Governing antimicrobial resistance: a narrative review of global governance mechanisms
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Governing antimicrobial resistance: a narrative review of global governance mechanisms Arne Ruckert1,9 · Patrick Fafard2 · Suzanne Hindmarch3 · Andrew Morris4 · Corinne Packer1 · David Patrick5 · Scott Weese6 · Kumanan Wilson7 · Alex Wong8 · Ronald Labonté1
© Springer Nature Limited 2020
Abstract Antimicrobial resistance (AMR), a central health challenge of the twenty first century, poses substantial population health risks, with deaths currently estimated to be around 700,000 per year globally. The international community has signaled its commitment to exploring and implementing effective policy responses to AMR, with a Global Action Plan on AMR approved by the World Health Assembly in 2015. Major governance challenges could thwart collective efforts to address AMR, along with limited knowledge about how to design effective global governance mechanisms. To identify common ground for more coordinated global actions we conducted a narrative review to map dominant ideas and academic debates about AMR governance. We found two categories of global governance mechanisms: binding and non-binding and discuss advantages and drawbacks of each. We suggest that a combination of non-binding and binding governance mechanisms supported by leading antimicrobial use countries and important AMR stakeholders, and informed by One Health principles, may be best suited to tackle AMR. Keywords Antimicrobial resistance · Global governance · International law · Health regulations Abbreviations AMR Antimicrobial resistance FAO Food and Agricultural Organization GLASS Global Antimicrobial Surveillance System IHRs International Health Regulations IPC Infection Prevention and Control Electronic supplementary material The online version of this article (https://doi.org/10.1057/s4127 1-020-00248-9) contains supplementary material, which is available to authorized users. * Arne Ruckert [email protected] Extended author information available on the last page of the article Vol.:(0123456789)
A. Ruckert et al.
OIE World Organisation for Animal Health PHEIC Public Health Emergency of International Concern PPP Public–private partnership SDGs Sustainable development goals WHO Wold Health Organization WTO World Trade Organization
Introduction Antimicrobial resistance (AMR) has been widely recognized as one of the central health challenges of the twenty first century [1–3]. Since discovery of antibiotics, they have been a cornerstone of modern medicine [4, 5]. AMR predates human use of antibiotics and is naturally occurring as the outcome of the evolutionary adaptation process of microbes. But it has become increasingly clear that use of antibiotics, both in human and veterinarian practice and agriculture and animal husbandry, contributes to antimicrobial resistance [6]. AMR poses significant population health risks, with annual deaths estimated to be around 700,000 globally [7]. The international community recently identified it as a major threat to achievement of the Sustainable Development Goals, SDGs [8]. AMR has
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