LML members publish new article identifying nine collective action problems affecting antimicrobial resistance governance

Antimicrobial resistance (AMR) poses at least nine distinct collective action problems, according to a new article by LML members Dr. Isaac Weldon, Prof. Kathy Liddell, Dr. Stephanie Palmer, and Prof. Timo Minssen.

AMR causes over 1.27 million deaths annually, making it one of today's most urgent health threats. Despite this urgency, large-scale global initiatives to address AMR have been met with limited success. The authors propose a novel approach to understanding and addressing this challenge using collective action theory – a theory that analyses how individuals and groups work together to manage shared resources and achieve common goals.

Drawing on the work of Nobel laureate Elinor Ostrom, the authors highlight three key risks that must be avoided when applying collective action frameworks to formulate AMR policy:

1. mischaracterizing the kinds of challenges that AMR presents;
2. over-simplifying the problem by reducing it to a single type of collective action problem while ignoring others; and
3. overstating the ability of collective action theory to formulate effective solutions

By applying their new framework to the issue of AMR, the authors identify nine interlinked collective action problems around both public and common goods:

1. Suboptimal conservation of antimicrobial effectiveness is a Commons Dilemma – a situation where individual use of a shared resource can lead to its depletion
2. Suboptimal investments in innovation for new antimicrobials is a Volunteer’s Dilemma – where the responsibility for contributing to a common good, such as developing new drugs, falls on a few while everyone benefits.
3. Suboptimal provision of universal access to effective antimicrobials is a Weakest Link Problem – where the effectiveness of global efforts depends on the strength of the weakest component of the systems.
4. Underinvestment in public AMR surveillance systems is a Weakest Link Problem – which highlights the global impact of insufficient investment in systems that track and prevent AMR.
5. Suboptimal provision of coordinated AMR surveillance methods is a Pure Coordination Problem – where the lack of harmonized efforts across institutions leads to ineffective monitoring and response.
6. Challenges in implementing effective AMR surveillance represent a Stag Hunt– a scenario where collective cooperation is needed to achieve the best outcome, but where individual incentives may lead to lesser results.
7. Suboptimal provision of universal access to diagnostic technologies and alternative therapies is a Weakest Link Problem – emphasizing the importance of ensuring that all regions have access to critical healthcare tools.
8. Suboptimal investments in innovation for surveillance and diagnostics is a Volunteer’s Dilemma – similar to the challenge of investing in new drugs, where innovation is stifled when too few contribute.
9. Suboptimal investments in global infection prevention is a Weakest Link Problem – where inadequate prevention efforts in one area can undermine global progress against AMR.

Moving forward, it will be crucial to explore global strategies that translate theory into practice and transform patterns of mutual inaction into robust collective solutions. Successfully addressing these challenges, the authors argue, will generate more resilient global health infrastructures, bringing us significantly closer to a world with good health and well-being for all.

Dr. Weldon (first author) commented:

"Our article challenges the oversimplified "tragedy of the commons" view of AMR. We break down AMR into nine distinct collective action challenges, offering policymakers a clear framework to address this global threat. With the UNGA High Level Meeting on AMR coming up this September, our paper is a call for more comprehensive global efforts to achieve sustainable antimicrobial use for all."

Prof. Liddell commented:

“We believe this approach offers a more nuanced understanding of AMR, paving the way for more effective policy solutions. I'm grateful to my wonderful co-authors for their collaboration on this work.”

Read the article here.