Interventions to address antimicrobial resistance: an ethical analysis of key tensions and how they apply in low- income and middle-income countries

Sunil Pokharel; Bipin Adhikari; Tess Johnson; Phaik Yeong Cheah

doi:10.1136/bmjgh-2023-012874

journal article Open Access Apr 01, 2024

Interventions to address antimicrobial resistance: an ethical analysis of key tensions and how they apply in low- income and middle-income countries

Sunil Pokharel Bipin Adhikari

Tess Johnson Phaik Yeong Cheah

BMJ Global Health Vol. 9 No. 4 pp. e012874 · BMJ

View at Publisher Save 10.1136/bmjgh-2023-012874

Abstract

Abstract
Antimicrobial resistance (AMR) is a global health and one health problem. Efforts to mitigate the problem of AMR are challenging to implement due to unresolved ethical tensions. We present an in-depth ethical analysis of tensions that might hinder efforts to address AMR. First, there is a tension between access and excess in the current population: addressing lack of access requires facilitating use of antimicrobials for some populations, while addressing excessive use for other populations. Second, there is a tension between personal interests and a wider, shared interest in curbing AMR. These personal interests can be viewed from the perspective of individuals seeking care and healthcare providers whose livelihoods depend on using or selling antimicrobials and who profit from the sales and use of antimicrobials. Third, there is a tension between the interests of current populations and the interests of future generations. Last, there is a tension between addressing immediate health threats such as pandemics, and AMR as a ‘silent’, chronic threat. For each of these tensions, we apply ‘descriptive ethics’ methods that draw from existing evidence and our experiences living and working in low-income and middle-income countries to highlight how these ethical tensions apply in such settings.

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References

Details

Published: Apr 01, 2024
Vol/Issue: 9(4)
Pages: e012874
License: View

Authors

S

Sunil Pokharel

Nuffield Department of Medicine, University of Oxford, Oxford, UK

B

Bipin Adhikari

Nuffield Department of Medicine, University of Oxford, Oxford, UK; Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University Phayathai Campus, Bangkok, Thailand

T

Tess Johnson

Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK

P

Phaik Yeong Cheah

Nuffield Department of Medicine, University of Oxford, Oxford, UK; Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University Phayathai Campus, Bangkok, Thailand

Funding

Wellcome Trust Award: 096527

British Academy 'A Just Transitions Framework for The Equitable and Sustainable Mitigation of Antimicrobial Resistance’ project Award: GCPS2\100009

Cite This Article

Sunil Pokharel, Bipin Adhikari, Tess Johnson, et al. (2024). Interventions to address antimicrobial resistance: an ethical analysis of key tensions and how they apply in low- income and middle-income countries. BMJ Global Health, 9(4), e012874. https://doi.org/10.1136/bmjgh-2023-012874

Interventions to address antimicrobial resistance: an ethical analysis of key tensions and how they apply in low- income and middle-income countries

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