Governing the complex problem of antimicrobial resistance: Comparative assessment of social-ecological resilience and transformability to limit AMR in one-health systems
Principal investigator: Dr Didier Wernli
Post-doc: Dr Anaïs Léger
Summary
Antimicrobial resistance, the growing resistance of microbes to anti-infective drugs is a complex governance challenge characterised by a tension between antibiotic use in human and animal health, untracked dissemination to the environment and international spread, conflicting goals between supporting innovation through intellectual property rights and developing access to medicines, and a strong link to sustainable development. As antimicrobial resistance has recently received increased attention at the global level, there is a need to understand what responses are needed to tackle the problem across sectors. This interdisciplinary collaborative research project undertaken by a consortium of academic institution from Sweden, Canada and Switzerland aims to contribute to this endeavour through a social ecological perspective.
Resilience captures the ability of systems to respond to surprise while maintaining vital functions and is an important attribute for health systems in the context of rising global risks such as emerging infectious diseases and growing antimicrobial resistance. The theoretical and empirical foundation underpinning one-health systems’ resilience to AMR, is largely undeveloped. This includes the aspect of transformability; the capacity to undertake fundamental change to achieve a more sustainable or desirable state. In the area of AMR, a transformative intervention could be livestock production without antimicrobial use for growth promotion or classes relevant for human use.
Our research consortium recently introduced and formalized resilience and transformation frameworks for AMR. Here, we extend these to assess the resilience and transformability of one health systems and interventions at local, national and global levels. With a focus on resistant Enterobacteriaceae and MRSA, we assess factors governing resilience and transformations in selected high-income and lower-middle income countries focusing on South and East Asia, explicitly considering the link between both agriculture, aquaculture and human health.
Using a multi-method approach, we undertake a systematic literature review, case study analysis and participatory assessment to build a database identifying factors linked to resilience and transformability. We then seek to identify indicators of resilience and transformability with the aim to be able to predict these dynamics in the future. Together, and through a comprehensive set of outreach activities to practitioners and decision makers these activities will inform future management and policy to better limit antimicrobial use and antimicrobial resistance across animal and human health.
This project is funded by the Swiss National Science Foundation for three years (2018-2021) within the National Research Programe 72 on Antimicrobial resistance. More information on the NRP72 website http://www.nrp72.ch/en/projects/jpiamr-cross-border-research/making-healthcare-systems-resilient-to-antimicrobial-resistance and the Stockholm Resilience Center website: http://www.stockholmresilience.org/research/research-news/2018-01-23-building-capacity-to-limit-antibiotic-resistance.html