Soft governance against superbugs: How effective is the international regime on antimicrobial resistance?

Antimicrobial resistance (AMR) and the declining effectiveness of antibiotic medicines due to misuse are among the biggest global health crises and a major challenge for global governance in this century. Since drug-resistant bacteria spread easily across borders, government policies that exacerbate or mitigate AMR affect other countries. International organizations and governments chose to address the global public good of maintaining antimicrobial protection by creating a soft governance regime largely devoid of legally binding rules and enforcement mechanisms. This paper presents a cross-national empirical assessment of the effectiveness of the international AMR regime combining novel data on national action plans and data on antibiotic consumption in 191 countries between 2000 and 2018. We find that the regime sets ambitious goals and achieves broad participation, substantial implementation, and meaningful change in the use of antibiotics. The involvement of the largest consumers of antibiotics has been crucial for both effectiveness and equity.