Grant: JPIAMR Final Conference Travel Awards

Given the complexity of addressing antibiotic resistance (ABR), a One Health governance approach is imperative to effectively deal with ABR as a global commons issue. We use a social science lens to compare national politico-institutional frameworks across high-, middle- and low-income countries and their regional and international contexts to analyse their governance of antibiotic stewardship and capacities in managing ABR from a One Health perspective. Our situational analysis determines the extent to which effective practices and structures were developed in each country to address ABR, and identify where gaps remain in policy implementation. Our findings will inform governments currently in the process of renewing their National Action Plan (NAP) on ABR to overcome existing barriers and identify effective solutions to current challenges. We focus on the purposeful efforts of supranational, state and local institutions and actors to steer policy and behaviour. Institutional analysis incorporates the theory of complex global governance to evaluate transnational/state governance of antibiotic stewardship to identify governance factors that shape progressive policy development and implementation, and contrast with less effective approaches. Institutional analysis identifies the conditions under which change unfolds, including the nature of governance structures, systems, and public policies that influence future decisions. We assess institutional change, through an analysis that clarifies ongoing struggles in current institutional arrangements, with a focus on the factors that influence change and institutional transformation. Political context and institutional aspects can shape the mode of change expected by influencing the types of change agents and policy entrepreneurs that emerge across contexts and act as institutional supporters or challengers in fostering change. Our legal analysis maps international, regional and national legal instruments (both soft and hard) that frame antibiotic stewardship from a One Health perspective. It allows for the systematic monitoring of the legal landscape in a way that helps to more comprehensively explain and analyse the existing institutional rules and frameworks that shape the governance of the ABR issue and degree of coordination among the different implementing levels (international, regional, national and sub-national). The legal analysis evaluates the type and modes of legal instruments that can facilitate or obstruct our ability to effectively steward antibiotics in order to better understand the systemic factors that need to be reshaped and re-orientated in our governance systems using One Health principles. The Dutch Ministry of Health currently leads Work Package 5 of the Joint Action Antimicrobial resistance and Healthcare-Associated Infections (EU-JAMRAI) project. A main aim of this WP involves assessing European member state needs concerning the development and implementation of their AMR National Action Plan. Our legal analysis will provide insights concerning the implications, facilitators and barriers of current soft and hard laws that affect Antibiotic stewardship which will inform future legal and policy design.