Exploring the evidence base for national and regional policy interventions to combat resistance
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Date
2016
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Publisher
Elsevier
Abstract
An array of local, national and global policy initiatives to control antimicrobial resistance (AMR) have
been launched, but the effectiveness of these policies is not yet fully understood. A stronger evidence
base to inform effective policy interventions in high and low/middle income country (HIC and LMIC)
settings, and across both the human and animal sectors, is needed. We examine existing policies
covering three domains: 1) responsible use, 2) surveillance and 3) infection prevention and control,
and consider which policies are likely to be most effective at national and regional levels. Specific case
studies highlight the complexities of applying AMR prevention and control policies across sectors and
in widely varying political and regulatory environments, and demonstrate gaps that have emerged in
the evidence base. We make recommendations for policy action given the current state of evidence
2and demonstrate that there is a need for more comprehensive AMR control policy evaluations
including of their cost-effectiveness and generalisibility; by providing a contextual analysis of the
political, regulatory and technical environments in which they are implemented. This is especially
important across LMICs, and in the animal and environmental sectors. We conclude that standardised
frameworks for evaluating AMR control policies should be developed and a cross-sectoral open-access
central repository established to capture national and regional experience. A ‘One Health’ approach
would enable an inclusive, sensitive and flexible process for AMR policy development that
accommodates the needs and circumstances of each sector involved, and addresses specific country
and regional concerns.
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Keywords
Antimicrobial Resistance, effective antibiotic, access, policy interventions