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Antibiotic tablets

A new study by Tess Johnson at Oxford Population Health’s Ethox Centre has presented an ethical framework for evaluating coercive antimicrobial stewardship policies, such as banning or taxing use of antibiotics in certain circumstances to slow the growth of antimicrobial resistance (AMR). The study is published in Public Health Ethics

Antimicrobial resistance (AMR) has been declared a top ten global public health threat by the World Health Organization, with potential to cause 10 million deaths each year by 2050 if no action is taken. Often termed a ‘silent pandemic’ or a ‘hidden threat’, there is low public awareness of the problem.

To address AMR, health policymakers may implement antimicrobial stewardship measures, which support appropriate use of existing antibiotic stocks. Of these, coercive stewardship measures can include bans or taxes on antibiotic use in some sectors, capping doctors’ prescriptions, or eliminating over-the-counter antibiotic sales. 

These policies, like all in public health, require ethical justification. But what does a strong ethical justification look like?

This study brings together ethical arguments for coercive antimicrobial stewardship into an ethical framework and, importantly, considers the limitations of those arguments.

The paper also explores some of the challenges related to developing an ethical evaluation framework, including how such a framework should be adapted for different contexts, and how ethical justifications should feature alongside other health priorities.

Tess Johnson, GLIDE Postdoctoral Researcher in the Ethics of Pandemic Preparedness, Surveillance, and Response, said ‘Antimicrobial resistance is a hidden threat facing health policymakers throughout the world. As we work toward global coordination in addressing antimicrobial resistance, policymakers must consider how to ethically justify the actions they take, particularly for coercive antimicrobial stewardship measures such as bans on antibiotic use or caps on prescriptions.

'It’s very important that we both offer ethical concepts that might justify coercive measures and keep strongly in mind how different national contexts affect whether an ethical concept can be used in a justification for a coercive measure.

'In this paper I offer the beginnings of a framework that could help policymakers understand ethical justifications for coercive antimicrobial stewardship policies, as well as the limits of those justifications.’

Further development of ethical guidance will allow policymakers to better communicate their reasoning to the public, and will allow the public to better hold policymakers to account for implementing context-appropriate, ethically acceptable coercive antimicrobial stewardship policies.