Making sense of ‘implementation gaps’ as a governance problem of antimicrobial resistance

BACKGROUND: Antimicrobial resistance (AMR) is a pressing global health issue. National Action Plans on AMR (NAP-AMR) are key to mitigate AMR, however, effective translation of action plans has been a governance challenge worldwide. This study explores the implementation gap in Austria by examining experiences of experts involved in domestic AMR policy. METHODS: This study was guided by grounded theory. Data were collected through qualitative interviews, a focus group, and participation in AMR symposia. Overall, 13 participants were identified through theoretical sampling. Data collection and analysis took place until theoretical saturation was achieved. RESULTS: Experts identified the following central themes affecting AMR mitigation: absence of a binding legal framework, paucity of AMR data, low risk perception among decision makers, lack of funding, and insufficient incentive systems for people dedicated to AMR stewardship. CONCLUSIONS: The interpretation of these findings suggests policy fragmentation, scattered responsibilities, agenda conformity and a lack of recognition as core features which impede a sustainable and effective AMR-related governance. The results should alert policymakers to sustainable public health interventions in the following areas: a) Institutional responsibilities need to be restructured to prioritize AMR stewardship as a guiding principle. b) Investments are necessary for nationwide implementation of AMR stewardship and surveillance systems. c) Financial and symbolic incentives for people dedicated to AMR mitigation are imperative. KEY MESSAGES: • There is a tension between local efforts to make adjustments to mitigate AMR and the current approach of ‘superimposing’ reforms on existing structures. • Effective measures to address AMR require that priority be given to mitigating AMR.