Developing an approach to assessing the political feasibility of global collective action and an international agreement on antimicrobial resistance

Background:Antimicrobial resistance(AMR)is a global issue.International trade,travel,agricultural practices,and environmental contamination all make it possible for resistant microbes to cross national borders.Global collective action is needed in the form of an international agreement or other mechanism that brings states together at the negotiation table and commits them to adopt or implement policies to limit the spread of resistant microorganisms.This article describes an approach to assessing whether political and stakeholder interests can align to commit to tackling AMR.Methods:Two dimensions affecting political feasibility were selected and compared across 82 countries:1)states’global influence and 2)self-interest in addressing AMR.World Bank GDP ranking was used as a proxy for global influence,while human antibiotic consumption(10-year percent change)was used as a proxy for self-interest in addressing AMR.We used these data to outline a typology of four country archetypes,and discuss how these archetypes can be used to understand whether a proposed agreement may have sufficient support to be politically feasible.Results:Four types of countries exist within our proposed typology:1)wealthy countries who have the expertise and financial resources to push for global collective action on AMR,2)wealthy countries who need to act on AMR,3)countries who require external assistance to act on AMR,and 4)neutral countries who may support action where applicable.Any international agreement will require substantial support from countries of the first type to lead global action,and from countries of the second type who have large increasing antimicrobial consumption levels.A large number of barriers exist that could derail efforts towards global collective action on AMR;issues of capacity,infrastructure,regulation,and stakeholder interests will need to be addressed in coordination with other actors to achieve an agreement on AMR.Conclusions:Achieving a global agreement on access,conservation,and innovation–the three pillars of AMR–will not be easy.However,smaller core groups of interested Initiator and Pivotal Countries could develop policy and resolve many issues.If highly influential countries take the lead,agreements could then be scaled up to achieve global action.

Probing popular and political discourse on antimicrobial resistance in China

Background:Antimicrobial resistance(AMR)is an increasing threat to global public health that is largely exacerbated by the overuse and misuse of antimicrobial medicines.As the largest antimicrobials producer and user in the world,China has a critical role to play in combatting AMR.By examining Chinese news articles and policy statements,we aim to provide an authentic understanding of public discourse in China on AMR.Methods:A search was conducted using two of the most comprehensive digital libraries for Chinese news media documents.Chinese policy documents were retrieved from official Chinese government websites.Records from June 2016 to May 2017 were included.Grounded theory was used to analyze included records,and we followed an iterative thematic synthesis process to categorize the key themes of each document.Results:Across 64 news articles,most articles delivered general knowledge about AMR and debunked AMR-related myths,explored the implications of AMR-relevant policies,and discussed the misuse of antimicrobials in the agricultural sector.All policy documents provided guidance for healthcare workers,encouraging them to better manage antimicrobial prescriptions and usage.Conclusions:While the Chinese media actively educates the public on strategies for AMR prevention,certain news articles risk misleading readers by downplaying the hazards of domestic AMR issues.Further,although several national policies are geared towards combatting AMR,the government faces difficult challenges in overcoming public misconceptions regarding antimicrobial use.Records from the regional level should also be examined to further explore China’s public discourse on AMR.