from prophylactic and growth-promoting AMU [37]. A more ambitious proposal envisions cap-and-trade systems modeled on carbon markets, in which tradable permits directly limit total AMU and align sectoral practices with broader public health goals [1]. While still largely theoretical, such mechanisms reflect a growing consensus that market-based incentives can complement direct regulation in mitigating AMR.

Governments also rely on regulatory tools such as prescription mandates, import controls, and sanitary and phytosanitary (SPS) standards to align domestic practices with trade obligations. Increasing public concern over residues and AMR has driven stricter regulations, while effective enforcement relies on robust customs, testing, and interagency data sharing. In addition to rules and financial instruments, governments increasingly recognize the need for cross-ministerial and multi-level coordination, given that AMU intersects with public health, agriculture, trade, and environmental conservation. National action plans, often aligned with the Global Action Plan on AMR spearheaded by the World Health Organization (WHO), Food and Agriculture Organization of the United Nations (FAO), World Organisation for Animal Health (WOAH), and United Nations Environment Programme (UNEP) exemplify integrated governance. These strategies typically encompass improved surveillance, enhanced diagnostics, public awareness campaigns, and inter-sectoral training programs, illustrating how government-led coordination can amplify the benefits of responsible AMU.

Ultimately, effective government interventions strike a delicate balance; they must safeguard public health and environmental sustainability without compromising the livelihoods of producers, particularly in low-income regions. By acknowledging that AMU choices have far-reaching consequences, including impacts on macroeconomic performance, trade competitiveness, and social well-being, policymakers can design targeted, evidence-based measures that optimize resource allocation while mitigating the long-term threat of AMR. Sustained international cooperation, including technical and financial support for low-income countries, is essential to ensure equitable and effective enforcement of AMU regulations globally.

4.3. Institutions

Institutions, including veterinary authorities, financial systems, and international organizations, form the structural backbone of AMU governance, ensuring that policy measures are both feasible and sustainable. At the national level, veterinary services are central to this institutional architecture. Where veterinary capacity is strong, producers benefit from accurate diagnoses, targeted treatment guidance, and reliable monitoring of antimicrobial prescriptions [36]. In contrast, weak veterinary infrastructures, whether due to funding shortages, uneven geographic coverage, or inadequate training, create conditions for indiscriminate sales, self-medication, and substandard drug use, all of which heighten AMR risks [37]. Robust surveillance systems are essential for tracking AMU and meeting international reporting standards, while institutional gaps in monitoring can hinder market access and undermine antimicrobial stewardship.

Institutional efficacy hinges on the quality of AMU and AMR surveillance systems. Timely, high-resolution data can alert policymakers to emerging hotspots of resistance, enabling a rapid response and more precise interventions [11]. Inadequate or fragmented surveillance, however, not only jeopardizes public health but can undermine trade relations if international partners question the credibility of a country's monitoring and reporting regimes [33]. Thus, investments in data infrastructure and coordination among governmental, academic, and private stakeholders become critical components of AMR mitigation strategies.

Financial institutions further shape AMU patterns by influencing producers' access to credit, insurance, and other capital resources. Without adequate financing, small-scale farmers may lack the means to transition toward higher-welfare housing, vaccination, and preventive management strategies, instead resorting to routine antimicrobial usage [38]. Institutions also serve as delivery channels for market-based incentives, including subsidies for vaccination or biosecurity improvements, and insurance schemes that reduce the financial risks of adopting lower-AMU production systems. Conversely, credit programs or risk-sharing mechanisms that incentivize biosecurity investments can lower the perceived costs of reduced AMU, making responsible practices more attractive.

International organizations such as WHO, FAO, WOAH, and UNEP provide overarching guidelines, coordinate capacity-building efforts, and promote best practices across borders. These institutions facilitate policy harmonization, create platforms for data sharing, and offer technical support to countries with limited resources. However, their effectiveness in shaping AMU outcomes depends on national commitments and the extent to which international guidelines are incorporated into domestic legislation and practice. Beyond technical support, institutional effectiveness depends on governments' ability to enforce regulations, conduct inspections, and apply penalties for non-compliance, functions that are often under-resourced in many low-income settings. Disparities in governance capacity, regulatory enforcement, and economic development often result in uneven implementation, perpetuating opportunities for high AMU and associated AMR risks.

Moreover, institutions play a vital role in fostering education and awareness among both producers and consumers. Targeted training programs for veterinarians and extension agents, coupled with community-level outreach, can transform AMU practices by clarifying dosage, withdrawal periods, and the importance of monitoring. Over time, such efforts not only strengthen the scientific basis of livestock health management but also raise societal awareness of AMR. This, in turn, can alter consumer behavior, driving demand for products adhering to stricter AMU standards and reinforcing market incentives for prudent usage. In essence, well-functioning institutions enable a virtuous cycle; informed stakeholders adopt responsible AMU, which sustains animal and public health, stabilizes markets, and bolsters national and global food security. Strengthening institutional capacity, particularly in low-resource settings, is essential to ensure equitable and effective implementation of global AMU governance.

5. Macroeconomic forces shaping AMU

Macroeconomic forces strongly influence patterns of AMU in livestock, shaping both the incentives to rely on antimicrobials and the ROI in stewardship. National growth strategies, fiscal pressures, trade competitiveness, and global demand for animal protein interact with on-farm decisions, reinforcing or undermining efforts to reduce AMU. Assessing AMU through a macroeconomic lens therefore provides a clearer picture of the potential spillovers of stewardship, highlighting how domestic policy, trade regimes, and global governance shape the balance between immediate returns and sustainable economic outcomes.

5.1. Domestic economy

Livestock production is a major driver of agricultural gross domestic product (GDP) in many low- and middle-income countries, contributing substantially to national incomes and employment [17]. Beyond farm-gate revenues, the sector sustains upstream industries such as feed manufacturing and veterinary pharmaceuticals, and downstream activities including processing, transport, and retail. These linkages create multiplier effects that stimulate wider economic growth [39]. Compared with many crop-based systems, livestock value chains tend to generate greater value addition through processing, branding, and cold chain logistics, thereby amplifying spillover effects across the economy [40].

Within this system, AMU shapes the domestic return on investment in livestock. In the short-term, widespread AMU can sustain productivity and lower production risks, supporting output, jobs, and fiscal revenues. Yet this reliance also exposes structural vulnerabilities. If antimicrobial prices rise, regulations tighten, or supply chains for veterinary drugs and feed are disrupted, production costs may escalate, reducing competitiveness and triggering volatility in food prices. Such shifts affect consumer purchasing power and inflation, with broader implications for economic stability. In net food-importing countries, AMU-related trade restrictions can further affect food availability and prices, placing pressure on both households and government budgets.

Domestic AMU patterns also influence fiscal and consumer dynamics. Reduced livestock productivity from rising AMR may shrink the tax base, while public spending on health care or subsidies for alternative technologies increases fiscal pressure. Governments increasingly deploy market-based instruments, such as taxes on non-therapeutic AMU or subsidies for AMR-reducing technologies, to realign producer incentives with public health objectives. At the same time, consumer concerns over AMR and residues in animal-source foods are shifting demand toward “antibiotic-free” products [41]. This creates both pressure and opportunity for domestic producers: those investing in certification and transparent supply chains may gain credibility and competitiveness, while others risk losing market share.

5.2. Trade

Livestock-producing economies operate in a deeply interconnected global trade system where cost competitiveness often determines export success. In the short term, AMU supports cost-effective production by reducing disease risks and sustaining high volumes, a clear advantage for exporters competing in price-sensitive markets [33]. This cost orientation is reinforced by the absence of binding international rules on AMU, leaving enforcement largely at the national level. As a result, producers may prioritize short-term returns through intensive AMU strategies, even if such practices raise longer-term risks.

Over the longer term, however, evolving international standards and stricter residue limits increasingly shape market participation. Non-compliance with residue thresholds [42] can trigger import bans, heightened inspections, and reputational costs, undermining exporters' access to high-value markets. In contrast, countries that adopt stringent AMU regulations and certification systems can gain access premium markets at higher price points, although compliance raises production costs and may disadvantage small-scale or resource-constrained producers. The European Union illustrates this dynamic, where strict residue limits, aligned with Codex standards, have been compatible with exporters that phased out AGPs, securing access to premium markets in the EU and United States [43]; whereas exporters with weaker AMU oversight have faced periodic restrictions and, redirects to lower-value markets [44].

Trade disruptions linked to foodborne AMR also illustrate the risks of excessive reliance on AMU. In 2018, the European Union suspended poultry imports due to Salmonella strains resistant to multiple antimicrobials, while between 2019 and 2020, the U.S. Food and Drug Administration rejected shrimp shipments after detecting multidrug-resistant Vibrio species [44,45]. For exporters, such incidents represent lost revenues and reputational harm; for import-dependent countries, they threaten food availability and affordability, with implications for food security.

Consumer preferences in importing countries add another layer of complexity. Rising demand for responsibly produced, certified, or “antibiotic-free” products creates lucrative niches for exporters that invest in prudent AMU practices [41,46]. At the same time, persistent global demand for low-cost animal protein sustains incentives for high-volume production reliant on AMU [30]. These divergent signals mean that AMU choices shape not only immediate competitiveness but also longer-term access to markets.

From an ROI perspective, reliance on AMU delivers short-term efficiency gains and export revenues but exposes producers to mounting risks as standards tighten and consumer scrutiny grows. Countries and producers that invest early in compliance, certification, and alternative health management strategies may face higher costs initially, yet they secure resilience, price premiums, and stable market access over time. Conversely, those that delay adaptation risk exclusion from premium markets, growing vulnerability to trade disruptions, and long-term erosion of export competitiveness.

5.3. Global economy

Rising global demand for animal-source foods, particularly in developing regions, places sustained pressure on AMU to maintain high yields and disease control. In the short-term, AMU enables producers to maintain output and contain costs, which is critical for both food security and economic development. Yet reliance on this strategy creates systemic vulnerabilities. As leading exporters reduce the use of growth-promoting antimicrobials or tighten residue limits, these supply-side shifts can raise international prices, affecting affordability and altering welfare distribution among nations. Countries with historically high AMU dependence may find it difficult to remain competitive in global markets, risking disruptions to domestic livelihoods and food availability. Policy changes in one region, such as AMU bans or stricter maximum residue limits, can also create ripple effects across global supply chains, reshaping trade flows and price dynamics, with food-insecure import-dependent countries bearing the greatest risks [33,42].

Over the long-term, the unchecked misuse of AMU and the consequent rise of AMR could impose far greater costs on the global economy. Once resistance becomes widespread, higher AMU no longer guarantees effective disease control, undermining livestock productivity and food supply stability. The broader economic burden of AMR, including rising healthcare expenditures, productivity losses, and reduced agricultural efficiency, threatens public finances and could widen disparities between countries at different income levels [1,47].

These challenges are compounded by inequality. High-income countries can often absorb compliance costs and invest in alternative technologies, maintaining access to premium markets. By contrast, low- and middle-income countries may struggle to implement strict measures, risking exclusion from high-value trade and facing sharper welfare losses from higher food prices [43,44]. At the same time, the need to protect immediate herd health through metaphylaxis and prophylaxis must be weighed against the longer-term erosion of antimicrobial effectiveness. Because modern economies are tightly interconnected, regulatory changes in one country can trigger economic repercussions elsewhere, reinforcing the urgency of coordinated global action. Harmonized customs policies, trade agreements, and targeted international support are therefore essential to prevent market fragmentation and to ensure equitable access to safe and affordable animal-source foods.

6. Discussion

We propose a One Health economic framework to evaluateROI in livestock antimicrobial stewardship. By integrating microeconomic, governance, and macroeconomic dimensions, the framework demonstrates how decisions about AMU generate both immediate productivity gains and longer-term societal costs. This multi-level perspective is essential to capture the full economic consequences of AMU, which cannot be understood through narrow or sectoral analyses alone. It complements earlier One Health costing frameworks [48] by extending them into a macroeconomic assessment of returns to stewardship.

At the farm-level, AMU decisions often reflect rational responses to constraints in capital, labor, and infrastructure. For smallholders in particular, antimicrobials function as a low-cost form of insurance that stabilizes production and protects household assets. Yet these micro-level practices generate externalities that extend far beyond the farm, reinforcing the misalignment between private incentives and collective welfare.

Governance structures determine whether stewardship appears as a burden or an investment. In environments where antimicrobials are inexpensive and weakly regulated, misuse is reinforced, and preventive alternatives remain unattractive. By contrast, strong institutions, effective regulatory frameworks, and market incentives can shift the balance in favor of responsible use. The return on stewardship is therefore not fixed, but highly dependent on policy context and institutional capacity.

Macroeconomic forces amplify these dynamics. While widespread AMU can support output, trade, and fiscal revenues in the short-term, it increases vulnerability to productivity losses, evolving consumer standards, and trade restrictions in the longer term. Countries that invest early in stewardship may bear higher initial costs, yet they secure competitiveness, resilience, and access to premium markets, while those that delay face greater risks of exclusion and long-term welfare losses.

This framework advances beyond previous approaches by moving from sectoral assessments of productivity or public health costs to a unified structure that links farm-level incentives with national and global outcomes. It provides a conceptual foundation for embedding antimicrobial stewardship into economic modelling. Future research should operationalize these pathways within dynamic CGE models, such as the LPSM, to explore alternative policy scenarios, assess trade-offs, and conduct sensitivity analyses under varying technological, market, and governance conditions.

Finally, stewardship outcomes hinge on the interaction of key stakeholders. Farmers shape AMU through their production decisions, policymakers set incentives and regulatory environment, pharmaceutical firms influence both drug availability and the development of alternatives, and consumers create demand patterns that reinforce or shift production practices. Aligning these roles is essential for translating the framework into practice, as it provides a structured basis for dialogue across actors and for designing strategies that are both economically viable and sustainable in the long-term.

7. Conclusion

This framework is an initial step toward understanding the economic linkages between AMU in livestock and the broader economy. By situating farm-level incentives within governance arrangements and macro-level forces, it shows that AMU cannot be addressed in isolation and provides a basis for evaluating the ROI in livestock antimicrobial stewardship, where short-term productivity gains must be weighed against longer-term societal costs. Sustainable reductions in both AMU and AMR require recognition of the interconnected roles of livestock production, public health, trade, and environmental stewardship. The framework reframes AMU as an economic and policy issue rather than solely a veterinary concern and serves as a foundation for more comprehensive analyses.

The next challenge is to translate these conceptual insights into actionable policy measures. Further research is needed to test the framework's assumptions across diverse production systems and country contexts, and to incorporate the behavioral dimensions of farmer decision-making. Ensuring that interventions are both equitable and implementable will be critical to aligning the sector's near-term productivity goals with the longer-term imperative of safeguarding antimicrobial effectiveness. This requires coherent policy packages, stronger institutional capacity, and international support to transform stewardship from an abstract objective into measurable reductions in AMU.

Looking ahead, the framework provides a foundation for empirical applications capable of quantifying the economic ROI in livestock antimicrobial stewardship. Its conceptual pathways can be operationalized within dynamic CGE models to examine alternative policy scenarios, assess trade-offs, and test sensitivity under varying technological, market, and governance conditions. At the same time, such extensions will not only validate the framework but also facilitate policy dialogue among stakeholders and generate context-specific evidence to guide adaptive strategies for AMU reduction that safeguard public health and support the sustainable transformation of livestock production systems.

CRediT authorship contribution statement

Alejandro Acosta: Writing – review & editing, Writing – original draft, Visualization, Supervision, Methodology, Formal analysis, Conceptualization. David Roland Holst: Writing – original draft, Visualization, Formal analysis. Francesco Nicolli: Writing – original draft, Visualization, Formal analysis. Wondmagegn Tirkaso: Writing – review & editing. Jozimo Santos Rocha: Writing – review & editing. Junxia Song: Writing – original draft, Funding acquisition.

Declaration of competing interest

The authors declare no competing interest.

Data availability

No data was used for the research described in the article.