The imperative of linking the ‘technical’ with the ‘social’ to drive policy and advocacy

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The generation and sharing of antimicrobial resistance, use and consumption (AMR/U/C) data is invaluable for underpinning national and global AMR prevention and control strategies. However, these efforts are of limited use if such data and research findings are not simultaneously transformed into policy and practice actions.

A complex web of communication challenges and limited capacities for analysis and visualization appears to be hindering the use of AMR data and evidence to inform policy development. The figure below, using self-reported country data from the global Tripartite AMR Country Self-assessment Survey (TrACSS) 2019-2020 database, emphatically demonstrates that both globally, and particularly in Fleming Fund priority countries, a significant proportion of governments are not yet making use of their AMR/U/C data to amend or inform their national AMR strategy and plans.

Preliminary findings from 54 in-depth Key Informant Interviews (KIIs) with stakeholders across 6 countries in Asia and Africa, and another 26 with regional/global AMR experts, conducted recently by RADAAR, indicate that:

• Despite constraints of technical capacities and resources in developing countries, the Fleming Fund has been instrumental in catalyzing countries to strengthen their AMR surveillance systems. Slow but steady progress is being made in improving the quality and volume of AMR data.
• However, there was almost universal acknowledgement across key informants, that capacities and skills for data analysis and visualization, which make a compelling case for AMR to policymakers, requires strengthening. Data has not yet been leveraged strategically for policy advocacy to the extent required to generate change.
• While multi-sectoral coordination from a One Health perspective was slowly improving and edging towards the beginnings of a “whole-of-government” approach, there seemed to be little movement towards building a “whole-of-society” response, which AMR demands. While this is not specifically within the Fleming Fund’s remit, it is the use of data that will be one of the drivers of the response.
• Several countries will soon develop second iterations of their National Action Plans (NAPs). All countries had followed the AMR Global Action Plan (GAP) framework for their previous NAPs and were likely to do so for their second iterations. However, several key informants expressed concern that while the GAP/NAP framework seemed useful as an organizing principle for high-income countries, the process was not well connected with policy and practice frameworks in low- and middle-income countries (LMICs).
• Several country and regional/global AMR stakeholders expressed the need for ‘step-by-step’ guidelines on using AMR data for developing compelling policy briefs, to support advocacy and engagement with decision-makers and capitalize on political leadership.

The above findings, are likely to be further validated upon completion of the online RADAAR Regional Data Sharing and Analysis Survey, currently being conducted across all the Fleming Fund priority countries.

Policy analysis and formulation are inherently highly political processes. Too much attention to the content of policy, at the cost of neglecting the role of various actors in the policy process and the context within which policies are introduced and implemented, can often derail efforts in unanticipated ways.

The sheer number of actors across the One Health landscape, and the complex networks these stakeholders represent, as well as their understanding and response to how the AMR problem has been framed, sets the stage for contested meanings and power struggles within the AMR policy arena1. Furthermore, given that AMR is driven mostly by human actions and behaviours, a predominantly technical and biomedical response (focused largely on surveillance systems and laboratories) is unlikely to offer lasting solutions to the social and political complexities of AMR – though it is a vital ingredient. The failure of current AMR communication framing and advocacy approaches to effectively communicate the risk of AMR and build widescale public support to underpin policy implementation, calls for reframing the communication and advocacy on AMR, especially in LMICs.

Given the complex socio-political contexts, competing development priorities, stretched health systems and disproportionate global burden of infectious diseases, LMICs require much more hands-on support in generating and using data and research. Additional support is required to translate emerging global lessons into national policies and country and region-specific policy actions.

The next phase of RADAAR activities, through 2021, will attempt to identify and pilot solutions to address this very gap in selected countries of Asia and Africa.

Following from the comprehensive ‘bottleneck assessment’ of barriers and enablers to data sharing and analysis, RADAAR will conduct a series of planned regional data and policy workshops; pilot and assess a regional data sharing framework and hub; conduct a series of compelling webinars involving AMR thought leaders; and develop a framework and practical guidance to support AMR policy advocacy in LMICs.

References

1. Legido-Quigley, H., Khan, M. S., Durrance-Bagale, A., & Hanefeld, J. (2019). Something borrowed, something new: A governance and social construction framework to investigate power relations and responses of diverse stakeholders to policies addressing antimicrobial resistance. Antibiotics, 8(1), 3.