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Yang D, Dyar OJ, Yin J, Ma W, Sun Q, Lundborg CS. Antimicrobial resistance in China across human, animal, and environment sectors - a review of policy documents using a governance framework. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 48:101111. [PMID: 38948912 PMCID: PMC11214315 DOI: 10.1016/j.lanwpc.2024.101111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 05/13/2024] [Accepted: 05/23/2024] [Indexed: 07/02/2024]
Abstract
Antimicrobial resistance (AMR) poses a multifaceted threat to the human, animal, and environment sectors. In response, China has formulated a series of policies since the 2000s. Thus far, there has been no comprehensive assessment of these policy documents. This study aims to review the content of AMR policy documents at the national level using a governance framework covering three areas: Policy Design; Implementation Tools; and Monitoring and Evaluation. We identified 44 AMR documents from 2003 to 2022 sourced from government agency websites. Our findings have revealed noticeable discrepancies across the three governance areas. The Policy Design and Monitoring and Evaluation areas should be strengthened, particularly in the domains of 'Coordination', 'Accountability', 'Sustainability', and 'Effectiveness'. From a 'One Health' perspective, the environment sector has received less attention compared to the human and animal sectors. Effectively addressing these challenges requires a stronger commitment and widespread support from diverse stakeholders.
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Affiliation(s)
- Ding Yang
- Department of Global Public Health, Karolinska Institutet, 17177, Stockholm, Sweden
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Oliver James Dyar
- Department of Public Health and Caring Sciences, Uppsala University, 75122, Uppsala, Sweden
| | - Jia Yin
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Wenwen Ma
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Qiang Sun
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
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Carelli DE, Ogne JB, Pierre J. Coming of age: governance challenges in updated AMR national action plans in the EU. Eur J Public Health 2024:ckae067. [PMID: 38578613 DOI: 10.1093/eurpub/ckae067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND National action plans (NAPs) are key instruments for governing antimicrobial resistance (AMR). In Europe, we can now observe many countries updating their NAPs which raise two key research questions; what substantial modifications are states opting for, and how do they wish to address challenges related to AMR governance in a comparative perspective? METHODS Building on a previous analytical classification, we address these two questions by examining data of updated versions of NAPs in 13 European Union member states covering seventeen elements related to AMR governance. RESULTS Our results substantiate the large variation with regard to both substantive issues and governance-related matters. Most tellingly, they highlight the growing importance of the One Health approach in updated versions of NAPs. Our analysis also shows that while substantive issues remain important, One Health and the coordination and collaboration issues it entails are becoming more salient in the second or third generation of NAPs. CONCLUSIONS Updated NAPs suggest that EU member states are becoming increasingly knowledgeable on the causes and consequences of AMR and how it needs to be addressed. The enhanced level of knowledge also leads these countries to address the next set of issues and challenges; to improve domestic and international coordination and collaboration. Thus, the revised NAPs present a noticeable development from substantive issues towards governance issues.
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Affiliation(s)
- Daniel E Carelli
- Department of Political Science, University of Gothenburg, Gothenburg, Sweden
| | - Josefin B Ogne
- School of Public Administration, University of Gothenburg, Gothenburg, Sweden
| | - Jon Pierre
- Department of Political Science, University of Gothenburg, Gothenburg, Sweden
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Carelli DE, Mitsouli ET, Ogne JB, Pierre J. The best laid plans?: international governance perspectives in AMR national action plans in Europe. Eur J Public Health 2023:7169436. [PMID: 37196335 PMCID: PMC10393504 DOI: 10.1093/eurpub/ckad080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND There is a broad consensus in the European public health community that international collaboration and coordination are key in the fight against antimicrobial resistance (AMR). Yet, while experts typically testify the importance of cross-national learning and a coordinated effort to reduce the spread of multi-resistant bacteria, there are mixed views about how that is best realized in practice, particularly on the dichotomy between horizontal and vertical activities. METHODS National action plans (NAP) from all EU member states were systematically overviewed by two independent researchers. We followed a fixed procedure for locating a broad and comparable content on the international dimensions, and letting these vary on scales. RESULTS We find that countries adhere to four different strategies for international coordination, varying between 'high' and 'low' on values of vertical and horizontal activities. Most countries spend none or very little space to discuss international activities, while some countries use their NAPs to outline their aspiration for taking leading roles in the international struggle. Moreover, in line with previous research, we find that many countries directly mimic the Global Action Plan, but also that a large share of countries describe independent arrangements in their international strategies. CONCLUSIONS European countries recognize AMR and its inherent international governance challenge differently in their NAPs, which may have implications for coordinated action to address the issue.
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Affiliation(s)
- Daniel E Carelli
- Department of Political Science, University of Gothenburg, Gothenburg, Sweden
| | | | - Josefin B Ogne
- School of Public Administration, University of Gothenburg, Gothenburg, Sweden
| | - Jon Pierre
- Department of Political Science, University of Gothenburg, Gothenburg, Sweden
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Patel J, Harant A, Fernandes G, Mwamelo AJ, Hein W, Dekker D, Sridhar D. Measuring the global response to antimicrobial resistance, 2020-21: a systematic governance analysis of 114 countries. THE LANCET. INFECTIOUS DISEASES 2023; 23:706-718. [PMID: 36657475 DOI: 10.1016/s1473-3099(22)00796-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/13/2022] [Accepted: 11/18/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Understanding strategic commitments and policy responses to overcome antimicrobial resistance at the national, regional, and global levels is required to evaluate current progress and direct future planning. National action plans (NAPs) are the primary mechanism for guiding national strategy and action for antimicrobial resistance governance. Although several NAPs have been developed, no comprehensive content analysis of these plans exists. Using a governance framework, we aimed to assess all publicly available NAPs on antimicrobial resistance. METHODS We systematically reviewed the contents of NAPs on antimicrobial resistance from 114 countries, applying a governance framework containing 18 domains and 54 indicators in three integral areas: policy design, implementation tools, and monitoring and evaluation. As well as manually searching NAPs and doing online and literature searches that were relevant to specific indicators from repository inception to June 1, 2022, several data sources were used to generate scores, including the Tripartite Antimicrobial Resistance Country Self-Assessment Survey, the Global Antimicrobial Resistance and Use Surveillance System, the Global Antimicrobial Resistance Research and Development Hub, and various WHO datasets. NAPs were included if the country had also submitted the NAP to the Tripartite Antimicrobial Resistance Country Self-Assessment Survey 2020-21, if the NAP was retrievable through a publicly accessible database or website, and if the NAP was either published in English or eligible for machine translation. Three researchers independently reviewed each NAP and were initially blinded to the evaluations of other researchers. They generated a score using a quantification system for each of 54 indicators. The Cochrane protocol for ensuring reliability was followed. The three researchers were then unblinded and met to resolve any disagreements in scoring to reach a consensus agreement. In each case of discrepancy, consensus was reached between the researchers. We developed criteria to standardise the process of quantifying each indicator. We also weighted and collated relevant national data from various sources to generate composite scores concordant with the key governance areas. We transformed these data to a scale of 0 (worst) to 100 (best), ranked countries on the basis of their mean scores, and used descriptive statistics to analyse global and regional trends. FINDINGS 306 NAPs were identified and 114 were eligible for analysis. Between 2020 and 2021, the mean antimicrobial resistance governance score was 51 (SD 14). Norway had the highest governance score (mean 85 [SD 32]), and the Federated States of Micronesia had the lowest governance score (28 [37]). The highest scoring domain was participation (83 [16]), and the lowest scoring domains were accountability (30 [18]) and feedback mechanism (30 [25]). Domains relating to policy design (55 [13]) and implementation tools (54 [17]) scored similarly, whereas monitoring and evaluation (38 [20]) efforts were lower. INTERPRETATION International efforts to control antimicrobial resistance varied considerably between countries. Monitoring and evaluation efforts need improving for continuous understanding of national and international progress. International response might not be commensurate with the scale and severity of antimicrobial resistance. FUNDING None.
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Affiliation(s)
- Jay Patel
- Global Health Governance Programme, Usher Institute, University of Edinburgh, Edinburgh, UK; School of Dentistry, Faculty of Medicine and Health, University of Leeds, Leeds, UK.
| | - Anne Harant
- German Institute of Global and Area Studies, Hamburg, Germany; Faculty of Business, Economics and Social Sciences, University of Hamburg, Hamburg, Germany
| | - Genevie Fernandes
- Global Health Governance Programme, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Ambele Judith Mwamelo
- Global Health Governance Programme, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Wolfgang Hein
- German Institute of Global and Area Studies, Hamburg, Germany
| | - Denise Dekker
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Devi Sridhar
- Global Health Governance Programme, Usher Institute, University of Edinburgh, Edinburgh, UK
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5
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Degeling C, Hall J. Governing Antibiotic Risks in Australian Agriculture: Sustaining Conflicting Common Goods Through Competing Compliance Mechanisms. Public Health Ethics 2022. [DOI: 10.1093/phe/phac029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Abstract
The One Health approach to antimicrobial resistance (AMR) requires stakeholders to contribute to cross-sectoral efforts to improve antimicrobial stewardship (AMS). One Health AMR policy implementation is challenging in livestock farming because of the infrastructural role of antibiotics in production systems. Mitigating AMR may require the development of more stringent stewardship obligations and the future limitation of established entitlements. Drawing on Amatai Etzioni’s compliance theory, regulatory analyses and qualitative studies with stakeholder groups we examine the structural and socio-cultural dimension of antibiotic use and AMS compliance in Australian beef and dairy production. We found a disconnect between how antibiotic use is conceptualised by farmers and the way in which AMS policies construe agricultural AMR risks. Under the umbrella of food safety standards and national-level prescribing restrictions, farmers and veterinarians interact around antibiotic use with different operating logics and compliance mechanisms. These parallel regimes service distinct and sometimes competing common goods of food security and antibiotic preservation. Further reforms to mitigate AMR need to account for the value orientations of different groups and the embeddedness of the constraints imposed by existing systems. Advocacy for greater AMR precaution in agriculture should acknowledge and compensate for erosions in competing common goods and the cost of proposed interventions.
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Affiliation(s)
- Chris Degeling
- Australian Centre for Health Engagement, Evidence and Values, University of Wollongong , Wollongong, NSW , Australia
| | - Julie Hall
- Australian Centre for Health Engagement, Evidence and Values, University of Wollongong , Wollongong, NSW , Australia
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Doyle E, Heller J, Norris JM. Factors influencing dairy cattle farmer use of antimicrobials on farms in New South Wales, Australia. Aust Vet J 2022; 100:587-595. [PMID: 36173313 PMCID: PMC10086797 DOI: 10.1111/avj.13209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 08/15/2022] [Accepted: 09/09/2022] [Indexed: 11/29/2022]
Abstract
Antimicrobial use (AMU) in the food chain is a potential driver of antimicrobial resistance. Despite Australia's strong regulation of AMU limited to veterinary prescriptions, a proportion of empirical antimicrobial treatments are administered by dairy farmers to manage common cattle health problems. This cross-sectional survey identified key influences on AMU by dairy cattle farmers within New South Wales, Australia, to detect opportunities for antimicrobial stewardship (AMS) engagement. The study identified existing relationships, resources and attitudes of the dairy farmers that could be optimised for on-farm AMS strategies. Farmers were most highly influenced by veterinary advice and clinical signs of the animal followed by the withholding period and the potential for antimicrobial resistance development. Farmers' high confidence regarding their own knowledge of antimicrobials (>90%), their high regard for veterinary advice (>90%) and high rate of veterinary health care plan use (69%) provides a strong framework to build the profile and practice of AMS on dairy farms. Positive engagement by dairy farmers (survey response of 20%), was achieved by working with the NSW Food Authority. Despite respondents reporting low reliance on formal (government and commercial) organisations for information about AMU, their engagement demonstrates an opportunity for groups with unparalleled access to dairy farmers to drive AMS. An association between frequent use of veterinary advice and respondents keeping ceftiofur on-farm requires further investigation. Quantitative and qualitative analysis of on-farm resources, decision-making, and practices is required to understand how practices relate to veterinary advice and accepted standards of appropriate AMU on dairy farms.
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Affiliation(s)
- E Doyle
- Sydney School of Veterinary Science, University of Sydney, Sydney, New South Wales, 2006, Australia
| | - J Heller
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, 2650, Australia
| | - J M Norris
- Sydney School of Veterinary Science, University of Sydney, Sydney, New South Wales, 2006, Australia.,Sydney Institute for Infectious Diseases, University of Sydney, Sydney, New South Wales, 2006, Australia
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7
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A comparative assessment of action plans on antimicrobial resistance from OECD and G20 countries using natural language processing. Health Policy 2022; 126:522-533. [DOI: 10.1016/j.healthpol.2022.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/13/2022] [Accepted: 03/22/2022] [Indexed: 11/18/2022]
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Antimicrobial Resistance Surveillance of Pigs and Chickens in the Lao People’s Democratic Republic, 2018–2021. Antibiotics (Basel) 2022; 11:antibiotics11020177. [PMID: 35203780 PMCID: PMC8868105 DOI: 10.3390/antibiotics11020177] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/17/2022] [Accepted: 01/27/2022] [Indexed: 02/01/2023] Open
Abstract
The use of antimicrobials in the livestock sector has been identified as a driver for the emergence of antimicrobial resistance (AMR), and AMR has become a growing public health and economic threat in the Lao PDR. We conducted surveillance for AMR in five provinces of the Lao PDR, in order to determine the antimicrobial susceptibility of Escherichia coli and Salmonella spp. isolated from caecal samples from slaughtered pigs at slaughterhouses and from slaughtered chickens at markets during two different time periods: 2018/2019 and 2020/2021. Antimicrobial susceptibility was determined using a panel of 14 antimicrobials using the broth microdilution technique. E. coli and Salmonella from chickens (62% and 33%, respectively) and pigs (88% and 81%, respectively) exhibited resistance to ≥3 classes of antimicrobials. Of important public health concern was the detection of Salmonella resistant to cefotaxime/ceftazidime, ciprofloxacin, and colistin, deemed as critically important antimicrobials in human medicine. This study aimed to evaluate a national sampling strategy at slaughterhouses and wet markets, and to pilot the laboratory methodologies for bacterial recovery and AMR testing. Experiences from this study will inform capacity development for a national AMR surveillance program, and these early data could serve as reference points for monitoring the impact of the Lao PDR’s national action plan to contain AMR.
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Haenni M, Dagot C, Chesneau O, Bibbal D, Labanowski J, Vialette M, Bouchard D, Martin-Laurent F, Calsat L, Nazaret S, Petit F, Pourcher AM, Togola A, Bachelot M, Topp E, Hocquet D. Environmental contamination in a high-income country (France) by antibiotics, antibiotic-resistant bacteria, and antibiotic resistance genes: Status and possible causes. ENVIRONMENT INTERNATIONAL 2022; 159:107047. [PMID: 34923370 DOI: 10.1016/j.envint.2021.107047] [Citation(s) in RCA: 58] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/09/2021] [Accepted: 12/11/2021] [Indexed: 06/14/2023]
Abstract
Antimicrobial resistance (AMR) is a major global public health concern, shared by a large number of human and animal health actors. Within the framework of a One Health approach, actions should be implemented in the environmental realm, as well as the human and animal realms. The Government of France commissioned a report to provide policy and decision makers with an evidential basis for recommending or taking future actions to mitigate AMR in the environment. We first examined the mechanisms that underlie the emergence and persistence of antimicrobial resistance in the environment. This report drew up an inventory of the contamination of aquatic and terrestrial environments by AMR and antibiotics, anticipating that the findings will be representative of some other high-income countries. Effluents of wastewater treatment plants were identified as the major source of contamination on French territory, with spreading of organic waste products as a more diffuse and incidental contamination of aquatic environments. A limitation of this review is the heterogeneity of available data in space and time, as well as the lack of data for certain sources. Comparing the French Measured Environmental Concentrations (MECs) with predicted no effect concentrations (PNECs), fluoroquinolones and trimethoprim were identified as representing high and medium risk of favoring the selection of resistant bacteria in treated wastewater and in the most contaminated rivers. All other antibiotic molecules analyzed (erythromycin, clarithromycin, azithromycin, tetracycline) were at low risk of resistance selection in those environments. However, the heterogeneity of the data available impairs their full exploitation. Consequently, we listed indicators to survey AMR and antibiotics in the environment and recommended the harmonization of sampling strategies and endpoints for analyses. Finally, the objectives and methods used for the present work could comprise a useful example for how national authorities of countries sharing common socio-geographic characteristics with France could seek to better understand and define the environmental dimension of AMR in their particular settings.
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Affiliation(s)
- Marisa Haenni
- Unité Antibiorésistance et Virulence Bactériennes, ANSES (French Agency for Food, Environmental and Occupational Health & Safety) - Université de Lyon, Lyon, France
| | - Christophe Dagot
- Université of Limoges, RESINFIT, UMR INSERM 1092, CHU, F-87000 Limoges, France
| | - Olivier Chesneau
- Collection de l'Institut Pasteur (CIP), Microbiology Department, Institut Pasteur, Paris, France
| | - Delphine Bibbal
- INTHERES, Université de Toulouse, INRAE, ENVT, Toulouse, France
| | - Jérôme Labanowski
- Université de Poitiers, UMR CNRS 7285 IC2MP, ENSI Poitiers, Poitiers, France
| | | | - Damien Bouchard
- National Agency for Veterinary Medicinal Products, ANSES, Fougères, France
| | | | - Louisiane Calsat
- Risk Assessment Department (DER), ANSES (French Agency for Food, Environmental and Occupational Health & Safety), Maisons-Alfort, France
| | - Sylvie Nazaret
- Université de Lyon, Université Claude Bernard Lyon 1, UMR CNRS 5557, UMR INRAE 1418, VetAgro Sup, Ecologie Microbienne, F-69622 Villeurbanne, France
| | - Fabienne Petit
- UNIROUEN, UNICAEN, CNRS, M2C, Normandie Université Rouen, France; Sorbonne Université, CNRS, EPHE, PSL, UMR METIS, Paris F-75005, France
| | | | | | - Morgane Bachelot
- ANSES (French Agency for Food, Environmental and Occupational Health & Safety), Maisons-Alfort, France
| | - Edward Topp
- Agriculture and Agri-Food Canada, and University of Western Ontario, London, ON, Canada
| | - Didier Hocquet
- UMR Chronoenvironnement CNRS 6249, Université de Bourgogne Franche-Comté, Besançon, France; Hygiène Hospitalière, Centre Hospitalier Universitaire, 25030 Besançon, France.
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10
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Degeling C, Brookes V, Hill T, Hall J, Rowles A, Tull C, Mullan J, Byrne M, Reynolds N, Hawkins O. Changes in the Framing of Antimicrobial Resistance in Print Media in Australia and the United Kingdom (2011-2020): A Comparative Qualitative Content and Trends Analysis. Antibiotics (Basel) 2021; 10:1432. [PMID: 34943644 PMCID: PMC8698020 DOI: 10.3390/antibiotics10121432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/19/2021] [Accepted: 11/20/2021] [Indexed: 01/21/2023] Open
Abstract
Educating the public about antimicrobial resistance (AMR) is considered a key part of an optimal public health response. In both media depictions and policy discourses around health risks, how a problem is framed underpins public awareness and understanding, while also guiding opinions on what actions can and should be taken. Using a mixed methods approach we analyse newspaper content in Australia and the United Kingdom (UK) from 2011 to 2020 to track how causes, consequences and solutions to AMR are represented in countries with different policy approaches. Analyses demonstrate greater variability in the frames used in UK newspapers reflecting large hospital and community outbreaks and a sustained period of policy reform mid-decade. Newspapers in Australia focus more on AMR causes and consequences, highlighting the importance of scientific discovery, whereas UK coverage has greater discussion of the social and economic drivers of AMR and their associated solutions. Variations in the trends of different frames around AMR in UK newspapers indicate greater levels of public deliberation and debate around immediate and actionable solutions; whereas AMR has not had the same health and political impacts in Australia resulting in a media framing that potentially encourages greater public complacency about the issue.
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Affiliation(s)
- Chris Degeling
- Australian Centre for Health Engagement, Evidence and Values, The Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW 2522, Australia; (J.H.); (O.H.)
| | - Victoria Brookes
- Sydney School of Veterinary Science Faculty of Science, The University of Sydney, Sydney, NSW 2006, Australia;
| | - Tarant Hill
- Illawarra-Shoalhaven Local Health District, NSW Health, Warrawong, NSW 2502, Australia;
| | - Julie Hall
- Australian Centre for Health Engagement, Evidence and Values, The Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW 2522, Australia; (J.H.); (O.H.)
| | - Anastacia Rowles
- School of Health & Society, The Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW 2522, Australia; (A.R.); (C.T.)
| | - Cassandra Tull
- School of Health & Society, The Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW 2522, Australia; (A.R.); (C.T.)
| | - Judy Mullan
- Centre for Health Research Illawarra Shoalhaven Population, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia;
| | - Mitchell Byrne
- College of Human and Health Sciences, Charles Darwin University, Darwin, NT 0909, Australia;
| | - Nina Reynolds
- School of Business, Faculty of Business and Law, University of Wollongong, Wollongong, NSW 2522, Australia;
| | - Olivia Hawkins
- Australian Centre for Health Engagement, Evidence and Values, The Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW 2522, Australia; (J.H.); (O.H.)
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Overton K, Fortané N, Broom A, Raymond S, Gradmann C, Orubu ESF, Podolsky SH, Rogers Van Katwyk S, Zaman MH, Kirchhelle C. Waves of attention: patterns and themes of international antimicrobial resistance reports, 1945-2020. BMJ Glob Health 2021; 6:e006909. [PMID: 34740914 PMCID: PMC8573652 DOI: 10.1136/bmjgh-2021-006909] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/17/2021] [Indexed: 11/04/2022] Open
Abstract
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.
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Affiliation(s)
- Kristen Overton
- Infectious Diseases Department, Prince of Wales Hospital Randwick, Sydney, New South Wales, Australia
- Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Nicolas Fortané
- IRISSO, CNRS, INRAE, Paris-Dauphine University, PSL, Paris, France
| | - Alex Broom
- School of Social and Political Sciences, Sydney Centre for Healthy Societies, The University of Sydney, Sydney, New South Wales, Australia
| | - Stephanie Raymond
- School of Social and Political Sciences, Sydney Centre for Healthy Societies, The University of Sydney, Sydney, New South Wales, Australia
| | - Christoph Gradmann
- Institute of Health and Society, Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
| | - Ebiowei Samuel F Orubu
- Institute for Health System Innovation and Policy, Boston University, Boston, Massachusetts, USA
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts, USA
| | - Scott H Podolsky
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Muhammad H Zaman
- Department of International Health, Boston University, Boston, Massachusetts, USA
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12
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Eriksen J, Björkman I, Röing M, Essack SY, Stålsby Lundborg C. Exploring the One Health Perspective in Sweden's Policies for Containing Antibiotic Resistance. Antibiotics (Basel) 2021; 10:antibiotics10050526. [PMID: 34063697 PMCID: PMC8147834 DOI: 10.3390/antibiotics10050526] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/01/2021] [Accepted: 05/02/2021] [Indexed: 11/24/2022] Open
Abstract
Antibiotic resistance is considered to be a major threat to global health. The main driver of antibiotic resistance is antibiotic use. Antibiotics are used in humans, animals, and food production and are released into the environment. Therefore, it is imperative to include all relevant sectors in the work to contain antibiotic resistance, i.e., a One Health approach. In this study, we aimed to describe and analyse Sweden’s policies related to containing antibiotic resistance, from a One Health perspective. Twenty-three key policy documents related to containment of antibiotic resistance in Sweden were selected and analysed according to the policy triangle framework. Sweden started early to introduce policies for containing antibiotic resistance from an international perspective. Systematic measures against antibiotic resistance were implemented in the 1980s, strengthened by the creation of Strama in 1995. The policies involve agencies and organisations from human and veterinary medicine, the environment, and food production. All actors have clear responsibilities in the work to contain antibiotic resistance with a focus on international collaboration, research, and innovation. Sweden aims to be a model country in the work to contain antibiotic resistance and has a strategy for achieving this through international cooperation through various fora, such as the EU, the UN system, and OECD.
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Affiliation(s)
- Jaran Eriksen
- Department of Global Public Health—Health Systems and Policy (HSP): Improving the Use of Medicines, Karolinska Institutet, Tomtebodavägen 18A, 171 77 Stockholm, Sweden;
- Unit of Infectious Diseases, Venhälsan, Södersjukhuset, 118 83 Stockholm, Sweden
- Correspondence:
| | - Ingeborg Björkman
- Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Husargatan 3, 751 22 Uppsala, Sweden; (I.B.); (M.R.)
| | - Marta Röing
- Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Husargatan 3, 751 22 Uppsala, Sweden; (I.B.); (M.R.)
| | - Sabiha Y. Essack
- Antimicrobial Research Unit, College of Health Sciences, University of KwaZulu-Natal, Durban 4001, South Africa;
| | - Cecilia Stålsby Lundborg
- Department of Global Public Health—Health Systems and Policy (HSP): Improving the Use of Medicines, Karolinska Institutet, Tomtebodavägen 18A, 171 77 Stockholm, Sweden;
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