Table 2.

Drivers and mechanisms for revising future governance for AMR prevention

Drivers for governance changes for AMR prevention	Mechanism for change	New perspective on AMR prevention governance	Objective	Suggested actions towards the new perspective governance for AMR prevention
Complexitya	Diffusiond	Network governance	Create a new academic/industrial/biotech skills mix based on systems thinking and complexity science.	Build inter-sectoral training in cooperation with schools of infectious disease, microbiology/hygiene, public health, business schools and policy.
			Increased accountability across healthcare and non-healthcare organizations.	Include HCPs, users, citizens and mass media in the governance approach and decision-making via independent agencies or organizations to implement new assessments and accountability frameworks.
	Diffusion and shared valuee		Include AMR as a goal at governmental and societal level, as a key component of sustainable development	Engage organizations far beyond those involved in AMR sectors or even health (other ministers such as finance minister, business leaders, users) [2]
Inter-dependenceb	Diffusion	Multi-level governance	Control interactions and promote coherence between sectors by an alignment of priorities	Cooperation among the various levels, e.g. geographical (regions and countries), clinical (primary and secondary care), species (antibiotics in humans/animals/agriculture/wider environment) following the “One Health” concept [61].
			Sharing information and experience	Pool reports of best and failed innovative practices in working with other organizations, groups, sectors via regular meetings for shared goals at the regional, national level and beyond.
		Mixing regulation and persuasion	Promote growing interest in nudge policiesf	Monitoring progress through a mixture of hard and soft governance mechanisms to engage for AMR.
Co-productionc	Diffusion	Adaptive governance	Transparency	Users, public and private organizations must work together to define new indicators for monitoring change and progress in AMR with new measures, shared for all parties and accessible to the public.
			Flexible and adaptable systems approaches with self-organization and decentralized decision	Create a dedicated structure to assess and monitor governance at the local, national, and international level, to adapt governance mechanisms to innovations (i.e. new mode of communication). Cybernetic approachg utilizing communications and information for guidance and control.
	Democracy	Participatory governance, e-governance	Empower and involve users; public accountability; and strengthen health literacy	Dialogue with HCPs, users and citizens on AMR through new information and communication technologies (e.g. social media); open-data initiatives, tracking systems, digital and mobile approaches to strengthen health literacy.
	Preparedness	Anticipatory governance	Finding solutions for a better future adaptation	Development of simulation models including feedback loops. Creation of new forecasting tools for anticipatory governance, shared for all actors and fields to deal with emergent events.

Abbreviations: AMR antimicrobial resistance, HCPs healthcare professionals.

^aComplexity theory: sense that everything is indeed related to everything else

^bInter-dependence: refers to situations characterized by reciprocal effects among countries or among actors in different countries. Interdependence exists where transactions have reciprocal – and not necessarily symmetrical – costly effects

^cCo-production: achieving outcomes by working together with the involvement and cooperation of citizens and enabled by the proliferation

of new technologies and access to information

^dDiffusion of governance: whole-of-government and whole-of-society approaches crossing the boundaries of organizations, creating network-based public service production systems

^eShared value: policies and operating practices that enhance the competitiveness of a company while simultaneously advancing economic and social conditions in the communities in which it operates

^fNudge Policies: interventions based on behavioural science, political theory and economics which propose positive reinforcement and indirect suggestions to try to achieve non-forced compliance to influence the motives, incentives and decision making of groups and individuals

^gCybernetic approach: emphasis on central government use of information for guidance and control though feedback as a means of inducing self-correcting behavior at the organizational level