AMR policy development: looking forward through history

Lead Research Organisation: University of Exeter
Department Name: Institute of Health Research


The use of antibiotics is vital in the prevention and treatment of infections for humans and animals. Unfortunately as we have grown to rely on them over the past 75 years, they are losing their power as bacteria become resistant to them. As such antimicrobial resistance (AMR) is one of the most pressing global public health crises today.

AMR is a global problem and requires global solutions. Policy responses to address AMR require many different actors to come together, for example, governments, those representing human health, animal health, the environment and industry (e.g. pharmaceutical companies). Effective policy responses also require national and international cooperation. As such many different institutions have to engage with each other to create opportunities for cooperation. AMR has become an important global issue but challenges exist for policymaking as the consequences and necessary solutions to AMR stretch well into the future. In order to increase the likelihood of policies successfully addressing AMR, it is important to use robust research and analysis to improve the efficiency and effectiveness of policymaking going forward.

In this research we will explore what we can learn from history and from looking at other complex policy issues that are relevant for AMR policy making. AMR is remarkable in its complexity but other policy issues share aspects of this complexity and may therefore provide valuable lessons. We consider climate policy and tobacco control to be two such issues worthy of comparison. Historical analysis can provide lessons for policy going forward and challenge currently held assumptions and views. Historians do not typically engage in forward looking research and in this project we will bring historians and policy makers together to consider what lessons history can provide for future development of policy. Through a combination of rigorous desk research and reviews and key informant interviews, we will assess the questions 'where are we now' and 'how have we got here?' for each of the three issue areas. This will allow us to identify the main drivers of the policy issues over time and the degree of certainty we have regarding those drivers.
We will then compare across the issue areas through engagement with key stakeholders including historians, policymakers and global public health researchers. Based on a horizon scanning exercise we will then develop scenarios which present challenging but plausible future scenarios for AMR. In a second interactive event, stakeholders will test the scenarios to identify what possible policy responses are available. Gaps in existing policy will be identified as well as future policy options. Following the event, we will produce a policy summary and ensure dissemination to a broader set of policymakers and key stakeholders.

A key part of our research is that we will deliberately attempt to disrupt 'traditional' policy and research spaces to create an alternative where historians and policymakers in particular can come together and think creatively about AMR policy design. The research brings together a team of researchers at RAND Europe with expertise in AMR, policy evaluation, global public health policy and futures oriented methodologies with experts in climate policy (Dr Tim Rayner, UEA), the history of AMR (Professor Cristoph Gradmann, University of Oslo) and the history of tobacco control (Professor Virginia Berridge, LSHTM). The research will make an important contribution to informing effective and efficient AMR policymaking and also make an important academic and methodological contributions through the innovative use of history in futures oriented methods for policymaking. There will be active engagement with policymakers, stakeholders and potential research users throughout the study, including through a project website, active online and social media presence, two interactive learning events and a dissemination event.

Planned Impact

Who might benefit from this research?

The research question focuses on the policy making process in the domain of AMR, and so the main beneficiaries of the research will be UK policymakers and delivery agents working in public health (Department of Health, NIHR, Public Health England, the NHS, and NICE) and animal health (Defra and the Veterinary Medicines Directorate). Through comparisons with other complex international issues, we anticipate that this research will also be relevant to European decision makers and the World Health Organisation, who have identified international cooperation as one of the key pillars of action in this area. Beneficiaries will also include practitioners (public health and animal health experts, as well as farmers, professional associations and consumer groups).
AMR research and our approach is inherently interdisciplinary and of relevance to a broad range of researchers in disciplines including history, public health, social sciences, international relations and politics.

How might beneficiaries benefit from this research?

We believe that the noted beneficiaries will benefit through the course of the research as well as from the research findings. Our chosen methodology with learning events and scenario planning is designed to deliberately create space for policymakers, historians and other stakeholders to think differently about their respective fields. History can provide the means to understand the narratives framing terms of debate, provide instructive parallels from which to understand current policy challenges and be a means to challenging currently dominant paradigms.
The research findings will create benefits for beneficiaries through the clearly articulated, specific and evidence based lessons for policymaking and identification of gaps in existing policy responses. For practitioners, the research will provide insights to inform their approach to providing input to the policymaking process. For academic and research beneficiaries, the research will provide important contributions, both substantively through understanding of AMR as a policy issue and methodologically through the use of history in futures oriented research.


10 25 50
Description By looking at the history of tobacco control and climate change policy we have been able to draw some lessons for AMR policymaking. These include the need for global governance mechanisms that take into account social, political and cultural factors as well as technical elements. It also stresses that while global consensus and action is advantageous there must be flexibility at a national level and space for bottom up approaches. Broader social change may be required rather than more narrow focus on behaviour change around antimicrobial usage, interesting parallels can be drawn across the policy areas.
Exploitation Route An article with findings has been submitted for publication and we are preparing commentary with Dame Sally Davies an colleagues to tie the findings directly to developments in global governance around AMR
Sectors Healthcare

Description We have completed an academic paper and commentary for policy audiences with Dame Sally Davies as outputs from the research. These are being submitted currently. impact unknown.
First Year Of Impact 2021
Sector Healthcare
Impact Types Policy & public services

Description Evidence to policy in public health - teaching seminars
Geographic Reach Europe 
Policy Influence Type Influenced training of practitioners or researchers
Description Training in policy analysis and awareness
Geographic Reach Local/Municipal/Regional 
Policy Influence Type Influenced training of practitioners or researchers
Description Developing a conceptual framework to improve understanding of AMR in livestock systems: translating research into policy and practice
Amount £987,216 (GBP)
Funding ID BB/T004452/1 
Organisation Biotechnology and Biological Sciences Research Council (BBSRC) 
Sector Public
Country United Kingdom
Start 06/2019 
End 05/2022
Description One Health Drivers of Antibacterial Resistance in Thailand
Amount £2,919,177 (GBP)
Funding ID MR/S004769/1 
Organisation Medical Research Council (MRC) 
Sector Public
Country United Kingdom
Start 04/2018 
End 04/2021
Description AMR in 2030: looking to the future to learn for AMR policy today 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact A scenario planning workshop involving around 30 participants including policymakers from different areas of government, the Chief Medical Officer, pharmaceutical industry representatives and key stakeholders in AMR, tobacco control and climate change policy.

We used the workshop to test scenarios we had developed from our historical analysis and foresight work to set a vision of AMR in the UK in 2030. Participants where then allocated to one of four government committees and asked how they would advise on set of key questions and in response to some changing circumstances.

The workshop sparked very interesting debates about lessons from global governance arrangements in climate change for AMR.
Year(s) Of Engagement Activity 2019
Description Risk and Responsibility: AMR as global challenge 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact We held a two-day workshop, co-hosted by the project, the Wellcome Centre for Cultures and Environments of Health, and in collaboration Professor Will Gaze who holds a NERC Knowledge Exchange Fellowship. The workshop sought to bring together policymakers and interdisciplinary perspectives to understand evidence requirements and policy in relation to AMR. This focused from basic science perspectives to economics and global policy analysis (our project).

The workshop was well received; highlighting further questions around potential to learn from tobacco control and climate change policy for AMR.
Year(s) Of Engagement Activity 2020