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The Global Governance of Antimicrobial Resistance: An Empirical Analysis of Participation and Effectiveness

抗菌素耐药性的全球治理：参与和有效性的实证分析

基本信息

批准号：
ES/W012332/1
负责人：
Mathias Koenig-Archibugi
金额：
$ 62.58万
依托单位：
London School of Economics and Political Science
依托单位国家：
英国
项目类别：
Research Grant
财政年份：
2022
资助国家：
英国
起止时间：
2022 至无数据
项目状态：
未结题

来源：
https://gtr.ukri.org/projects?ref=ES%2FW012332%2F1
关键词：
Global Governance Antimicrobial Resistance Empirical

项目摘要

Antimicrobial resistance (AMR) happens when micro-organisms such as bacteria, viruses and fungi evolve to become resistant to antimicrobial medicines. AMR is accelerated by the use, and especially the overuse and misuse, of antibiotics in health care and farming. It is also exacerbated by insufficient and inequitable access to sanitation, clean water and health care. Experts warn that AMR could lead to a future without effective antibiotics. Because drug-resistant bacteria spread internationally across borders, maintaining antimicrobial protection has the features of a global public good that requires international cooperation.To provide public goods effectively, international cooperation arrangements typically need to meet three conditions simultaneously: ambitious policy commitments, thorough implementation of those commitments, and participation of many countries across the world. The overarching research question of the project is the following: Which kind of international agreement on AMR has the best chance of attaining deep ambition, thorough implementation, and wide participation? The project will address the overarching research question by examining three more specific questions. First, how effective are existing international institutional arrangements in promoting meaningful progress in tackling the AMR problem? Current efforts pivot around the "Global Action Plan on Antimicrobial Resistance" endorsed by the general assemblies of the WHO, FAO and OIE in 2015, supported by the "Political Declaration" issued in 2016 by the United Nations. The project will apply statistical methods to data on most countries in the world between 2010 and 2020 to estimate the influence of a variety of factors on the adoption and content of national AMR action plans and trends in antibiotic consumption at the country level. These factors include the normative pressure created by the Global Action Plan and specifically by the publication of country performance indicators; external funding, such as the Fleming Fund of the UK Government; the adoption and implementation by countries closely connected through international organizations and other channels; and transnational civil society networks.Second, given a range of conceivable global agreements on AMR, which one is most likely to attain wide participation, ambitious goals and thorough implementation in the collective judgement of experts of national AMR policies? Using a statistical tool known as conjoint analysis, the project will survey experts on individual countries and ask them to estimate (a) the likelihood that the country would ratify a new global agreement on AMR with specified provisions, and (b), if accepted, the likelihood that the country would implement it thoroughly. The potential provisions include targets for human and animal antibiotic consumption to be reached within a specified timeframe; international monitoring; targets for contributions to two global funds for equitable antibiotics innovation and conservation; a governance structure that ensures transparent decision-making and gives significant voice to low- and middle-income countries.Third, would knowledge of a legally binding international treaty on AMR affect demand for antibiotics among the general population? Finding that international law on AMR could help align demand for antibiotics among the general population with evidence-based policy could provide a rationale for creating an international treaty. The project will conduct surveys (vignette experiments) involving representative samples of the general population of six countries, to examine whether information about legally binding international commitments on AMR affects the declared likelihood that individuals will ask a medical professional for antibiotics if they were to consult for symptoms that normally should be treated in other ways.

当细菌、病毒和真菌等微生物进化成对抗菌药物具有耐药性时，就会发生抗菌素耐药性（AMR）。抗生素耐药性的加速是由于医疗保健和农业中抗生素的使用，特别是过度使用和滥用。卫生设施、清洁用水和保健服务的不足和不公平也加剧了这一问题。专家警告说，AMR可能导致未来没有有效的抗生素。由于耐药菌在国际上的传播是跨越国界的，因此维持抗菌素保护具有需要国际合作的全球公共产品的特征。为了有效地提供公共产品，国际合作安排通常需要同时满足三个条件：雄心勃勃的政策承诺，彻底履行这些承诺，以及世界上许多国家的参与。该项目的首要研究问题是：哪种关于AMR的国际协议最有可能实现深刻的雄心，彻底的实施和广泛的参与？该项目将通过研究三个更具体的问题来解决总体研究问题。首先，现有的国际制度安排在促进解决抗生素耐药性问题取得有意义的进展方面有多有效？目前的工作重点是世卫组织、粮农组织和国际兽疫局大会于2015年批准的《抗生素耐药性全球行动计划》，并得到联合国2016年发表的《政治宣言》的支持。该项目将对2010年至2020年期间世界上大多数国家的数据应用统计方法，以估计各种因素对国家AMR行动计划的采用和内容以及国家一级抗生素消费趋势的影响。这些因素包括：《全球行动计划》，特别是国家业绩指标的公布所产生的规范压力;外部供资，如联合王国政府的弗莱明基金;通过国际组织和其他渠道密切联系的国家的通过和执行;第二，考虑到关于抗生素耐药性的一系列可设想的全球协定，哪一个协定最有可能获得广泛参与，雄心勃勃的目标和彻底执行国家AMR政策专家的集体判断？该项目将使用一种称为联合分析的统计工具，对各国的专家进行调查，并请他们估计：（a）该国批准具有具体条款的新的AMR全球协议的可能性，以及（B）如果接受，该国彻底执行该协议的可能性。可能的规定包括：在规定的时限内达到人类和动物抗生素消费的目标;国际监测;向两个全球基金捐款的目标，以促进公平的抗生素创新和保护;确保决策透明并给予中低收入国家重要发言权的治理结构。第三，了解具有法律约束力的AMR国际条约是否会影响普通人群对抗生素的需求？发现关于AMR的国际法可以帮助将普通人群对抗生素的需求与循证政策相结合，这可以为制定国际条约提供依据。该项目将对六个国家的一般人群进行有代表性的抽样调查（小插曲实验），以检查有关AMR的具有法律约束力的国际承诺的信息是否会影响个人在咨询通常应该以其他方式治疗的症状时向医疗专业人员寻求抗生素的可能性。