maart 2022

DESIGN: Designing One Health Governance for Antimicrobial Stewardship Interventions

Duration: Mar 2022 - Feb 2025

The rise of antimicrobial resistance (AMR) on a global scale heightens the need for improved global and national governance to strengthen antimicrobial stewardship. The impact of human, animal and environmental antimicrobial use has enhanced recognition of the need to apply One Health (OH) principles to more effectively govern AMR detection, control and prevention.
The OH approach is inherently comprehensive, multi-sectoral and multi-disciplinary. Addressing the challenges posed by AMR through a OH approach relies on intersectoral policy coordination - across public health, agricultural, environmental and pharmaceutical networks - as well as international policy coordination, making understanding and implementing stewardship complex. Global, regional and national governance to hasten its practical implementation and constrain the spread of AMR has proven challenging, given limited knowledge of how to operationalize and maximize its added value.
While OH principles are increasingly embraced across supranational governance fora, current regional and national initiatives to build collaboration across human health, animal, and environmental sectors remain largely focused on single disease control.

This project aims to analyse and support local, national and supranational governance, based on dialogue and resource-sharing to develop mutually beneficial policies and manage challenges in the face of complex reciprocal interdependence. Our goal is to assess governance and policy approaches used for antimicrobial stewardship through a comprehensive analysis of global and national approaches in low-, middle and high-income countries, that will enable better coordination among public health, agricultural and environmental regulatory measures to support a OH approach. A second goal is to advance innovative policy recommendations on national and international laws, norms, agreements and institutions that mediate relations between states, societies, citizens, and markets to address current challenges given the complex reciprocal interdependence.

Our three overarching research questions are:
1. How can human and animal health, and agricultural and environmental governance systems be reoriented to prioritize integrated initiatives informed by OH principles to improve AMR and surveillance and antimicrobial stewardship;
2. How might changes in local antimicrobial use systems interact with governance systems to impact on livelihoods, cultural practices, human and animal health, agriculture and the environment?
3. What are the policy design solutions needed to implement the emergent evidence from the institutional, systems, legal and impact analyses?
We examine how governance and policy approaches could ensure that global OH standards are integrated into regional and national policies, regulations and legal instruments to improve the global antimicrobial commons and effectively address AMR.

The gathered insights form the basis of engaging with a wide range of stakeholders to inform and support the development of policies, regulations and laws to move towards integral antimicrobial stewardship.

Method, project design, work packages
1. To address the challenges a One Health approach poses for AMR governance, in the DESIGN project Nivel together with our partners, will conduct a situational, institutional, legal and impact analysis of antibiotic stewardship policies in six countries across human, animal, and environmental settings. Nivel will conduct this analysis for the Dutch context (WP3 and WP4).
2. Second, a comparative analysis will identify innovative international policy, legal, design and regulatory elements of OH governance across our high-, medium- and low-income country sample. Third, we will apply systems analysis to understand the complex relationships and contingencies inherent in antibiotic stewardship governance in local and international contexts (WP5).
3. Finally, national workshops informed by evidence emerging from the situational, comparative and systems analysis will be at the heart of engagement with decision-makers and local stakeholders (WP6).
Nivel is involved in Work Packages 3, 4, 5 and 6. We lead Work Package 5, which contains a comparative analysis of the project’s case countries to identify best practice and conditions under which antimicrobial use policies and governance models are most likely to succeed.

Expected results
Based on the insights of AMR governance informed by a One Health approach, a number of Knowledge Translation tools will be developed, including a Policy Brief series and a OH Governance Toolkit that will outline OH-informed governance models and identify innovations in effective governance strategies that support the development of policies, regulations and laws to improve the global commons of AMR.
Dit project wordt gesubsidieerd door
Joint Programming Initiative on Antimicrobial Resistance (JPIAMR), Zonmw
York University, Canada (Coordinator); Agricultural Research for Development, France; Alpha Amadou Diallo, Institut Sénégalais de Recherches Agricoles, Senegal; University of the Philippines, Philippines; University of Szeged, Hungary