The power of legislation in influencing behaviour: the case of AMR
Misuse and overuse of antimicrobials are nowadays considered the main drivers in the development and rapid spread of drug-resistant pathogens, globally known as antimicrobial resistance (AMR)[1]. In addition to the natural occurrence of AMR, which is a biological process that occurs over time, the evidence shows that the rate of increase in AMR is being triggered, in large part, by the actions and choices of humans. It can therefore be currently considered as a behavioural issue too. Thus, it is not surprising that most of the actions identified, both at the international and national levels to combat AMR, aim to change the behaviour of individuals and intervene at multiple levels of antimicrobial stewardship.
Improving understanding of the global burden of AMR by raising awareness, conducting capacity-building activities, and implementing communication programmes are key and crosscutting action lines in the Global Action Plan on Antimicrobial Resistance, adopted by the WHO in 2015[2], as well as in most national action plans on AMR. The ultimate purpose of those actions is to promote behavioural change.
Legislation as a mechanism for behavioural change
The power of legislation as a tool to change individuals’ and societies’ behaviours is frequently overlooked. Without delving into the philosophical question of whether legislation should force changes or, on the contrary, only reflect or mirror those changes already accepted by societies (the chicken or the egg question), it is a fact that well-designed legislation has the capacity to shape people’s behaviour, such as steering behaviour towards responsible antimicrobial use.
For example, direct and immediate means to influence behaviour through legislation are provisions introducing stricter controls on the sale of antibiotics. Requiring prescriptions and requiring that they be issued only by authorized professionals, curtailing the use of antimicrobials for growth promotion purposes, and promoting responsible prescription practices by healthcare professionals, are all basic steps to reduce the inappropriate use of antimicrobials.
To achieve sustainable long-term change, it is crucial that the process of legislative change be pursued in a manner that is inclusive and representative from the start. Proposed draft legislation needs to be discussed with key stakeholders, and then adopted through participatory law-making processes. Doing so, will not only increase the understanding and acceptance of new legal provisions, but it will also increase compliance rates and decrease the need for costly sanctioning processes[3].
Legislation should not be seen as a separate strategy to fight AMR but as part and parcel of a broader strategy that must include complementary approaches such as education, public awareness campaigns, and community engagement to reinforce the effects of legislation and promote sustained behavioural change.
Valeria Pasarín Linares (FAO)
[1] WHO. 2021. (available at: https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance)
[2] WHO. 2015. Global Action Plan on Antimicrobial Resistance. (available at: https://www.who.int/publications/i/item/9789241509763)
[3] See previous article on “Drafting contract farming legislation through participatory law-making in Lesotho – an example of good governance”, by Teemu Viinikainen and Carmen Bullón (FAO) (available at: https://www.fao.org/legal-services/resources/detail/en/c/1643403/)