With evidence strongly supporting Covid-19 as a zoonotic, “animal to human disease,” this pandemic reinforces the “OneHealth” concept and the interconnectedness of human and animal health (1). Covid-19 is the most globally and societally impactful infectious disease to emerge at the human-animal interface. However, it is only one of many examples emphasising the links between human and animal health. For example, antimicrobial resistance (AMR) is a OneHealth emergency with equal, if not more, health and economic impacts (2). Antimicrobial resistance could be aggravated further as a result of Covid-19, with healthcare workers turning to antimicrobials to treat Covid-19 patients (2, 3).

Antimicrobial resistance is exacerbated by human behaviours that lead to overuse and misuse of antibiotics in human and animal health and the contamination of the environment with antibiotics. On the island of Ireland, a OneHealth approach frames the action plans of both governments to tackle AMR (4, 5). In the agricultural sector, incoming EU regulations in 2022 will target the habitually and culturally ingrained practises of using antibiotics for disease prevention in livestock and treating animals with antibiotics that are deemed critically important for human medicine (6, 7). Efforts have been intensifying to change farm-level practises in line with these regulations. Attention has also focused on how best to communicate with the public on this topic and to consider the role of market-level strategies to facilitate the systemic changes that are required (e.g., food labels and quality assurance schemes) (7, 8). On the island of Ireland, there are no quality assurance schemes which communicate specifically about antibiotic use and farm animal welfare on food labels to consumers. Front-of-pack labels require a baseline level of awareness and understanding by the consumer, and research suggests public awareness about antibiotic use on farms is low (9). Consumers are also not a homogenous group, and motivation to engage with such labels will vary. Furthermore, there are specific concerns around absence labelling schemes (e.g., “antibiotic-free”; “no antibiotics ever”) which fail to communicate the complexities of responsible antibiotic use in agriculture—on the one hand, agriculture needs to reduce its' use of antimicrobials, but to eliminate them completely could lead to unintended impacts on farm animal welfare (10, 11). Such authors have instead argued the need for a more nuanced labelling approach that communicates “responsible antibiotic use.” Moving beyond labelling, it has been argued that transformational changes are needed in the food supply chain to forge greater links between consumers and food producers (12) To explore how best to communicate with the public on this topic, research is first required to understand consumers' perceptions of AMR, OneHealth, and antibiotic use in agriculture.

As we have seen previously with concerns around agricultural practises and environmental sustainability (13), if AMR becomes a social issue of increased importance to the public, it is likely consumers will form strong opinions on agricultural antibiotic practises which could shape their purchasing and consumption decisions. Given its inherent OneHealth nature, it is worth considering what role the Covid-19 pandemic has played in catalysing consumers in this respect. Covid-19 has brought about unprecedented change in the attitudes and behaviours of humans in many areas of daily life. With respect to food, studies have already demonstrated a Covid-19 impact on food choice and purchasing habits (14, 15); cooking skills (16); and food waste management (17). The current study was interested to understand whether this effect has extended specifically to increasing consumers' awareness of OneHealth issues such as AMR; their awareness of connected animal and human health; and their awareness of animal welfare information on food packaging labels.

Almost half (46.7%) of participants indicated that they agreed (38.1%) or strongly agreed (8.6%) with the statement that as a result of the Covid-19 pandemic, “I am now more aware of antibiotic resistance.” 42.9% of the participants indicated that they agreed (33.4%) or strongly agreed (9.5%) with the statement “I am now more aware of the connection between the management of animal health and impact on human health.” Finally, one in three (33.8%) indicated they agreed (26.3%) or strongly agreed (7.5%) with the statement “I look more at the labelling on food products for animal welfare information.”

Comparison of the five clusters showed they differed significantly on socio-demographic variables and on knowledge (objective and subjective) and beliefs (risk perception and responsibility attributions) related to antibiotic use in farming and AMR (Table 2). No significant association was detected between cluster membership and gender (p = 0.1584); age (p = 0.070); country (p = 0.057); urban-rural divide (p = 0.897); grandparent/relatives owning a farm (p = 0.591); and close neighbours/friends owning a farm (p = 0.859). Each segment profile is described in the following sections with results outlined in Table 2 and Figures 1, 2.

Covid-19 has created additional challenges for tackling AMR—not least of which includes concerns over increased indiscriminate use of antibiotics to treat ill Covid-19 patients (3); but, it has also created opportunities (20). It provides a basis to build momentum amongst stakeholders to embrace collaborative actions to tackle OneHealth emergencies. This pandemic has served to make the abstract nature of the “OneHealth” concept a daily reality for many individuals and ensuring “collective responsibility” to combat Covid-19 has been a particularly resonant concept. This could have implications for how people view similar OneHealth issues such as AMR going forward. This is important; AMR is a “collective moral action problem” (21) which requires all stakeholders (e.g., vets, doctors, farmers, patients, food consumers) to change their behaviour so as to minimise the spread and development of AMR; more responsibly use antibiotics; or alleviate the need for antibiotics in the first place. At the consumer level, this equates to changing food purchasing and consumption practises (e.g., choosing food from farm systems with responsible antibiotic use practises). The current study provides early evidence that Covid-19 has catalysed increased awareness of AMR and OneHealth. There may be appetite amongst some consumers to support actions for responsible antibiotic use on farms. However, the pathway for consumer change is not straightforward. A number of conditions need to be met to ensure an effective and responsible market-level strategy.

This study shows that Covid-19 has served to catalyse awareness of AMR, OneHealth and animal welfare information on labelling amongst a specific category of consumers who as a result, are likely to be increasingly primed for market-level strategies that place a value on responsible antibiotic use (e.g., OneHealth logos, “responsible use” logos, or quality assurance marks). The current study provides an indication of likely support; further research exploring consumers' willingness-to-purchase would be of value (22). However, any market-level strategy that incorporates antibiotic-use labelling needs to ensure an environment of complete consumer awareness and understanding about the role of antibiotics in farming—both its' contribution to AMR, and the need for responsible (rather than eliminated) use of antibiotics at farm level. This is a fundamental condition for an effective labelling strategy, not only to motivate individual consumer action regarding food choices, but also to avoid any unintended impacts or fall-out from consumer confusion regards the meaning of antibiotic-use labels (e.g., “antibiotic free”) (10, 11). The current study identifies consumer segments with low awareness levels about agricultural antibiotic use practises and the role of agriculture in tackling AMR. Such consumers at present are unlikely to engage with any form of antibiotic use labels. There is a need to consider what actions beyond mere labelling may be required to minimise the detachment of many consumers from the realities of farming and agri-food production. Covid-19 also presents an opportunity to consider larger transformational changes through short supply chain initiatives that have not only proven resilient in the face of the Covid-19 crisis, but also work to reconnect food producers and food consumers (12). By whatever means, an effective market-level strategy will require thorough consumer understanding of and motivation for responsible antibiotic use in farming, as well as an understanding of the role of collective responsibility, and where the consumer sits in this, in tackling a OneHealth emergency such as AMR.

A limitation of the current study was that the survey only measured perceived increases in consumers' awareness, captured through self-report. The increased awareness of AMR, connected human and animal health, and animal welfare information on labelling could signal that the public are increasingly interested in and aware of the potential impact of transfer through the food chain and desire more assurance in food production. However, we do not have any data to support whether this increased awareness has resulted in behaviour change. Future research avenues include exploring changes in purchasing and consumption behaviour including the extent to which consumers may begin to increase their use of welfare-specific food labels or purchase products with welfare-specific value attributes.

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements. The patients/participants provided their written informed consent to participate in this study.

AR was responsible for survey design and over-seeing data collection and led data analysis and paper write-up. SS was responsible for survey design and over-seeing data collection and contributed to paper write-up, CM, TB, and MD advised on survey design and contributed to paper write-up. JH advised on data analysis and contributed to paper write-up. All authors contributed to the article and approved the submitted version.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.