Exploring the Governance of Antimicrobial Stewardship and Deep Pandemic Prevention: From Siloed Approaches to Integrative Governance Models Informed by Urban Political Ecology

Governance of infectious disease prevention and antimicrobial resistance (AMR) share similar implementation challenges. Exploring the governance of antimicrobial stewardship and deep pandemic prevention that involves wildlife trade regulation as a source of zoonotic spillover may inform approaches to address AMR and other threats at the human-animal-environmental interface.

This dissertation aims to explore governance models that adopt a One Health (OH) lens to address the governance of infectious disease prevention and AMR through (i) assessing the role of wildlife trade regulatory approaches in the prevention of zoonotic spillover and infection transmission, (ii) mobilizing an urban political ecology (UPE) lens to assess the under-exposed dimensions and interdependencies of AMR, and (iii) deploying a UPE lens to inform the analysis of peer-reviewed literature on implementation of OH-AMR governance approaches.

To assess the role of wildlife trade regulatory approaches in the prevention of zoonotic spillover and infection transmission, a scoping review was conducted to identify and describe studies discussing different trade standards and regimes governing wildlife trade. To assess under-exposed urban dimensions of AMR and to inform AMR governance strategies, an interdisciplinary analysis was conducted to bridge the epistemic domains of UPE and OH. Lastly, a critical interpretive synthesis (CIS) of peer-reviewed literature was conducted through a UPE lens to clarify the extent to which OH-AMR governance responses institutionalize coordinated AMR-environmental approaches to address challenges and concerns.

Governance of infectious diseases prevention in wildlife trade involves institutional and regulatory purviews concerning zoonotic spillover prevention characterized by fragmentation and lack of oversight by a single global coordination authority. The deployment of a UPE lens as a guide to practical politics of sustainability and human-nature relationships contributes to an understanding of how AMR and other systemic threats may be confronted in policy and practice. A UPE-informed analysis of literature discussing AMR governance arrangements reveals opportunities and limitations to simultaneously generate health and environmental gains for targeted populations.

Mobilization of an OH approach that considers intersectoral linkages between wildlife trade and complex socioecological interactions that produce the interfaces where zoonotic spillover occurs may improve information sharing and intersectoral governance that contributes a better understanding of the role of global and national organizations in preventing zoonotic spillover and transmission.

In an urbanized and interconnected world, a UPE lens illuminates the interconnections among urban life, AMR risks, other global health threats, and aligns with calls to rescale governance arrangements by better taking societal relations with nature into account. More research is needed to consider the feasibility and relevance of designing intersectoral OH-AMR approaches informed by the UPE of AMR.