RT Journal Article
SR Electronic
T1 Waves of attention: patterns and themes of international antimicrobial resistance reports, 1945–2020
JF BMJ Global Health
JO BMJ Global Health
FD BMJ Publishing Group Ltd
SP e006909
DO 10.1136/bmjgh-2021-006909
VO 6
IS 11
A1 Kristen Overton
A1 Nicolas Fortané
A1 Alex Broom
A1 Stephanie Raymond
A1 Christoph Gradmann
A1 Ebiowei Samuel F Orubu
A1 Scott H Podolsky
A1 Susan Rogers Van Katwyk
A1 Muhammad H Zaman
A1 Claas Kirchhelle
YR 2021
UL http://gh.bmj.com/content/6/11/e006909.abstract
AB This article uses quantitative and qualitative approaches to review 75 years of international policy reports on antimicrobial resistance (AMR). Our review of 248 policy reports and expert consultation revealed waves of political attention and repeated reframings of AMR as a policy object. AMR emerged as an object of international policy-making during the 1990s. Until then, AMR was primarily defined as a challenge of human and agricultural domains within the Global North that could be overcome via ‘rational’ drug use and selective restrictions. While a growing number of reports jointly addressed human and agricultural AMR selection, international organisations (IOs) initially focused on whistleblowing and reviewing data. Since 2000, there has been a marked shift in the ecological and geographic focus of AMR risk scenarios. The Global South and One Health (OH) emerged as foci of AMR reports. Using the deterritorialised language of OH to frame AMR as a Southern risk made global stewardship meaningful to donors and legitimised pressure on low-income and middle-income countries to adopt Northern stewardship and surveillance frameworks. It also enabled IOs to move from whistleblowing to managing governance frameworks for antibiotic stewardship. Although the environmental OH domain remains neglected, realisation of the complexity of necessary interventions has increased the range of topics targeted by international action plans. Investment nonetheless continues to focus on biomedical innovation and tends to leave aside broader socioeconomic issues. Better knowledge of how AMR framings have evolved is key to broadening participation in international stewardship going forward.All data relevant to the study are included in the article or uploaded as supplementary information.