Global Strategy Lab, York University, Toronto, Ontario, Canada.
Osgoode Hall Law School, York University, Toronto, Ontario, Canada.
BMJ Glob Health. 2024 Oct 3;9(10):e015690. doi: 10.1136/bmjgh-2024-015690.
The Montreal Protocol has played a critical role in promoting global collective action to phase out the use of ozone-depleting substances, ultimately preventing millions of cases of skin cancer, cataracts and other health issues related to ultraviolet radiation exposure. This success entails transferable lessons for coordinated action required to improve the global governance of other challenges. Like ozone depletion, antimicrobial resistance (AMR) is a challenge of the global commons, requiring coordinated actions across human, animal and environmental sectors. We identify equity, flexibility and accountability as three core governance principles that underlie the success of the protocol and employ the 3-i framework to understand how interests, ideas and institutions contributed to the protocol's success. Equity-promoting strategies consisted of an inclusive negotiation process, supporting developing countries with multilateral funding and a progressive compliance model. Flexibility was built into the protocol through the development of country-specific strategies, reorienting incentive structures for industry and facilitating regular amendments in response to emerging scientific evidence. Accountability was promoted by mobilising public advocacy, establishing targets and enforcement mechanisms and conducting independent scientific and technical assessments. Applying our proposed principles presents an opportunity to improve the global governance of AMR. Finally, we acknowledge limitations to our analysis, including our focus on a single environmental treaty, significantly greater funding requirements and multifacetted stakeholder involvement in the case of AMR, differing market and incentives structures in antibiotic development and distribution, and ethical concerns with using trade restrictions as a policy tool.
《蒙特利尔议定书》在推动全球采取集体行动逐步淘汰消耗臭氧层物质方面发挥了关键作用，最终防止了数以百万计的皮肤癌、白内障和其他与紫外线辐射暴露有关的健康问题。这一成功为协调行动提供了可借鉴的经验，以改善其他挑战的全球治理。与臭氧消耗一样，抗微生物药物耐药性（AMR）是全球公域的一个挑战，需要在人类、动物和环境部门之间采取协调行动。我们确定公平、灵活性和问责制是该议定书成功的三个核心治理原则，并采用 3-i 框架来了解利益、观念和机构如何促成该议定书的成功。促进公平的战略包括包容性谈判进程、为发展中国家提供多边资金支持和逐步遵守模式。通过制定针对具体国家的战略、重新调整行业激励结构以及为应对新出现的科学证据定期修订协议，在协议中纳入了灵活性。通过动员公众宣传、建立目标和执行机制以及进行独立的科学和技术评估，促进了问责制。应用我们提出的原则为改善 AMR 的全球治理提供了机会。最后，我们承认我们的分析存在局限性，包括我们专注于一项单一的环境条约、AMR 需要更多的资金、涉及多方利益相关者、抗生素开发和分销的市场和激励结构不同以及使用贸易限制作为政策工具存在道德问题。
