Policy Options for Antimicrobial Resistance: Exploring Lessons From Environmental Governance.

Abstract

UNLABELLED: Policy Points Antimicrobial resistance (AMR) is a pressing global health crisis driven by complex collective action challenges, requiring locally tailored and context-sensitive solutions. Drawing insights from environmental governance where collective action problems are familiar, we propose nine adaptable strategies for AMR governance, offering policymakers and scholars a flexible policy toolkit for addressing AMR. These strategies integrate the roles of state, market, and community actors to advance sustainable and equitable collective action across diverse global contexts. CONTEXT: Antimicrobial resistance (AMR) is a pressing global health crisis rooted in complex collective action problems. Despite the urgency, policy responses have not kept pace with the escalating threat of drug resistance. By recognizing the similarities between AMR governance and other shared-resource challenges in environmental governance, this article examines potential strategies for AMR governance. METHODS: An analysis of 12 environmental governance frameworks identified three main approaches to collective action: market-driven, state-led, and community-centered strategies. From these strategies, we purposively selected three case studies to illustrate how each approach could inform AMR policy, focusing on: (1) market-based mechanisms in climate governance, (2) state-led initiatives in water management, and (3) community-led efforts in biodiversity conservation. FINDINGS: We propose nine policy options for AMR governance, drawing inspiration from established strategies in environmental governance. These include Pigouvian taxes, cap-and-trade systems, enhanced public-private partnerships with performance metrics and technology transfer, and access-and-benefit sharing agreements. Framed as adaptable strategies, we emphasize the importance of tailoring each option or a blend of options to the economic, political, and health care contexts unique to AMR challenges worldwide. CONCLUSIONS: Although environmental governance has not fully resolved the global issues it addresses, its lessons offer valuable guidance for designing adaptive, equitable, and collaborative AMR governance frameworks. Our analysis highlights the importance of a balanced approach, combining state, market, and community engagement to achieve sustainable AMR solutions. Recognizing the limits of environmental governance, we emphasize that effective AMR strategies should integrate ongoing evaluation, international collaboration, and inclusive stakeholder engagement to foster global commitment and meaningful action.