A Just Transitions framework for equitable and sustainable mitigation of antimicrobial resistance

Why is antimicrobial resistance (AMR) such a complex and multi-faceted challenge? In this interview, Phaik Yeong Cheah reflects on the multiple ethical tensions prevalent in efforts to mitigate AMR. She also explains why AMR is a secondary problem and even a distant issue for many people and why it disproportionately burdens poor and marginalised communities, and how the multi-disciplinary Just Transitions for AMR convening group is trying to tackle the issue.

The Just Transitions for AMR working group has made a formal submission to the United Nations Committee on Economic, Social and Cultural Rights (CESCR) to provide input into a General Comment (no. 27) that this committee is expected to issue towards the end of February 2025 about sustainable development.

Our input relates to the urgency to recognise a right to a healthy, sustainable and clean microbial environment for sustainable development. In particular, the submission highlights the threats of unsustainable consumption and production patterns on microbiota, arguing that the human right to a healthy, clean and sustainable environment implicit in the International Covenant on Economic, Social and Cultural Rights (the Covenant) encompasses a legal obligation to manage the microbial commons sustainably.

Read the submission in full by following the arrow below and selecting submission no. 37 – Just Transitions for AMR Working Group (joint submission).

Sonia Lewycka, co-lead of the global convening programme, talks about how One Health interventions in the community can help combat antimicrobial resistance. Antimicrobial resistance can be viewed through a One Health lens across humans, animals and the environment. Focussing on primary care, tests offered at point-of-care in Vietnam to curb antibiotic overuse yielded promising but nuanced results. The Just Transition initiative, examining justice implications of AMR policies globally, aims to align efforts with climate change mitigations for mutual benefits.

Researchers from Stellenbosch University facilitated five dialogue sessions with participants from the fields of health, food science, agriculture, animal health, and the environment as well as science communication and journalism. The dialogues, made possible through a Knowledge Translation Grant from the British Academy, provided an opportunity for sharing insights and concerns with one another as well as co-create solutions for the mitigation of AMR that are just and equitable and suitable for the local context of South Africa.

This two-day workshop, hosted by One Health Trust, and funded by WHO and the British Academy, focused on how social and economic inequities related to gender and caste in India can affect the emergence and spread of drug-resistant infections. It also investigated how gender inequity and climate change influence AMR. A diverse group of researchers looked at potential solutions and strategies to ensure gender, caste and climate considerations are included in important policies and health practices.

This commentary explores whether there is epistemic injustice in global antimicrobial resistance (AMR) research – who sets priorities, who produces knowledge, and which types of knowledge are valued. We argue that epistemic injustice may have created blind spots in policy. Addressing this requires a commitment to diversity, equity, and inclusion.

This issue of Monash Bioethics Review explores antimicrobial resistance (AMR) as a threat to global health, and focuses particularly on the social justice implications of measures to prevent, reduce, and innovate against AMR. Whilst AMR poses harm across the globe, these harms are not uniformly distributed among populations, either temporally or geographically. This is one facet of considering justice in the AMR context. Furthermore, the risks of resistance developing are not uniformly distributed, implying that there may be AMR ‘hotspots’ (in time and space) for which it is more effective to intervene using stewardship, surveillance, and/or innovation. The burdens of these interventions ought to be considered in comparison to the benefits to the populations of hotspots compared to other populations. Where greater harms are borne by already disadvantaged populations, there is the potential for interventions against AMR to exacerbate existing social injustice. Stewardship, surveillance and innovation measures must be ethically evaluated through this lens."

Commenting on the relevance and timeliness of this publication, issue editor Tess Johnson said: “I've been interested in this area ever since the pandemic. It's amazing how much attention big, urgent threats get, but it's easy for us to forget about ongoing and multifaceted health issues, like drug resistance".

A review by Deepshika Batheja and Srishti Goel that explores how biological, sociocultural and behavioural factors contribute to the differential incidence of AMR in women, delving into the gendered implications that are often overlooked when it comes to the threat of AMR.

A paper, by Edna Mutua and contributors, that deals with the question of morality in AMR discourse as seen through data collected on antibiotic prescription, dispensing and use in human and livestock health in Tanzania.

An ethnographic study (with Clare Chandler as contributor) looking at the present and everyday realities of AMR for frail bedridden patients through the theoretical lenses of precarity and care.

A comment piece (with Sonia Lewycka and Rogier van Doorn as contributors) about access to diagnostics (CRP testing) in low-income and middle-income countries to prevent overuse of antimicrobials.

A study on Point-of-care tests (with Clare Chandler as contributor) that reveals social and temporal intersections between processes of technological innovation and health systems. 

This article (with Phaik Yeong Cheah and Tess Johnson as contributors) delves into the ethical tensions that might make it difficult to address or solve the complex issue of Antimicrobial resistance (AMR). The ethical analysis reveals multiple competing interests and unresolved ethical tensions, drawing from existing evidence and the experiences of the contributors living and working in low-income and middle-income countries. To be effective, AMR policies need to take all these tensions into account and find solutions that service those who are worst affected by AMR.

An article by Marina Joubert, Phaik Yeong Cheah and Sonia Lewycka, written for World AMR Awareness Week, on the threat of AMR and why the global response needs to be fair to all. It includes the call for a new approach to solutions that prioritise equity and sustainability and the importance of embedding public and community voices.

A comment piece written by the Just Transitions for AMR Working Group outlining the need for a just transition approach for antimicrobial resistance in order to prioritise justice, sustainability, inclusivity and equity in the planning for a future with AMR.