Multilevel governance of antimicrobial resistance risks: a literature review

Figures & data

Table 1. Summary of policy frames on AMR. Source: Wernli, Jørgensen, Morel et al. (2017).

	AMR as healthcare problem	AMR as development issue	AMR as innovation challenge	AMR as security issue	AMR as One health challenge
Definition	Health impact of AMR on human health	Health impact of AMR on human health	Market failure and lack of access to antibiotics	AMR as threat to the stability of health and social systems	Health impact of AMR on animal and human health
Metaphor	War on microbes	Health for all	Magic pills	Fear of the ‘other’	The environmental link
Goals	Maximise the impact for patients	Guarantee access to medicine as a prerequisite for development	Provide new drugs to responds to growing demand from consumers	Protect against the international spreadof disease	Enhance human andanimal health
Measurements	Epidemiology of AMR and health impact	Access to medicine	Economic Investment in R&D	Escalating costs and impact of AMR on society	Consequences of AMR on animal and human health
Typical actors (non-exclusive)	General public, medical professionals, health systems	NGOs, international organisations, LMICs	Governments in HICs	Governments in HICs	Animal sector, International organisations, governments

HIC, high-income countries; LMIC, low-and-middle-income countries; NGOs, non-governmental organisations.

Figure 1. Visual representation of the IRGC Risk Governance Framework (IRGC 2017).

Figure 2. Flow diagram outlining the study selection process.

Table 2. Codes used in coding selected articles.

A	Advisory roles of experts
D	Differences between countries
E	Political economy (money, power)
F	Flexibility of decisions and rules (policy and regulation)
G	Governmental role
I	International context
K	Role of knowledge (institutions/organizations)
O	One Health approach
P	Proportionality of decisions and rules (policy and regulation)
L	Local/subnational networks
S	Link with security
U	Uncertainty
Z	Zoonoses

Figure 3. Number of publications per year based on first step in the search strategy.

Wernli, Didier, Peter S. Jørgensen, Stephan Harbarth, Scott P. Carroll, Ramanan Laxminarayan, Nicolas Levrat, John-Arne Røttingen, and Didier Pittet. 2017. “Antimicrobial Resistance: The Complex Challenge of Measurement to Inform Policy and the Public.” PLoS Medicine 14 (8): e1002378. doi:10.1371/journal.pmed.1002378.

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IRGC 2017. Introduction to the IRGC Risk Governance Framework. Revised version. Lausanne: EPFL International Risk Governance Center.

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