Equity in the governance of antimicrobial resistance surveillance: Global experts' perspectives

Antimicrobial resistance (AMR) is interwoven with uneven development and increasing socioeconomic demands that shape nature-society relations and place vulnerable groups at increased risk of resistant infections. While equity is integral to AMR governance, its relevance for AMR surveillance systems has not been fully conceptualized. An Urban Political Ecology (UPE) lens premised on equity and sustainable nature-society relations is used to both conceptualize and operationalize equity considerations in the governance of AMR surveillance. Key informant interviews with experts engaged in the Quadripartite Joint Secretariat on AMR, government agencies, academia, and the private sector were conducted to saturation. Exploring equity in AMR surveillance involves clarifying the pathways AMR-related policies and programs impact different sectors of society. Themes identified include global resource distribution, framings and intersectoral collaborations, capacity building, program feasibility, data accessibility, equity-deserving groups, Global North-South divide, sectoral balance, surveillance of root causes, social determinants of health. Greater understanding of these themes could help explain why biomedical approaches alone may not lead to a decline in AMR prevalence in some contexts. Our findings contribute a conceptual understanding of how a UPE lens focused on nature-society relations may assist states in explicitly incorporating equity considerations within One Health AMR surveillance to better address the main drivers of AMR.