The governance of antimicrobial resistance in Brazil: Challenges for developing and implementing a one health agenda

Corrêa, Juliana Silva; Zago, Luiz Felipe; Silva-Brandão, Roberto Rubem da; Oliveira, Sandi Michele de; Fracolli, Lislaine Aparecida; Padoveze, Maria Clara; Córdoba, Gloria

doi:10.1080/17441692.2023.2190381

Cited by 4 publications

(3 citation statements)

References 20 publications

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“…Although the CoNaCRA has provincial representatives, the AMR agenda had limited alignment with subnational and local governments for NAP implementation posing significant challenges in rural and remote areas. 38 Likewise in Brazil, 20 these areas are often highly exposed to AMR risks due to health deprivation. Readministering monetary and non-monetary resources to meet local needs and capacities and empowering provincial sentinel organisations are crucial to making AMR policies accountable.…”

Section: Discussionmentioning

confidence: 99%

Opportunities and challenges in antimicrobial resistance policy including animal production systems and humans across stakeholders in Argentina: a context and qualitative analysis

Allel,

Fernandez-Miyakawa,

Gaze

et al. 2024

BMJ Open

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IntroductionGaps in antimicrobial resistance (AMR) surveillance and control, including implementation of national action plans (NAPs), are evident internationally. Countries’ capacity to translate political commitment into action is crucial to cope with AMR at the human–animal–environment interface.MethodsWe employed a two-stage process to understand opportunities and challenges related to AMR surveillance and control at the human–animal interface in Argentina. First, we compiled the central AMR policies locally and mapped vital stakeholders around the NAP and the national commission against bacterial resistance. Second, we conducted qualitative interviews using a semistructured questionnaire covering stakeholders’ understanding and progress towards AMR and NAP. We employed a mixed deductive–inductive approach and used the constant comparative analysis method. We created categories and themes to cluster subthemes and determined crucial relationships among thematic groups.ResultsCrucial AMR policy developments have been made since 1969, including gradually banning colistin in food-producing animals. In 2023, a new government decree prioritised AMR following the 2015 NAP launch. Our qualitative analyses identified seven major themes for tackling AMR: (I) Cultural factors and sociopolitical country context hampering AMR progress, (II) Fragmented governance, (III) Antibiotic access and use, (IV) AMR knowledge and awareness throughout stakeholders, (V) AMR surveillance, (VI) NAP efforts and (VII) External drivers. We identified a fragmented structure of the food production chain, poor cross-coordination between stakeholders, limited surveillance and regulation among food-producing animals and geographical disparities over access, diagnosis and treatment. The country is moving to integrate animal and food production into its surveillance system, with most hospitals experienced in monitoring AMR through antimicrobial stewardship programmes.ConclusionAMR accountability should involve underpinning collaboration at different NAP implementation levels and providing adequate resources to safeguard long-term sustainability. Incorporating a multisectoral context-specific approach relying on different One Health domains is crucial to strengthening local AMR surveillance.

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Section: Discussionmentioning

confidence: 99%

Opportunities and challenges in antimicrobial resistance policy including animal production systems and humans across stakeholders in Argentina: a context and qualitative analysis

Allel,

Fernandez-Miyakawa,

Gaze

et al. 2024

BMJ Open

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“…Self-reporting to international organizations can be problematic (Oechslin & Steiner, 2022). However, case studies of NAP implementation in specific countries do not provide reasons to believe that the situation is systematically misrepresented (Ahmed et al, 2022;Corrêa et al, 2023;Frumence et al, 2021;Godman et al, 2022;Hein et al, 2022;Lota et al, 2022;Sariola et al, 2022;Song et al, 2022;WHO, 2022a, c). Nevertheless, we hope that the substantial resources needed to build a nongovernmental monitoring system will be available over the next few years.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, many AMR policy-makers in Pakistan interviewed by Khan et al (2020, p. 979) suggested that "doctors and the pharmaceutical and livestock industries may be too powerful for government agencies to enforce rules on; the latter was presented as under-resourced, poorly organized and lacking in authority to implement the existing regulations." Lack of resources and expertise in national administrations is a recurring theme in case studies on the development and implementation of NAPs in other countries, such as Bangladesh, Benin, Brazil, Burkina Faso, Ghana, Kenya, Mali, the Philippines, and Tanzania (Ahmed et al, 2022;Corrêa et al, 2023;Frumence et al, 2021;Godman et al, 2022;Hein et al, 2022;Lota et al, 2022;Sariola et al, 2022;Song et al, 2022;WHO, 2022a, c cf. also Thomas & Lo, 2020.…”

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confidence: 99%

Soft governance against superbugs: How effective is the international regime on antimicrobial resistance?

Heinzel,

Koenig-Archibugi

2023

Rev Int Organ

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Antimicrobial resistance (AMR) and the declining effectiveness of antibiotic medicines due to misuse are among the biggest threats to global health and a major challenge for global governance in this century. Since drug-resistant bacteria spread easily across borders, government policies that exacerbate or mitigate AMR affect other countries. International organizations and governments addressed the global public good of maintaining antimicrobial protection by creating a soft governance regime largely devoid of legally binding rules and enforcement mechanisms. This article presents a cross-national empirical assessment of the effectiveness of the international AMR regime combining novel data on national action plans and data on antibiotic consumption in 191 countries between 2000 and 2018. We find that the regime sets ambitious goals and achieves broad participation, substantial implementation, and meaningful change in the use of antibiotics. The involvement of the largest consumers of antibiotics has been crucial for both effectiveness and equity.

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National action on antimicrobial resistance and the political economy of health care

Heinzel,

Koenig-Archibugi

2024

Journal of European Public Policy

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The governance of antimicrobial resistance in Brazil: Challenges for developing and implementing a one health agenda

Cited by 4 publications

References 20 publications

Opportunities and challenges in antimicrobial resistance policy including animal production systems and humans across stakeholders in Argentina: a context and qualitative analysis

Opportunities and challenges in antimicrobial resistance policy including animal production systems and humans across stakeholders in Argentina: a context and qualitative analysis

Soft governance against superbugs: How effective is the international regime on antimicrobial resistance?

National action on antimicrobial resistance and the political economy of health care

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