Rogers Van Katwyk Susan, Danik Marie Évelyne, Pantis Ioana, Smith Rachel, Røttingen John-Arne, Hoffman Steven J
Global Strategy Lab, Centre for Health Law, Policy & Ethics, Faculty of Law, University of Ottawa, Ottawa, Canada.
School of Epidemiology, Public Health, and Preventive Medicine, University of Ottawa, Ottawa, Canada.
Glob Health Res Policy. 2016 Dec 13;1:20. doi: 10.1186/s41256-016-0020-9. eCollection 2016.
Antimicrobial resistance (AMR) is a global issue. International trade, travel, agricultural practices, and environmental contamination all make it possible for resistant microbes to cross national borders. Global collective action is needed in the form of an international agreement or other mechanism that brings states together at the negotiation table and commits them to adopt or implement policies to limit the spread of resistant microorganisms. This article describes an approach to assessing whether political and stakeholder interests can align to commit to tackling AMR.
Two dimensions affecting political feasibility were selected and compared across 82 countries: 1) states' global influence and 2) self-interest in addressing AMR. World Bank GDP ranking was used as a proxy for global influence, while human antibiotic consumption (10-year percent change) was used as a proxy for self-interest in addressing AMR. We used these data to outline a typology of four country archetypes, and discuss how these archetypes can be used to understand whether a proposed agreement may have sufficient support to be politically feasible.
Four types of countries exist within our proposed typology: 1) wealthy countries who have the expertise and financial resources to push for global collective action on AMR, 2) wealthy countries who need to act on AMR, 3) countries who require external assistance to act on AMR, and 4) neutral countries who may support action where applicable. Any international agreement will require substantial support from countries of the first type to lead global action, and from countries of the second type who have large increasing antimicrobial consumption levels. A large number of barriers exist that could derail efforts towards global collective action on AMR; issues of capacity, infrastructure, regulation, and stakeholder interests will need to be addressed in coordination with other actors to achieve an agreement on AMR.
Achieving a global agreement on access, conservation, and innovation - the three pillars of AMR - will not be easy. However, smaller core groups of interested Initiator and Pivotal Countries could develop policy and resolve many issues. If highly influential countries take the lead, agreements could then be scaled up to achieve global action.
抗菌药物耐药性（AMR）是一个全球性问题。国际贸易、旅行、农业实践和环境污染都使得耐药微生物有可能跨越国界。需要采取全球集体行动，形式可以是一项国际协定或其他机制，将各国聚集在谈判桌前，并促使它们采取或实施政策来限制耐药微生物的传播。本文描述了一种评估政治利益和利益相关者利益是否能够一致以致力于应对AMR的方法。
选择了影响政治可行性的两个维度，并在82个国家之间进行比较：1）各国的全球影响力和2）应对AMR的自身利益。世界银行国内生产总值排名被用作全球影响力的代理指标，而人类抗生素消费量（10年变化百分比）被用作应对AMR的自身利益的代理指标。我们利用这些数据勾勒出四种国家原型的类型，并讨论如何利用这些原型来理解一项拟议的协定是否可能获得足够支持从而在政治上可行。
在我们提出的类型中存在四种类型的国家：1）有专业知识和财政资源推动全球AMR集体行动的富裕国家，2）需要就AMR采取行动的富裕国家，3）需要外部援助来应对AMR的国家，以及4）可能在适用情况下支持行动的中立国家。任何国际协定都将需要第一类国家的大力支持来引领全球行动，以及第二类国家（其抗菌药物消费量大幅增加）的支持。存在大量可能破坏全球AMR集体行动努力的障碍；能力、基础设施、监管和利益相关者利益等问题需要与其他行为体协调解决，以就AMR达成协定。
就AMR的三大支柱——获取、保存和创新——达成全球协定并非易事。然而，由感兴趣的发起国和关键国家组成的较小核心群体可以制定政策并解决许多问题。如果极具影响力的国家发挥带头作用，那么协定就可以扩大规模以实现全球行动。
