Table 2. Ten options for achieving global collective action on antimicrobials.
| Option | Implementation |
Institutional weaknesses addressed |
Policy imperatives served |
|||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Decision-making mechanisms | Operational mechanisms | Accountability mechanisms | Governance | Compliance | Leadership | Financing | Access | Conservation | Innovation | |||
| Institution | ||||||||||||
| 1. Monitored milestones, including setting goals, timelines, indicators, regular reporting, and UN-, industry- or civil society-led transnational advocacy network monitoring | World Health Assembly or UN General Assembly | UN agencies, civil society networks and/or industry groups | Independent review and evaluation, shadow reports and naming and shaming | – | X | – | – | X | X | – | ||
| 2. Code of practice, including minimum expectations for responsible use efforts, surveillance and research and development investment among willing actors | Political agreement among willing states, such as G8 countries | Informal governmental networks | Naming and shaming | – | X | – | – | – | X | X | ||
| 3. Inter-Agency Task Force, coordinating UN and civil society groups | Steering committee of agency representatives | Secretariat of lead UN agency | Annual reports | X | – | X | – | X | X | – | ||
| 4. Intergovernmental panel, involving scientific working groups and regular reports | Government assembly working groups | Technical support units and academic institutions | Annual reports | – | – | X | – | – | X | – | ||
| Incentive | ||||||||||||
| 5. Funding agreement, including coordinating joint assistance from development agencies and joint calls for proposals from research funders | Contractual agreement between major donors or research funders | Board of major funders and a secretariat | Annual reports, financial audits and domestic litigation | – | – | – | X | X | X | X | ||
| 6. Global pooled fund, either to finance antimicrobial policies, reward achieving milestones, procure antimicrobials, or promote research and development | Board of key stakeholders and advisory committees | Secretariat and World Bank as fund trustee. Financing from states, charities and industry | Annual reports, financial audits, independent review and evaluation. Loss of benefits | X | X | – | X | X | X | X | ||
| 7. Conditioning benefits or support, such as imposing input-, activity-, output- or outcome-based criteria for receiving aid, gaining trade advantages or participating in international initiatives | Governing body of multilateral organization and review panel | Secretariat of multilateral organization | Independent review and evaluation and automatic loss of benefits | – | X | – | – | X | X | – | ||
| Interest mobilizer | ||||||||||||
| 8. Special representatives, to rally interest groups, coordinate advocacy, attract attention and encourage action | World Health Assembly or UN General Assembly appoints representative | Office of the representative | Political pressure, naming and shaming | – | X | X | – | X | X | – | ||
| 9. High level panel, involving eminent persons raising political prioritization of antimicrobials | World Health Assembly or UN General Assembly appoints panel | Offices of the panel’s chairs or conveners | Political pressure | – | X | X | – | X | X | – | ||
| 10. Multi-stakeholder partnership, involving an alliance of many actors, working groups and advocacy | Coordinating committee. Surveillance committee | Offices of partnership members | Annual reports, independent review and evaluation | X | X | – | – | X | X | X | ||
UN: United Nations.
Note: Each option was assessed by two of the authors for whether it would be likely to address the four identified problems in the global antimicrobial regime – governance, compliance, leadership and financing – and contribute to advancing the three antimicrobial policy imperatives – access, conservation and innovation. Assessments were reviewed and commented upon by the remaining authors. Disagreements were resolved through discussion.