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A framework for improved one health governance and policy making for antimicrobial use
  1. Dominic Moran
  1. Global Academy of Agriculture and Food Security, The Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Edinburgh, UK
  1. Correspondence to Professor Dominic Moran; dominic.moran{at}


There is a need to develop an evaluation framework to identify intervention priorities to reduce antimicrobial use (AMU) across clinical, agricultural and environmental settings. Antimicrobial resistance (AMR) can be conceptualised and therefore potentially managed in the same way as an environmental pollution problem. That is, over-use of antimicrobial medicines as inputs to human and animal health leads to unintended leakage of resistance genes that further combine with natural or intrinsic resistance in the environment. The diffuse nature of this leakage means that the private use decision is typically neither cognisant, nor made responsible for the wider social cost, which is the depletion of wider antibiotic effectiveness, a common pool resource or public good. To address this so-called market failure, some authors have suggested a potential to learn from similar management challenges encountered in the sphere of global climate change, specifically, capping use of medically important drugs analogous to limits set on greenhouse gas emissions. Drawing on experience of the economics of greenhouse gas mitigation, this paper explores a potential framework to develop AMU budgets based on a systematic comparative appraisal of the technical, economic, behavioural and policy feasibility of AMU reduction interventions across the One Health domains. The suggested framework responds to a call for global efforts to develop multi-dimensional metrics and a transparent focus to motivate research and policy, and ultimately to inform national and global AMR governance.

  • antimicrobial use
  • governance
  • One Health
  • economics

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  • Handling editor Peter MacGarr Rabinowitz

  • Contributors DM conceived the idea and drafted paper.

  • Funding The authors acknowledge support from UK Newton Fund awards co-funded by the Economic and Social Research Council grant numbers ES/S000216/1 and ES/S000208/1, linked to the India Department of Biotechnology grant numbers BT/IN/Indo-UK/AMR/05/NH/2018-19 (DARPI), and BT/IN/Indo-UK/AMR/03/RKE/2018-19 (DOSA).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement There are no data in this work.