Planetary Antimicrobial Resistance Regimes and Collective Action

This dissertation considers how the enduring phenomenon of antimicrobial resistance (AMR) challenges us to reconsider the way we ask questions about and govern global issues. AMR occurs when disease-causing microbes develop resistance to the antimicrobial agents and medicines that are designed to treat, prevent, and stop the spread of deadly infections. AMR, which this dissertation understands as a primarily social issue, was associated with 4.95 million deaths in 2019. The introduction to this dissertation presents AMR as a defining problem of the Anthropocene. It proceeds to outline the research inquiries and methodologies adopted, the causes and consequences of AMR, and the main arguments and narrative arc across the dissertation’s five chapters. The second chapter explores how the problem of AMR is understood as a series of global collective action problems. It develops a framework to systematically identify the various collective action problems that arise around public and common goods. Applying the framework to AMR, Chapter 2 articulates eight interdependent collective action problems for AMR governance. Chapter 3 then investigates how AMR is governed in today’s interconnected world. It identifies and outlines the emerging ‘regime complex for AMR governance’, which is defined as the array of principles, norms, rules, and procedures that collectively guide human behavior around the challenge. It examines how the complexity of AMR, including its many interlinked collective action problems, has contributed to the rise and evolution of this decentralized global governance structure. Chapter 4 reframes AMR as a socio-ecological problem arising from deep tensions in the relationship between human societies and invisible microbial worlds. It adopts the concept of ecological fit, defined as the alignment between human social systems and biological ecosystems, to diagnose 18 misfits between the social institutions that govern AMR and the ecological nature of the problem. Chapter 4 proposes three principles for designing global health institutions that better fit the problems they are meant to govern. Finally, Chapter 5 concludes the dissertation by distilling cross-cutting insights and implications for the future of global AMR policy. This final chapter defines a safe antimicrobial operating space for humanity.