The War on AMR is not working: a new ecological perspective on AMR offers insights for global governance

Academic title: “Fit for Purpose?” Assessing the Ecological  
Fit of the Social Institutions that Globally Govern Antimicrobial Resistance

Key findings: 

• Antimicrobial resistance (AMR) happens when antimicrobial medicines stop working against germs (or microbes). This challenge is a fundamental outcome of our society’s relationship with microbial worlds. Creating adaptable and flexible systems can help reduce AMR and keep our medicines working longer.  
• The way we currently deal with AMR isn’t working. Seeing AMR as just a medical problem or as a “war on superbugs” is setting us up to fail. Instead, we should treat AMR as a never-ending challenge connected to how humans have evolved with microbes. Otherwise, we will be stuck in an arms race that we cannot win.  
• The demand for “quick fixes” has contributed to the problem of antimicrobial resistance. We can no longer rely on silver bullet solutions. We need many different plans for different places, and local solutions work best when they are woven into a shared global plan. Just focusing on creating new drugs without resolving overuse of antibiotics means treating only the symptoms of AMR. 
• AMR is inevitable. To make our systems last, we need to be ready for change. Institutions that can’t change will not be able to keep up with the pace of microbial evolution and spread. To ensure our governance systems are ready for the future, we can integrate rapid cycles of learning and promote a diverse range of strategies.  

Why is this study important? 

This groundbreaking study provides a new perspective on the global institutions that govern antimicrobial resistance (AMR). Instead of fighting AMR as “a medical condition”, the study argues that we need to design robust institutions that sustainably manage the social and ecological factors accelerating AMR. 

What is the study? 

This study looks at AMR as an outcome of the relationship between human societies and invisible microbial worlds. Over the past century, the discovery of antimicrobials has changed how we live with germs, shifting our relationship with them. The article asks, “Is our current system of global governance capable of sustainably managing the relationship between these two worlds?” It answers this question by looking at how well human societies fit with the basic features of microbial ecosystems, similar to checking if a key fits a lock. 

With this subtle shift in perspective, the article identifies problems in our current approach to global AMR governance and introduces principles for creating new institutions that can reduce drug resistance and increase our chances of achieving sustainable antimicrobial use for all. 

 
Why isn’t our current approach working? 

The authors identify 18 problems between the current approach of AMR governance with the ecological features of the human–microbial relationship. Some examples of these problems include: 

• Lifesaving antimicrobials are not being distributed fairly and efficiently due to failures in political structure.  
• Delayed World Health Organization (WHO) response times in declaring international public health emergencies. 
• Failure to develop new economically sustainable antimicrobial drugs results in existing antibiotics becoming obsolete faster than replacements are created. 

 What can be done to improve the approach? 

Antimicrobial resistance cannot be stopped, but it does speed up when we misuse and overuse antimicrobials. It can be slowed down through better use and management of the antimicrobials we already have. The impact of AMR can also be mitigated with the development of new treatments. AMR does not only affect human health. It also affects animals, agriculture, the environment, development, and trade. 

The article introduces five new principles for building institutions to better harmonize the relationship between human microbial ecosystems, while maintaining our ability to treat infectious disease.

1. There is no one size fits all solution when it comes to solving antimicrobial resistance. Every region and community has its own set of challenges shaped by its socioeconomic, environmental, and political conditions. Trying to use the same approach everywhere is likely to be ineffective or even cause unintended harm.  
2. What works today may not work tomorrow. We need governance systems that can adapt to the changing nature of AMR, not ones that remain static. Drawing inspiration from the 2015 Paris Agreement, where countries regularly assess and enhance their climate action commitments, we can establish similar mechanisms for AMR governance.  
3. Many different strategies should be used simultaneously. Just like biodiversity is good for nature, having lots of different plans and strategies is good for human societies.  For mitigating and adapting to AMR, these include exploring alternative therapies in medicine, promoting sustainable agricultural practices, adopting holistic approaches to health and welfare, redefining food security and diets culturally, diversifying economic models in the market, and implementing comprehensive governance strategies.  
4. Policy and science must be pursued together. Some ideas won’t work, but others will. When we use science and policy together, we can find new ways to address AMR. By evaluating different policies, we can produce a living scientific evidence base and increase our chances of success. This evidence can provide an ongoing guide for adaptation and adjustments. Bridging organizations that play a key role in connecting diverse sectors, geographies, and scales to ensure successful coordination, ensures that fresh solutions are supported and adaptable in global frameworks that recognize and address AMR as a shared, worldwide problem. 
5. Participation is crucial for effective governance. Stakeholder participation in AMR governance involves engaging actors from diverse backgrounds such as health, agriculture, environment, and policymakers. This builds effective systems that create specific solutions for different situations, consider the complex relationship of evolving microbials and human activity, and effectively address the challenges of AMR.  

Methods  

The researchers adopted a socioecological perspective to examine the ecological fit between the institutions governing AMR and the ecological nature of the problem. They begin by looking at new ecological research to describe AMR as a widespread issue connected to other ecological processes that involve different sectors. Next, referencing research performed in other studies, it introduces the idea of a regime complex, which is a concept that looks at how different global organizations have come together to address AMR.  

By systematically comparing the principles of AMR governance with the ecological features of the problem, this article identifies 18 discrepancies. These issues show how the concept of ecological fit offers a fresh perspective on global health management challenges. Using data from existing biodiversity governance research, the researchers proposed 5 concepts for designing institutions for AMR governance based on obstacles and strategies that have been previously encountered.  

Conclusion 

Addressing antimicrobial resistance involves aligning our social systems with the dynamics of the natural world and creating institutions that fit the ecological and social dynamics of AMR. To fight AMR globally, we need to find political and policy strategies that match the problem, including exploring new forms of social organization. The process of AMR is inevitable, but whether it turns into a big social problem depends on how humans and germs interact. As this interaction changes, new institutions that guide societal changes alongside microbial life could help minimize diseases caused by AMR. As we continue to develop ways to create appropriate global action for AMR, finding political and policy strategies that can adapt to the evolving problem of human interactions with microbes will help to achieve sustainable antimicrobial use for all.