The international regime complex about antimicrobial resistance

The issue of antimicrobial resistance (AMR) crosses national boundaries, several sectors (eg human health, animal health, trade, and the environment), and scales of organisation (eg from local to international levels). Furthermore, AMR is not a single challenge of global collective action but several challenges including surveillance, containment of resistant microbes, conservation of antimicrobials, innovation for new antimicrobials, and diagnostics. AMR epitomizes a complex challenge of our time that requires collaboration between different organizations.

Coming from the literature in international relations, the concept of ‘regime complex’ describes the idea that for many global issues, there is not one organisation responsible but many different institutions with different norms, rules, and procedures. In other words, there is no centralised control but a multitude of interacting elements of governance that influence the response to the issue. Among other issues, this approach has been used to understand climate change, international trade, human trafficking, food security, and governance of the internet.

An important research goal is to capture the shape and state of the regime complex on AMR across the many dimensions mentioned above. With its large responsibility to protect human health, the World Health Organization (WHO) is the primary actor when we think about AMR. The WHO has worked on AMR for a very long time, with several departments working on different aspects of AMR, and has a role in coordinating action on AMR. In addition to the WHO, the World Animal Health Organisation (abbreviated OIE, due to its previous name Office international des épizooties) is important to address AMR in animal health. The OIE produces guidelines and guidance in different areas, including surveillance of antimicrobial use and the prudent use of antimicrobials in farming activities. In addition to OIE’s mandate and activities in animal health, the Food and Agriculture Organization (FAO) of the United Nations is also active on AMR. It has an important role regarding AMR in food-producing animals and food systems in both terrestrial and aquatic animals. WHO and FAO collaborate through the Codex Alimentarius Commission, which was established in 1961.

Beside these core organisations, often referred to as the Tripartite, some aspects of AMR relate to trade (eg international trade of food products) and intellectual property (innovation for new drugs and diagnostics), under the scope of the World Trade Organization through the Sanitary and Phytosanitary (SPS) agreement and the agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS). Several international organisations that promote and protect human rights have also been involved in supporting access to antimicrobials in low- and middle-income countries. Finally, financial organisations such as the World Bank are also involved measuring societal and economic risks associated with AMR.

These actors usually have different ways to frame the problem of AMR (see reference below). Some see the problem of AMR as a healthcare problem, others as a security problem or an economic issue. These frames usually rely on different values regarding what ought to be done, which in turn implies different solutions. Overall, the densification of regimes can have both positive and negative effects. In terms of pros, regime complexity can favour synergies and collaboration between organisations, increase the reach of policies, and foster innovation across sectors. On the other hand, high transaction costs can arise when too many stakeholders compete for the same goals and resources. Regime complexity can also generate confusion and conflicts in global governance with countries resorting to forum shopping and other strategies to deceive their obligations.

Understanding the nature and state of the regime complex on AMR can help understand interactions between different sectors and reflect on solutions to improve our collective capacity to tackle the problem. In this regard, this research project can be related to the broader question of understanding how we collectively address the current challenges of sustainability in a world characterised by growing interdependence.

Author: Dr. Didier Wernli