Waves of attention: patterns and themes of international antimicrobial resistance reports, 1945–2020

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.

Barriers and facilitators of implementing interventions to improve appropriate antibiotic use in low- and middle-income countries: a systematic review based on the Consolidated Framework for Implementation Research

“…However, investment from international donors is often short-term and project-based, and a large proportion of international investment has been focusing on pharmaceutical solutions [ 95 , 96 ]. Furthermore, international attention on AMR evolves in waves, given the many other competing policy priorities in global health [ 97 ]. Despite AMR being a persistent and accelerating problem, global attention (measured by the number of reports and international funding) has decreased since 2017 with interest further waning and resources diverted due to the demands of the COVID-19 pandemic [ 97 , 98 ].…”

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

“…Responding to this critical and emerging public health problem became of great importance to governments, transnational organisations, and policy-makers at the turn of the century [ 5 ]. Political interest increased markedly in 2012 and 2013 following key reports from the World Economic Forum, the US Centres for Disease Control and the Chief Medical Officer for England [ 6 , 7 , 8 ]. Human healthcare and agriculture have been the focus of AMR-related policymaking [ 6 , 9 , 10 ].…”

“…Human healthcare and agriculture have been the focus of AMR-related policymaking [ 6 , 9 , 10 ]. As a global health concern, the key strategies for managing AMR are to reduce antimicrobial use, stop the transmission of resistant microbes within and between human and animal populations, and improve the drug development pipeline [ 3 , 7 , 11 ]. National differences in antibiotic consumption rates do not clearly correspond to the prevalence of bacterial infections [ 12 , 13 ].…”

“…Therefore, news media representations of AMR remain important because they guide the way that many members of the public define and understand the problem, foreground particular causes, solutions, or both, and assign blame [ 37 , 38 ]. It is increasingly recognised that successfully addressing AMR requires a whole of society solution, and both national and intergovernmental health agencies continue to make statements as to the immediacy of the risks and the need for action [ 7 , 10 ]. In 2016, the O’Neill report (commissioned by the UK government and the Wellcome Trust in 2014) included an international call for all governments to promote greater public awareness through greater engagement with news and social media activity [ 39 ].…”

“…Understanding and directly comparing the public positioning of implicated institutions, how they have varied over time, and reflect the goals of key global and local national AMR stewardship initiatives provides context to the growing volume of critiques of AMR media and public engagement strategies [ 34 , 39 , 47 , 48 ]. On a broader scale, as greater attention is being paid to efforts at AMR governance and the critical importance of social and economic reforms is increasingly recognised [ 49 , 50 ], better knowledge of how public discourses about AMR have evolved over the last decade in countries with different policy approaches and settings can contribute to efforts to improve public engagement with and participation in future stewardship efforts [ 7 , 33 ].…”