Policy and Regulatory Interventions to Reduce Antimicrobial Resistance: Evidence and Analytic Strategies

Abstract

Background: Antimicrobial resistance (AMR) is a widely recognized threat to global health that has been accelerated by the overuse of antimicrobials. Policy and regulatory interventions offer a useful approach to bring about widespread change in antimicrobial use. Objectives: This dissertation aims to investigate and characterize the role of policy interventions on antimicrobial use, to understand which policy levers have been used, which interventions have proven to be effective, and to identify analytic strategies that assist researchers and policymakers in developing evidence-informed approaches to address human AMR. Methods: To investigate effectiveness of policy interventions, I developed a systematic review and evidence map and appraised the quality of research on government policies to reduce antimicrobial use. To evaluate the extent of policy action on AMR in the Canadian context, I conducted an environmental scan of AMR action between 2008-2018. Finally, to facilitate advances in the scientific evidence base on antimicrobial resistance policy, I developed a framework for planning, conducting, and disseminating AMR intervention research. Findings: Governments have a variety of policy options at their disposal to respond to the growing threat of AMR, however, most of these policy options have not been rigorously evaluated and their effectiveness is unknown. Some regulatory, communication, guidelines, and fiscal interventions have been effective in particular settings, however, the interventions were too disparate to generalize about the effectiveness of any particular policy approach and reporting gaps in pose challenges for interpreting and replicating study results. In Canada, policy interventions have been too few, too small and too uncoordinated to achieve our AMR goals. Building on these findings, I developed a framework for planning, conducting, and disseminating AMR intervention research that identifies challenges, areas for increased coordination with policymakers, and best-practices for overcoming common limitations in AMR research. Discussion: Governments around the world have committed to respond to AMR, however, rigorous evidence to inform their policy and regulatory strategies is lacking. As the threat posed by AMR grows, it is increasingly important to strengthen the scientific evidence base on AMR policy interventions, to learn from existing policies and programs, and integrate scientific evidence into the global AMR response.