The socioeconomic drivers and impacts of Antimicrobial Resistance: Implications for policy and research [Internet]

Excerpt

The policy community, international and national, recognizes the significant health and economic impacts of antimicrobial resistance (AMR) on individuals, households, health systems and society. It is seeking sustainable solutions but often neglects the socioeconomic and sociocultural drivers of AMR.

1. Socioeconomic and sociocultural factors play a critical role in driving AMR, shaping its health and economic impacts, and influencing the effectiveness of innovations that seek to tackle it.

2. AMR policy needs to take socioeconomic drivers and impacts into account.

3. Socioeconomic drivers of AMR in humans are complex but understanding them can inform better interventions. The emergence and spread of AMR relate to a mix of factors including gender, living situations, educational level, healthcare access, (poor) governance, human mobility, conflict, climate change, agriculture and pollution. Policy that understands these and the way they interact with one another will be more likely to achieve its aims.

4. Building key elements into design of AMR policy can help ensure socioeconomic considerations are embedded during policy implementation, monitoring, and evaluation:

   1. People-centredness fosters an equity-orientation and encourages policies that are responsive to individuals’ needs and challenges.

   2. Multisectorality recognizes AMR policy as a cross-cutting issue and brings on board various government departments and stakeholders reflecting the socioeconomic context.

   3. Effective governance and leadership that are mindful of the drivers of AMR are central to coordinating multisectoral action to address AMR’s wider determinants.

   4. Evidence-based policy helps ensure that policy formulation looks beyond the biomedical model and involves interdisciplinary research and surveillance to understand and tackle the socioeconomic drivers of AMR.

5. There are four policy areas that policy-makers could usefully regard as priorities:

   1. Prevention, including infection prevention and control (IPC) in healthcare; biosecurity measures in agricultural settings; and equitable, global access to clean water, sanitation and hygiene (WASH) infrastructure.

   2. Access involves promoting equitable access to diagnostics and treatments for infection. This requires reducing barriers to accessing essential healthcare services, and strengthening procurement and the supply-chain.

   3. Innovation, which requires investment in new technologies and incentives for research and development but which must also respond to global needs and contexts, including in low and middle-income countries (LMICs), and address access and affordability.

   4. Stewardship policies are also needed to conserve pre-existing and emerging antimicrobials and to promote responsible use in ways that acknowledge the constraints and realities of different global contexts and avoid inadvertent discrimination against particular populations.