There is increasing concern globally about the enormity of the threats posed by antimicrobial resistance (AMR) to human, animal, plant and environmental health. A proliferation of international, national and institutional reports on the problems posed by AMR and the need for antibiotic stewardship have galvanised attention on the global stage. However, the AMR community increasingly laments a lack of action, often identified as an ‘implementation gap’. At a policy level, the design of internationally salient solutions that are able to address AMR’s interconnected biological and social (historical, political, economic and cultural) dimensions is not straightforward. This multidisciplinary paper responds by asking two basic questions: (A) Is a universal approach to AMR policy and antibiotic stewardship possible? (B) If yes, what hallmarks characterise ‘good’ antibiotic policy? Our multistage analysis revealed four central challenges facing current international antibiotic policy: metrics, prioritisation, implementation and inequality. In response to this diagnosis, we propose three hallmarks that can support robust international antibiotic policy. Emerging hallmarks for good antibiotic policies are: Structural, Equitable and Tracked. We describe these hallmarks and propose their consideration should aid the design and evaluation of international antibiotic policies with maximal benefit at both local and international scales.
- health policies and all other topics
- public health
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Handling editor Seye Abimbola
Twitter @Kirchhelle, @BroomAlex, @IsabelFrost19, @shoffmania, @koutterson, @anthroamr, @OxonAndrew
Contributors CK and CC conceived the concept and cowrote this article with contributions from PA, AB, KC, JPF, NF, IF, CG, SH, SJH, JL, SN, KO, SHP, SR, APR, SRVK, ACS, ADS, LS, ET. CC acquired funding for the workshop and the articles.
Funding AMIS is funded by The Antimicrobial Resistance Cross Council Initiative supported by the seven research councils in partnership with other funders. The lead funders are the Economic and Social Research Council (ESRC) with the Department of Health and the Arts and Humanities Research Council (AHRC). Kirchhelle’s work was supported by a Wellcome Trust University Award at University College Dublin and the Oxford Martin School. Fortané was supported by INRAE (ANR-18-CE03-001), Frost by CDDEP, Nayiga by ESRC, Taylor by the UK Fleming Fund. APR would like to acknowledge funding from the AMR Cross-Council Initiative through a grant from the Medical Research Council, a Council of UK Research and Innovation (Grant Number; MR/S004793/1)
Disclaimer The views expressed in this article are those of the authors and do not necessarily reflect those of CIHR, the Government of Canada, or WHO.
Competing interests SH is Scientific Director of CIHR’s Institute of Population and Public Health and CIHR’s Scientific Co-Lead for Antimicrobial Resistance. He is Director of the WHO Collaborating Centre on Global Governance of Antimicrobial Resistance. KO in principal investigator of CARB-X, a project at Boston University (my employer), funded by three governments (US, UK and Germany) and two charitable foundations (Wellcome Trust and the Bill & Melinda Gates Foundation). CARB-X is a non-profit, making grants for preclinical antibacterial research. I do not view this as a conflict, but disclose in an abundance of caution. APR is the co-ordinator of the JPIAMR funded Network NEAR-AMR. ADS reports grants from ReAct-Action on Antibiotic Resistance and from Open Society Foundation during the conduct of the study. He served as Co-Convener of the UN Interagency Coordination Group on Antimicrobial Resistance (2018–2019), as a member of the Expert Commission on Addressing the Livestock Contribution to the Antibiotic Resistance Crisis (2016–2017), as a commissioned author to the UK Commission on AMR on 'A Framework for Costing the Lowering of Antimicrobial Use in Food Animal Production' (2016), as Head of the Secretariat of the Antibiotic Resistance Coalition, and as a Member of the Working Group on Antibiotic Resistance for the President’s Council of Advisors on Science and Technology (2013–2014).
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.