setting the standard multidisciplinary hallmarks for structural equitable and tracked CORD-Papers-2022-06-02 (Version 1)

Title: Setting the standard: multidisciplinary hallmarks for structural equitable and tracked antibiotic policy
Abstract: There is increasing concern globally about the enormity of the threats posed by antimicrobial resistance (AMR) to human animal plant and environmental health. A proliferation of international national and institutional reports on the problems posed by AMR and the need for antibiotic stewardship have galvanised attention on the global stage. However the AMR community increasingly laments a lack of action often identified as an implementation gap. At a policy level the design of internationally salient solutions that are able to address AMRs interconnected biological and social (historical political economic and cultural) dimensions is not straightforward. This multidisciplinary paper responds by asking two basic questions: (A) Is a universal approach to AMR policy and antibiotic stewardship possible? (B) If yes what hallmarks characterise good antibiotic policy? Our multistage analysis revealed four central challenges facing current international antibiotic policy: metrics prioritisation implementation and inequality. In response to this diagnosis we propose three hallmarks that can support robust international antibiotic policy. Emerging hallmarks for good antibiotic policies are: Structural Equitable and Tracked. We describe these hallmarks and propose their consideration should aid the design and evaluation of international antibiotic policies with maximal benefit at both local and international scales.
Published: 2020-09-23
Journal: BMJ Glob Health
DOI: 10.1136/bmjgh-2020-003091
DOI_URL: http://doi.org/10.1136/bmjgh-2020-003091
Author Name: Kirchhelle Claas
Author link: https://covid19-data.nist.gov/pid/rest/local/author/kirchhelle_claas
Author Name: Atkinson Paul
Author link: https://covid19-data.nist.gov/pid/rest/local/author/atkinson_paul
Author Name: Broom Alex
Author link: https://covid19-data.nist.gov/pid/rest/local/author/broom_alex
Author Name: Chuengsatiansup Komatra
Author link: https://covid19-data.nist.gov/pid/rest/local/author/chuengsatiansup_komatra
Author Name: Ferreira Jorge Pinto
Author link: https://covid19-data.nist.gov/pid/rest/local/author/ferreira_jorge_pinto
Author Name: Fortan Nicolas
Author link: https://covid19-data.nist.gov/pid/rest/local/author/fortan_nicolas
Author Name: Frost Isabel
Author link: https://covid19-data.nist.gov/pid/rest/local/author/frost_isabel
Author Name: Gradmann Christoph
Author link: https://covid19-data.nist.gov/pid/rest/local/author/gradmann_christoph
Author Name: Hinchliffe Stephen
Author link: https://covid19-data.nist.gov/pid/rest/local/author/hinchliffe_stephen
Author Name: Hoffman Steven J
Author link: https://covid19-data.nist.gov/pid/rest/local/author/hoffman_steven_j
Author Name: Lezaun Javier
Author link: https://covid19-data.nist.gov/pid/rest/local/author/lezaun_javier
Author Name: Nayiga Susan
Author link: https://covid19-data.nist.gov/pid/rest/local/author/nayiga_susan
Author Name: Outterson Kevin
Author link: https://covid19-data.nist.gov/pid/rest/local/author/outterson_kevin
Author Name: Podolsky Scott H
Author link: https://covid19-data.nist.gov/pid/rest/local/author/podolsky_scott_h
Author Name: Raymond Stephanie
Author link: https://covid19-data.nist.gov/pid/rest/local/author/raymond_stephanie
Author Name: Roberts Adam P
Author link: https://covid19-data.nist.gov/pid/rest/local/author/roberts_adam_p
Author Name: Singer Andrew C
Author link: https://covid19-data.nist.gov/pid/rest/local/author/singer_andrew_c
Author Name: So Anthony D
Author link: https://covid19-data.nist.gov/pid/rest/local/author/so_anthony_d
Author Name: Sringernyuang Luechai
Author link: https://covid19-data.nist.gov/pid/rest/local/author/sringernyuang_luechai
Author Name: Tayler Elizabeth
Author link: https://covid19-data.nist.gov/pid/rest/local/author/tayler_elizabeth
Author Name: Rogers Van Katwyk Susan
Author link: https://covid19-data.nist.gov/pid/rest/local/author/rogers_van_katwyk_susan
Author Name: Chandler Clare I R
Author link: https://covid19-data.nist.gov/pid/rest/local/author/chandler_clare_i_r
sha: 7c89f26ffff6f0d36e63b5a46c90b5533435da00
license: cc-by
license_url: https://creativecommons.org/licenses/by/4.0/
source_x: Medline; PMC
source_x_url: https://www.medline.com/https://www.ncbi.nlm.nih.gov/pubmed/
pubmed_id: 32967980
pubmed_id_url: https://www.ncbi.nlm.nih.gov/pubmed/32967980
pmcid: PMC7513567
pmcid_url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7513567
url: https://www.ncbi.nlm.nih.gov/pubmed/32967980/ https://doi.org/10.1136/bmjgh-2020-003091
has_full_text: TRUE
Keywords Extracted from Text Content: antibiotic-controlled participants SDGs St Bartholomew's Hospital OIE Member azithromycin nongovernmental lens-who SDG 3 IPC humans Food WASH LMICs Over-reliance bodies polio Scandinavian countries recipients COVID-19 Bank UK's 2019 AWaRe consumption/ human AMR-specific SDG globe tylosin WHONET non-classic joint UK livestock Niger enforced-as CIAs SET Vice organ transplants AMR-as AMRfocused non-HIC polymyxin people polymyxins centre MCR-1 Staphylococcus aureus AMR's Denmark's farms bloodstream HICs lower-dosed avoparcin AMR-focused mcr-1 AMR HIC LICs granular LIC Brazil. FAO FDA narrow-spectrum HIC-centric [2] [3] [4] [5] [6] E. coli AMR-specific donors future-focused wastewaters Escherichia coli H1N1 patients colistin safe-guard MICs short-termist lymphatic environment-perhaps
Extracted Text Content in Record: First 5000 Characters:There is increasing concern globally about the enormity of the threats posed by antimicrobial resistance (AMR) to human, animal, plant and environmental health. A proliferation of international, national and institutional reports on the problems posed by AMR and the need for antibiotic stewardship have galvanised attention on the global stage. However, the AMR community increasingly laments a lack of action, often identified as an 'implementation gap'. At a policy level, the design of internationally salient solutions that are able to address AMR's interconnected biological and social (historical, political, economic and cultural) dimensions is not straightforward. This multidisciplinary paper responds by asking two basic questions: (A) Is a universal approach to AMR policy and antibiotic stewardship possible? (B) If yes, what hallmarks characterise 'good' antibiotic policy? Our multistage analysis revealed four central challenges facing current international antibiotic policy: metrics, prioritisation, implementation and inequality. In response to this diagnosis, we propose three hallmarks that can support robust international antibiotic policy. Emerging hallmarks for good antibiotic policies are: Structural, Equitable and Tracked. We describe these hallmarks and propose their consideration should aid the design and evaluation of international antibiotic policies with maximal benefit at both local and international scales. Since their introduction in the 1930s, antibiotics have acquired infrastructural importance in global health and food production. 1 However, antibiotic reliance comes with a trade-off: using antibiotics accelerates the emergence of antimicrobial resistance (AMR), which diminishes their future effectiveness. This makes effective antibiotics a precious 'global common-pool resource', [2] [3] [4] [5] [6] which can benefit humanity but will provide diminishing benefits if we fail to coordinate plans for preservation (a tragedy of the commons). Over the past decade, rising concern about AMR has highlighted the need for collective action to protect our antibiotic 'commons'. 2 7-12 Governmental and nongovernmental organisations have devoted substantial resources to tackling AMR and preserving antibiotic effectiveness on national and international stages. 13 Increasing attention and funding have been accompanied by a proliferation of expert reports and policy proposals. 14 While these AMR-focused initiatives have succeeded in achieving a clear international consensus on the need for action, many lament a lack of action in practice, dubbed an 'implementation gap'. Substantial uncertainties also remain about Summary box ► The global crisis of antimicrobial resistance has led to a proliferation of expert reports and national and international antibiotic action plans. ► Implementing international antibiotic policy that is meaningful in different social, cultural and economic contexts continues to prove challenging. ► Our multidisciplinary analysis has identified four critical challenges of metrics, prioritisation, implementation and inequality for international antibiotic policy-making. ► We propose a corresponding SET of basic hallmarks of good antibiotic policy, which we define as Structural, Equitable and Tracked. ► Our SET of hallmarks can orientate disciplinary debates and provide a framework for developing robust international interventions. BMJ Global Health the effects of different policy interventions, how international policies could be enforced globally, and who will pay in the long term. The main difficulty with managing the antibiotic commons seems to lie in jointly addressing the complex biological and social (understood here to be historical, political, economic and cultural) dimensions of AMR. Policy formation for the latter dimension is particularly challenging because it entails addressing different metrics, meanings and challenges in different settings. We propose a new wide-angle approach to AMRfocused antibiotic regulation. Two basic questions guide our reflective process: (A) Is a universal approach to AMR policy and antibiotic stewardship possible? (B) If yes, what hallmarks characterise 'good' antibiotic policy? To answer these questions, we have developed an innovative heuristic evaluation framework, which accounts both for AMR's biological and social facets. Our approach was informed by the numerous national and international reports proposing various principles for antibiotic policy-making 2 10 11 15-17 and the historical success of the 3Rs (Reduction, Refinement and Replacement) that restructured laboratory animal testing protocols. Developed as principles of 'good animal experimentation' in 1959, the 3Rs were concrete and aspirational enough to trigger a progressive evolution of protocols and dialogue in a contested policy arena. 18 (So et al have proposed three Rs for antimicrobial development). 19 Applying this approach to AMR and antibiotic policy, our collaborative mul
Keywords Extracted from PMC Text: stakeholders.124 Food different.111 129 protected1 WHONET AMR.34 76 137 156 157 lower-dosed avoparcin databases.31 methods74 settings.34 77 107 mechanisms.10 colistin tylosin FAO humans HIC investment.33 HIC-centric non-classic polymyxins participants farms FDA plans.11 13 London52 narrow-spectrum IPC resource',2–6 AMR— facilities87 UK MICs livestock comparable.28 29 E. coli human azithromycin AMR-specific LICs bloodstream 's COVID-19 pandemic.95–98 Brazil.57 60 Brazil.88 Vice efforts.54 HIC concerns.125 126 lymphatic SET data.34–37 LIC polymyxin OIE Member Inequality).30 EUCAST human medicine.75 H1N1 Islands.104 fixes'106 LMICs policy-making.10 20 21 111 HICs bodies world.48–51 Denmark's mcr-1 SDG 3 settings.73 Scandinavian countries.43 53 55 people Niger Escherichia coli fragmentary13 paywalled literature.32 WASH proposals.14 Reserve medicines— AMR-specific SDG patients elusive.10 112 St Bartholomew's onwards.39 policy-making2 10 11 15–17 needs.105 onwards.89 AWaRe AMR-focused MCR-1 gene.57 granular arena.18(So Staphylococcus aureus data,64 UK's 2019 use.121–123 interventions.10 20 21 rates.45–47 built.10 20 132 globe actors.7 12 109 110 targets.63 AMR.53 terms.158–160 sales116—or 2018–2019 varies.8 20 110 111 short-termist AMR CIAs Well-being).73
Extracted PMC Text Content in Record: First 5000 Characters:Since their introduction in the 1930s, antibiotics have acquired infrastructural importance in global health and food production.1 However, antibiotic reliance comes with a trade-off: using antibiotics accelerates the emergence of antimicrobial resistance (AMR), which diminishes their future effectiveness. This makes effective antibiotics a precious 'global common-pool resource',2–6 which can benefit humanity but will provide diminishing benefits if we fail to coordinate plans for preservation (a tragedy of the commons). Over the past decade, rising concern about AMR has highlighted the need for collective action to protect our antibiotic 'commons'.2 7–12 Governmental and non-governmental organisations have devoted substantial resources to tackling AMR and preserving antibiotic effectiveness on national and international stages.13 Increasing attention and funding have been accompanied by a proliferation of expert reports and policy proposals.14 While these AMR-focused initiatives have succeeded in achieving a clear international consensus on the need for action, many lament a lack of action in practice, dubbed an 'implementation gap'. Substantial uncertainties also remain about the effects of different policy interventions, how international policies could be enforced globally, and who will pay in the long term. The main difficulty with managing the antibiotic commons seems to lie in jointly addressing the complex biological and social (understood here to be historical, political, economic and cultural) dimensions of AMR. Policy formation for the latter dimension is particularly challenging because it entails addressing different metrics, meanings and challenges in different settings. We propose a new wide-angle approach to AMR-focused antibiotic regulation. Two basic questions guide our reflective process: (A) Is a universal approach to AMR policy and antibiotic stewardship possible? (B) If yes, what hallmarks characterise 'good' antibiotic policy? To answer these questions, we have developed an innovative heuristic evaluation framework, which accounts both for AMR's biological and social facets. Our approach was informed by the numerous national and international reports proposing various principles for antibiotic policy-making2 10 11 15–17 and the historical success of the 3Rs (Reduction, Refinement and Replacement) that restructured laboratory animal testing protocols. Developed as principles of 'good animal experimentation' in 1959, the 3Rs were concrete and aspirational enough to trigger a progressive evolution of protocols and dialogue in a contested policy arena.18(So et al have proposed three Rs for antimicrobial development).19 Applying this approach to AMR and antibiotic policy, our collaborative multidisciplinary analysis employed a three-stage evidence gathering, evaluation and consultation process (box 1), which consisted of: (1) asking selected medical humanities and sciences researchers whether they believe antibiotic policies could feasibly be guided by a universal set of guiding principles, and what they consider those guiding principles could be; (2) identifying possible hallmarks of good policy with a broad group of stakeholders from academia, medicine, animal/plant production, policy and funding bodies at an international workshop and (3) refining identified hallmarks in light of multidisciplinary feedback. We believe that the resulting heuristic compass based first on the identification of central challenges of antibiotic policy-making (metrics, prioritisation, implementation, inequality) and second on the formulation of a corresponding Structural, Equitable and Tracked (SET) of hallmarks of good antibiotic policy, which we define as SET can orientate disciplinary debates and provide a framework for robust international interventions.10 20 21 Since the first warnings about 'drug fastness' in microorganisms in 1907,23 24 there has been no clear transdisciplinary or international consensus on how to define AMR. The constantly evolving nature of AMR, the introduction of new drugs and the different availability and use of antibiotics means that terms like drug sensitive, intermediate resistant or resistant, mean different things in different regional contexts. There is also no transdisciplinary consensus on whether to define AMR according to predefined clinical breakpoints, minimum inhibitory concentrations, epidemiological cut-offs, pharmacokinectic/pharmacodynamic models, the presence or absence of resistance-conferring genetic elements or clinical impact on patients or animals. Disagreement over this latter point is highlighted by the common absence of drug-resistant infection as an official cause of death. Historically, the lack of consensus over AMR has led to differing microbiological and public health definitions of AMR with the former measuring incremental changes of microbial susceptibility and the latter measuring instances of treatment failure at predefined dosages.25–27 Interna
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