Making Use of Existing International Legal Mechanisms to Manage the Global Antimicrobial Commons: Identifying Legal Hooks and Institutional Mandates

Abstract

Antimicrobial resistance (AMR) is an urgent threat to global public health and development. Mitigating this threat requires substantial short-term action on key AMR priorities. While international legal agreements are the strongest mechanism for ensuring collaboration among countries, negotiating new international agreements can be a slow process. In the second article in this special issue, we consider whether harnessing existing international legal agreements offers an opportunity to increase collective action on AMR goals in the short-term. We highlight ten AMR priorities and several strategies for achieving these goals using existing "legal hooks" that draw on elements of international environmental, trade and health laws governing related matters that could be used as they exist or revised to include AMR. We also consider the institutional mandates of international authorities to highlight areas where additional steps could be taken on AMR without constitutional changes. Overall, we identify 37 possible mechanisms to strengthen AMR governance using the International Health Regulations, the Agreement on the Application of Sanitary and Phytosanitary Measures, the Agreement on Trade-Related Aspects of Intellectual Property Rights, the Agreement on Technical Barriers to Trade, the International Convention on the Harmonized Commodity Description and Coding System, and the Basel, Rotterdam, and Stockholm conventions. Although we identify many shorter-term opportunities for addressing AMR using existing legal hooks, none of these options are capable of comprehensively addressing all global governance challenges related to AMR, such that they should be pursued simultaneously with longer-term approaches including a dedicated international legal agreement on AMR.

Understanding antibiotic use: practices, structures and networks

“…what will work) than their resistance (what will not). 52 , 125 Adopting a networks perspective and working across countries also draws attention to regulatory responses, 127 an important, if currently understudied, component of efforts to reduce the global burden of AMR. 62 …”

A Global Pandemic Treaty Must Address Antimicrobial Resistance

“…14 Like the COVID-19 pandemic response, previous efforts to manage the global antimicrobial commons have also suffered from a lack of effective surveillance and enforcement that would enable the early identification of new threats and opportunities. 15 Harmonized monitoring and accountability mechanisms that are simple, robust, transparent, and responsive are needed for all global health threats. A comprehensive and well-designed pandemic treaty should provide these mechanisms so that they can be applied to any of the main pandemic sources, regardless of the perceived speed at which they move.…”

Setting the standard: multidisciplinary hallmarks for structural, equitable and tracked antibiotic policy

“…127 This role could be fulfilled by the existing Tripartite and a One Health Global Leadership Group on AMR. 153 Another option suggested by some authors is creating a new dedicated international AMR body or pooled fund similar to 8 Ultimately, the structural challenges posed by AMR exceed the capabilities of any one nation. Overcoming the significant levels of inequality that have hampered previous responses will depend on intensifying international collaboration, equitably pooling resources and knowledge, and openly addressing the global disparities driving infectious disease burdens and the resulting need for antibiotics.…”

“… 7 12 109 110 There are a number of challenges with this model: global trade flows are not easily regulated by nation-level policies; with few exceptions like the International Health Regulations on pandemics, international organisations like the WHO cannot enforce health agreements negotiated under their umbrella; the ability of governments to implement policies varies. 8 20 110 111 Described implementation problems are exacerbated by the widespread absence of basic data and robust metrics (see above) to inform international policymaking. For example, while it may seem straightforward to define and evaluate policy success as reductions of drug usage in HICs, these metrics will likely fail in settings without reliable consumption/usage data and where informal grey market and unregulated over-the-counter sales account for a large part of the antibiotic supply.…”