'LMICs as reservoirs of AMR': a comparative analysis of policy discourse on antimicrobial resistance with reference to Pakistan
'LMICs as reservoirs of AMR': a comparative analysis of policy discourse on antimicrobial resistance with reference to Pakistan
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DOI：
10.1093/heapol/czz022
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发表时间：
2019-04-01
影响因子：
3.2
通讯作者：
Hanefeld, Johanna
中科院分区：
文献类型：
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作者：
Khan, Mishal S.;Durrance-Bagale, Anna;Hanefeld, Johanna
抗微生物药物耐药性（AMR）最近已成为一个突出的全球问题，解决AMR的政策制定已成为一个有争议的领域，各方对该问题和可能的解决方案的解释相互竞争，有时甚至相互矛盾。为促进围绕抗菌素耐药性制定和实施国家政策，需要做更多工作，使低收入和中等收入国家的政策制定者有效参与。然而，关于外部机构和低收入和中等收入国家决策者在抗生素耐药性问题上的问题框架差异的研究却很少；这种分析对于确定冲突和/或潜在的趋同领域是必要的。我们比较了多边机构、捐助国和一个处于全球应对巴基斯坦抗微生物药物耐药性前沿的低收入和中等收入国家制定的九份政策文件中对抗微生物药物耐药性的表述。我们分析了通常用于将卫生问题定义为需要采取行动的五种叙述的文本：经济影响、人类发展的阻碍、卫生公平的后果、卫生安全威胁以及与粮食生产的关系。我们发现，抗生素耐药性最常被视为对人类健康安全和经济发展的威胁，美国、英国和国际上的一些文件将中低收入国家描述为抗生素耐药性的“热点”。该问题的人力发展和公平方面较少作为解决抗生素耐药性日益增加的负担的理由加以讨论。很明显，没有出现关于抗微生物药物耐药性的单一连贯叙述，巴基斯坦和外部机构主导的文件以及主要从事人类与动物卫生工作的各利益攸关方在框架方面存在显著差异。虽然将抗菌素耐药性视为对经济增长和人类安全的威胁已引起高收入国家政府的高度政治关注并促使其采取行动，但我们的分析表明，与巴基斯坦政策制定者相关的相互矛盾的叙述可能会影响政策制定，并阻碍解决抗菌素耐药性所需的综合倡议的发展和实施。
Antimicrobial resistance (AMR) has recently emerged as a salient global issue, and policy formulation to address AMR has become a contested space, with various actors sharing competingand sometimes contradictoryexplanations of the problem and the range of possible solutions. To facilitate national policy setting and implementation around AMR, more needs to be done to effectively engage policymakers in low- and middle-income countries (LMICs). However, there is a dearth of research on differences in issue framing by external agencies and LMIC's national policymakers on the problem of AMR; such analyses are imperative to identify areas of conflict and/or potential convergence. We compared representations of AMR across nine policy documents produced by multilateral agencies, donor countries and an LMIC at the forefront of the global response to AMRPakistan. We analysed the texts in relation to five narratives that have been commonly used to frame health issues as requiring action: economic impact, stunting of human development, consequences for health equity, health security threats and relationship with food production. We found that AMR was most frequently framed as a threat to human health security and economic progress, with several US, UK and international documents depicting LMICs as hotspots' for AMR. Human development and equity dimensions of the problem were less frequently discussed as reasons to address the growing burden of AMR. It is clear that no single coherent narrative on AMR has emerged, with notable differences in framing in Pakistani and external agency led documents, as well as across stakeholders primarily working on human vs animal health. While framing AMR as a threat to economic growth and human security has achieved high-level political attention and catalysed action from governments in high-income countries, our analysis suggests that conflicting narratives relevant to policymakers in Pakistan may affect policy-making and impede the development and implementation of integrated initiatives needed to tackle AMR.