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Setting the standard: multidisciplinary hallmarks for structural, equitable and tracked antibiotic policy
  1. Claas Kirchhelle1,2,
  2. Paul Atkinson3,
  3. Alex Broom4,
  4. Komatra Chuengsatiansup5,
  5. Jorge Pinto Ferreira6,
  6. Nicolas Fortané7,
  7. Isabel Frost8,9,
  8. Christoph Gradmann10,
  9. Stephen Hinchliffe11,
  10. Steven J Hoffman12,
  11. Javier Lezaun13,
  12. Susan Nayiga14,
  13. Kevin Outterson15,
  14. Scott H Podolsky16,
  15. Stephanie Raymond4,
  16. Adam P Roberts17,
  17. Andrew C Singer18,
  18. Anthony D So19,20,
  19. Luechai Sringernyuang21,
  20. Elizabeth Tayler22,
  21. Susan Rogers Van Katwyk12,23,
  22. Clare I R Chandler24
  1. 1School of History, University College Dublin, Dublin, Ireland
  2. 2Oxford Martin School, University of Oxford, Oxford, Oxfordshire, UK
  3. 3Department of Public Health and Policy/ Institute of Infection and Global Health, University of Liverpool, Liverpool, Merseyside, UK
  4. 4School of Social and Political Sciences, Faculty of Arts and Social Sciences, The University of Sydney, Sydney, New South Wales, Australia
  5. 5Princess Maha Chakri Sirindhorn Anthropology Center, Bangkok, Thailand
  6. 6Antimicrobial Resistance and Veterinary Products Department, World Organisation for Animal Health, Paris, Île-de-France, France
  7. 7Irisso, Paris-Dauphine University, PSL, INRAE, Paris, Île-de-France, France
  8. 8Center for Disease Dynamics Economics and Policy, Washington, DC, USA
  9. 9Department of Infectious Disease, Imperial College London, London, UK
  10. 10Institute for Health and Society, Dept. of Community Medicine and Global Health, University of Oslo, Oslo, Norway
  11. 11Geography, College of Life and Environmental Sciences and Wellcome Centre for Cultures and Environments of Health, University of Exeter, Exeter, Devon, UK
  12. 12Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, Toronto, Ontario, Canada
  13. 13Institute for Science, Innovation and Society, School of Anthropology and Museum Ethnography, University of Oxford, Oxford, Oxfordshire, UK
  14. 14Infectious Diseases Research Collaboration, Kampala, Central Region, Uganda
  15. 15School of Law, Social Innovation on Drug Program, Boston University, Boston, Massachusetts, USA
  16. 16Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
  17. 17Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, Liverpool, UK
  18. 18Pollution, UK Centre for Ecology & Hydrology, Wallingford, UK
  19. 19Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
  20. 20Innovation + Design Enabling Access (IDEA) Initiative, ReAct - Action on Antibiotic Resistance, Baltimore, Maryland, USA
  21. 21Faculty of Social Sciences, Mahidol University, Salaya, Nakhon Pathom, Thailand
  22. 22Global Coordination and Partnerships, AMR Division, World Health Organisation, Geneva, Switzerland
  23. 23Global Strategy Lab, York University, Toronto, Ontario, Canada
  24. 24Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
  1. Correspondence to Dr Clare I R Chandler; clare.chandler{at}


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
  • infections
  • diseases
  • disorders
  • injuries
  • 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.