Interventions to address antimicrobial resistance: an ethical analysis of key tensions and how they apply in low-income and middle-income countries
Issued Date
2024-04-03
Resource Type
eISSN
20597908
Scopus ID
2-s2.0-85190589820
Journal Title
BMJ Global Health
Volume
9
Issue
4
Rights Holder(s)
SCOPUS
Bibliographic Citation
BMJ Global Health Vol.9 No.4 (2024)
Suggested Citation
Pokharel S., Adhikari B., Johnson T., Cheah P.Y. 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 Vol.9 No.4 (2024). doi:10.1136/bmjgh-2023-012874 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/98097
Title
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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Corresponding Author(s)
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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.