Using AMR data for policy-making

Introduction

A policy is defined as:

‘Policy-maker’ is a broad term that covers all the people responsible for formulating or amending policy. Policy-makers may consult academics, clinicians and veterinarians (among others), and these professionals can in turn approach policy-makers during the policy-making process. Policy-makers are often time-poor, and tend to be generalists, but it is important not to underestimate their skills and experience – particularly when it comes to understanding complex issues and assimilating knowledge (NCCPE, n.d.).

The global coronavirus pandemic is expected to significantly alter the global infectious diseases landscape and conversation, even after it has passed. There is a clear need to rethink how to position the antimicrobial resistance (AMR) agenda in order to take an active role in shaping this new global environment, and clearly communicate this to the broader audience of policy-makers looking at more general health security and pandemic preparedness (Wellcome Trust, 2020). In this module you will cover the skills needed to take an active role in the policy-making process.

After completing this module, you will be able to:

• understand how AMR data can influence policy-making
• identify the relevant policy-makers and their roles
• use an engaging and accessible writing style for people who have major time constraints and who are not subject matter experts
• effectively deliver science advice to policy-makers
• recognise barriers to policy-making and how to overcome them.

1 Informing policy-making

The policy-making process is complex and often involves a number of different stakeholder groups.

Working with policy-makers can seem a daunting prospect to professionals with clinical, veterinary, laboratory-based or management backgrounds, aiming to communicate concepts in AMR. The following sections will elaborate on how AMR experts can work effectively with policy-makers to ensure that policies are informed and evidence-based.

1.1 Planning for engagement

Ideally, before beginning a project, those wishing to provide evidence for AMR policy should plan for policy engagement activities. However, even at the end of a project, they can still plan effective ways of bringing the message to people who can make a difference.

Think about the policy impact of your research early, when you design research projects. Scientific curiosity is a powerful driver for research, but if you are serious about policy impact, you must be prepared to adapt your research to the needs of policy actors (JRC, 2020).

Plan for impact strategically: policy-makers need quick responses, and questions evolve with political discussions. Who from government, civil society or industry would be interested in your results?

Before you engage with policy-makers, you need to think about:

• What is the key message with relevance for policy? (discussed in this section and Section 2)
• Why is this important for policy? (discussed in this section and Section 2)
• Who has the power to influence policy? (Section 3)
• When to engage? (Section 4)
• Where to engage? (Section 4)
• How to engage? (Section 5)

There are organisations that hold training sessions to cover the foundations of evidence-based policy development. In one recent example, the African Institute for Development Policy (AFIDEP), the Drivers of Resistance in Uganda and Malawi (DRUM), and the African Research Collaboration on Sepsis (ARCS) teams organised a four-day training workshop for policy developers in 2020, working on issues concerning AMR and sepsis. Video 1 shows one participant’s reflections on the workshop.

1.2 Using AMR data to inform policy-making

Anyone who wants to provide evidence for AMR policy should listen to the needs of policy-makers. How can your surveillance and/or research help them to make impactful policy decisions? Make sure you know what you want to achieve: what exactly do you want policy-makers to do? You need to present the clear benefits of the policy to policy-makers.

Policy-makers should consider whether they are reaching out to a diverse group of stakeholders to ensure their policies are evidence-based and will best serve their communities.

One Health AMR surveillance contributes information to understand the development, transmission and directional spread of AMR, and to estimate the burden of resistance in global settings. It therefore provides important evidence for designing AMR policy that addresses the important risk factors for AMR in the different sectors. It is very important to ensure that policy advice is based on reliable evidence that accurately represents the AMR situation.

National AMR surveillance and research is critical to containing and preventing the emergence and spread of AMR. The World Health Organization (WHO) has published its fourth Global Antimicrobial Resistance Surveillance System (GLASS) Report to document the status of existing or newly developed national AMR surveillance systems (WHO, 2021). GLASS is the first global system to incorporate official national data from surveillance of AMR in humans, in the food chain and in the environment (WHO, n.d. 1).

The GLASS country profiles dashboard contains summaries of AMR data reported to GLASS during the annual data call (WHO, n.d. 2). When AMR data is submitted, the dashboard’s colour-coded system shows the proportion of the data submission, and a second table gives an overview of the data reported. GLASS provides access to timely, reliable and actionable data that can provide an evidence base for AMR policy development.

1.3 Real-world examples

Now let’s look at two examples of how AMR data has informed policy-making in Ghana and Thailand.

Ghana’s NPAR

The Ministry of Health in Ghana has created the National Platform on Antimicrobial Resistance (NPAR) as the driving institution behind the AMR agenda (ReAct, n.d. 1). Ghana serves as an example to other low- and middle-income countries (LMICs) on how to use a multi-stakeholder platform to develop a policy on AMR, as described in Case Study 1 and Figure 1.

Maximise

Figure 1 Policy process for AMR policy in Ghana (Nortey, 2019).

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A schematic diagram representing the process of developing, implementing and monitoring policy related to AMR in Ghana, the stakeholders that are involved, and the way that the available AMR data is fed into the policy process.

Figure 1 Policy process for AMR policy in Ghana (Nortey, 2019).

This example demonstrates how, even with limited data, making data-gathering the priority can help to build a broad policy framework.

Thailand’s ASU programme

In contrast to Ghana’s NPAR, Thailand’s Antibiotics Smart Use (ASU) programme is an example of a policy that was started as a project from the community level rather than top-down, as described in Case Study 2.

Before 2007, rational use of medicines was a concept not routinely practiced in Thailand. Furthermore, there were very few resources in the fight against the irrational use of antibiotics.

The ASU programme is notable because it induced behavioural change with limited resources through a local approach; it had a clear, simple health message promoted by small teams of trained health educators creating local networks with local ownership that connect to central networks. The programme was scaled up to the entire country, where a pay-for-performance element was added.

You can read more about the ASU programme on the ReAct website (ReAct, n.d. 3).

2 Understanding and identifying policy-makers

In the previous section we covered why evidence-based policy development is important and saw examples of where AMR data has been used in policy-making. Anyone who wants to provide evidence for AMR policy should consider how their work could help policy-makers achieve the best policy decisions.

Now you are confident that AMR data is important for policy-making, and have considered how AMR data can inform policy decisions, we will move on to understanding how policy-making works, and identifying who policy-makers are. If you want to communicate effectively in policy-making systems, you will need to understand how policy-makers process evidence and the environment that they operate in.

2.1. How does policy-making work?

The policy-making process is supposed to be rational; it is usually presented as a logical flow between discrete phases (Figure 2).

Figure 2 The policy-making cycle (Coventry University, n.d.).

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In a policy-making cycle, pressure for change (new problem(s)) leads to the following stages, in sequence: reviewing evidence and consulting experts, policy options, examining the health impact for each option, identifying any barriers to local implementation, stakeholder consultation, revising policy, implementing policy, and, finally, evaluating policy. This leads back to pressure for change.

Figure 2 The policy-making cycle (Coventry University, n.d.).

However, presenting the process in discrete phases is a naive view of policy-making. Some of the constituent parts of Figure 2 are necessary for making good policy, but suggesting that policy can be made through a series of logical, sequential steps, with a clear beginning and end within a finite period, is an over-simplification.

The stages of policy-making often overlap, and are frequently inseparable. The pressures of the real world of policy frequently lead to identifying a policy goal (‘new problem(s)’ in Figure 2), and options selected for action become fused together. Policy-makers will have multiple policy goals that often conflict and sometimes change. Additionally, they may enter and exit the policy process at different stages (IfG, 2011).

So although it is simplistic to suggest that there are natural ‘stages’ where anyone wanting to provide evidence for AMR policy can input evidence into the policy-making process, there are some natural entry points and some useful tips and techniques when working with policy-makers (NCCPE, n.d.) (Figure 3).

Here are some useful tips and techniques when working with policy-makers (adapted from Oliver and Cairney, 2019):

2.2 Identifying policy-makers

Anyone who wants to provide evidence for AMR policy should aim to identify key individuals and groups who make, implement or influence AMR policy development. Individuals could be politicians, civil servants, professionals or businesspeople, and groups may include think tanks, NGOs, charities and international governance organisations. You should start to build relationships as early as possible.

The most effective routes to engagement may not be the most obvious. Start by investigating the policy areas that your research could contribute useful insights to; then map out all of the people and organisations with an influence in those policy areas (IfG, 2020), considering each of the following:

• Who makes the decisions? (It may involve more than one body.)
• Who influences these policy-makers?
• Who will implement the policy?

Once you have mapped out all the relevant organisations, weigh up the potential for influence against the challenges associated with working with them. For example:

• Are there some organisations that link to many others?
• Are there some perspectives that would be particularly useful?
• Who do you know that could make an introduction?
• What have you got to offer the people you want to meet?

Know who you want to reach: communicating with top-ranking government officials, for example, isn’t always the most effective way to spur change. Imagine that hospitals in your local area are experiencing outbreaks of an antibiotic-resistant strain of bacteria and your research has developed a rapid test to quickly identify it: such a local issue isn’t likely to be a priority for a national government official, but it does fall within the remit of your local health protection agency (Safford and Brown, 2019).

Your best partners might even be outside the government. Non-profit organisations, industry groups, advocacy organisations and private sector companies do not implement public policy, as such – but they certainly shape the debate. If you aren’t sure who you need to reach, ask around!

The African Institute for Development Policy (AFIDEP) is an African-led, regional non-profit research policy institute established in 2010 to help bridge the gaps between research, policy and practice in development efforts in Africa. Watch Video 3, which provides further information about how AFIDEP’s work is positively influencing African government policy and programmes.

AFIDEP conducted a series of week-long workshops on policy engagement and evidence uptake between October 2020 and February 2021. The workshops targeted PhD and post-doctoral early career researchers, as well as consortium leaders or senior researchers responsible for leading research uptake, and sought to enrich the skills of individuals to maximise research uptake and policy engagement (AFIDEP, n.d.). In Video 4, Beatrice R. Nassanga, a PhD student in Uganda, reflects on lessons learned during the workshop.

AMR Stakeholder Mapping  is a comprehensive document for organisations that work in the field of AMR (ReAct, 2016). It was commissioned by the WHO and covers more than 70 organisations and initiatives (both global and regional) across a number of sectors, including policy.

For the policy sector, global stakeholders and initiatives are grouped into three categories:

• UN institutions (pp. 9–15)
• intergovernmental and international institutions (pp. 16–23)
• policy institutes and think tanks (pp. 24–5).

3 Engaging with policy-makers

Engaging with public policy is not always easy – there is no one-size-fits-all approach. For some, achieving good engagement will mean focusing on a key area of policy and specific parts of government; for others, it will require more wide-ranging engagement and a combination of activities. For successful engagement, key elements to consider are when and where you plan to engage with policy-makers (IfG, 2020).

3.1 When should you engage with policy-makers?

The most effective stakeholder engagements are at the start of a project, with dialogue throughout the project lifecycle beginning at the planning stage.

Policy-makers and other stakeholders might have useful knowledge or suggestions that can help to shape your research and improve your impact (NCCPE, n.d.). If your project is significant, it may warrant a full-scale meeting of policy-makers and professionals. A workshop format is particularly suitable for engaging stakeholders during the lifecycle of a project.

It’s also important to understand the political cycle. There are certain moments when policy is more open to change than others – for example (IfG, 2020):

• at the beginning or end of an individual’s time in office
• at the start of a new parliamentary session
• before a spending review cycle
• at certain times where events or public and media pressure create a crisis point.

The Covid-19 pandemic is perhaps a classic example of an event that has created a crisis point where policy-makers may (but may not) be open to decisions that draw on AMR policy. These windows of opportunity occur when attention is drawn to a problem, and if there are policy ideas to solve it and political incentives to make them happen. An example is shown in Case Study 3.

The examples in Case Study 3 highlight the importance of catching windows of opportunity around political events, such as the publication of a NAP on AMR. Keeping track of the political calendar and being aware of all of the opportunities where a government or legislature would need expertise will mean that you can engage more effectively with the policy-making process.

Strategically selecting when to engage increases the chance that your idea will fall on receptive ears. Electoral and legislative calendars can help you to choose a good time: meetings with elected officials tend to be much more effective towards the beginning of a term (when policy priorities are being set) than later on.

When in doubt, engage early. By the time a bill comes up for a vote or a rule is in its final stages, most policy-makers will have been discussing it for months or longer: even highly credible input will be unlikely to change minds. Look out for newsletters or podcasts that can help you stay aware of when the topics that you care about are coming up for debate – and talk to legislators before this happens. Submit comments on draft rules and participate in stakeholder workshops when they are offered.

Current events can yield extra opportunities to advance your work. The value of a news-generated policy window has been well documented (Safford and Brown, 2019), so stay aware of what’s going on in the wider world and link your research to it.

If there is no window of opportunity on the horizon, it is still important to stay engaged with the people whose ideas will be drawn upon if and when the issue becomes salient. This also means that, to achieve impact, you may be talking about a piece of research years after you have completed it (IfG, 2020).

3.2 Where should you engage with policy-makers?

Politicians, civil servants and lobbyists are busy people, and there will be others competing for their attention. Make sure that engagement activities are convenient for your policy audience, and build funding for this into your project budget. Videoconferencing might be an appropriate solution if your policy audience’s place of work is a long distance from yours – the Covid-19 pandemic and lockdown restrictions have shown just how valuable and versatile this form of engagement can be.

If you set up engagement exercises such as policy workshops or community events, it is important to make sure that it is easy for policy-makers to attend. Not all policy-makers can devote a whole day to a meeting, and they may not be used to academic workshop formats with Post-it notes and presentations (Rose and Jarvis, 2020). You could consider what the relative advantage of engagement is for policy-makers and cover costs.

Engaging with local rather than national governments could mean that it becomes easier to establish links with a variety of local stakeholders and organisations, simply by virtue of proximity. Local engagement can also allow you to see how policies are implemented on the ground, providing links with the people affected (IfG, 2020).

Trust is key to influencing policy. Having a strong presence on relevant social media channels and capitalising on opportunities as they emerge can help to build trust and reputation. Policy events are sometimes live-streamed and can have dedicated Twitter hashtags, allowing you to follow and engage with the debate regardless of your location. They can also be recorded, with the videos later released on social media. So even if you are unable to attend, you can still follow the meeting (although not engage in the initial debate within the meeting).

4 Writing for a policy audience

At the end of a project, a press release, policy brief or report may be appropriate. Social media, such as Twitter, can be a powerful way to reach certain policy communities: see the Communicating AMR data to stakeholders for more on this. Try to combine the two approaches: Leave short, written briefs for policy-makers to read after meetings, and follow up with personal contact.

A press release is a short summary of your research. Journalists often use press releases to decide whether to write a news article on recent scientific research. Although some science journalists are scientists, they are unlikely to be experts in every area that they cover. Therefore, a press release should be clear, concise, engaging and – most importantly – accurate (ASBMB, 2021). The press release should be accessible to non-expert readers.

A policy brief is a short, to-the-point and jargon-free document written for non-specialists that (ffrench-Constant, 2014):

• presents research or project findings to policy actors
• highlights the relevance of the specific research to policy
• offers recommendations for change.

4.1 Writing a press release

Press releases should be written with a target audience in mind, but note that they are not written directly for that target audience: they are written for an editor, journalist or broadcaster, and are tailored to the readership, viewers or listeners of that publication or programme (Forrest-Turner, 2020).

Keep the title short and enticing, and use the active voice. Avoid including too much scientific detail in the title. For example, ‘Antimicrobial use influences bacterial resistance in all settings’ is a better option than ‘Surveillance of Enterococcus spp. reveals distinct species and antimicrobial resistance diversity across a One-Health continuum’ (Zaheer et al., 2020).

The first paragraph of a press release should outline the research in approximately three sentences, and should answer the following questions (ASBMB, 2021):

• Who are the authors?
• What is the main finding?
• When was the study done? (Include a journal title and the date of publication.)
• Why was the study done – how is it relevant?

Again, use the active voice and avoid scientific jargon. The first paragraph should be able to stand alone.

The second paragraph of a press release should put the research in context: why is it exciting or unexpected? However, note that the finding must not be overexaggerated or oversold. The third paragraph should introduce details: not specific experimental details but a description of how the finding advances scientific knowledge, reinforces a key idea or provides a new method. The fourth paragraph should include a relevant quote to add information, credibility and/or opinion – something brief from a researcher involved in the work, or from a colleague familiar with the importance of the finding (but make sure that they agree to be quoted) (ASBMB, 2021).

Remember to include contact information for the corresponding author, including their name, email address and phone number, and their institution. You should also provide information for accessing the original paper, such as a URL or DOI.

4.2 Writing a policy brief

A policy brief must be easy to read, so it’s important to get the structure right. Its length can vary depending on the discipline and content: it could be one, two or four pages, but no longer – policy-makers are time-poor and will struggle to engage with longer documents (ffrench-Constant, 2014). You should ensure that everything the reader really needs to know is on the first page.

A policy brief should include the following features:

• Title: Keep it snappy, short and informative.
• Executive summary: Two to three sentences summing up the entire brief. Use recognisable keywords and emphasise the relevance of the research to encourage the policy-makers to want to read on.
• Introduction, or summary of the problem: Explain the policy issue and why it is particularly important or current. Put the research into context.
• Methods, approaches and results: Present the research or project findings in an accessible way for a non-specialist. Explain the methodology that was used to reach the results: for example, was it a synthesis of existing research or literature, or new research data? A policy-maker will want to see robust results that are repeatable or corroborated by others.
• Conclusions: Reinforce the key message to take away from the policy brief. Remember that content that would typically be in a conclusion will already be in the executive summary; do not simply repeat it.
• Policy recommendations: Try and make only one feasible policy recommendation. If you are making more than one recommendation, differentiate them clearly (in bullet points, for example) and keep to a maximum of three.
• References and suggested sources: You should use references sparingly. Suggest a few additional sources at the end to give either background or more detail on the policy issue.
• Acknowledgements, author details and disclaimers: You should list any funding used for the research, and note down the authors’ current positions and contact details. If the policy brief is being produced by an institution, a disclaimer may be needed.

You should break up the text into short paragraphs, and consider using boxes, subheadings and lists – as long as the text still makes sense. Consider using diagrams and tables to save on words. Put important points in bold or italics, but do not overuse them or the brief will appear cluttered and confusing (Bennett, 2017).

4.3 Your writing style

You should try to avoid writing in an ‘official style’ that is common in academic publications and other sectors. This language tends to be obscure, confusing and long-winded. Instead, you should think about the message you want to get across, and how you can most clearly and concisely state it.

According to Bennett (2017), good writing is:

• logical, direct and unambiguous, and so it does not lead to misinterpretation
• a story that engages the reader’s attention
• well-structured, breaking down complex messages or large amounts of information so that they can be easily understood
• written with familiar words, wherever possible, avoiding any jargon that most readers will not understand.

Make your document as short as possible without sacrificing clarity. Try to write short sentences, which are easier to understand. Keep to one issue or topic for each paragraph. Don’t be afraid to leave things out – not everything will be important to your readers. Make sure that each word or phrase adds something relevant, and look for the shortest way to express something.

Use language that readers will understand. If jargon or technical wording is important, explain what it means and, if appropriate, include a glossary or appendix. Cite sources and references clearly and consistently. Some readers will wish to follow these up, so make it easy for them to do so (Bennett, 2017).

5 Barriers to policy-making

Making an impact on policy is difficult: not only because of the challenges of translating research into a language that policy-makers understand, but also because of challenges inherent in the policy-making process itself.

A barrier to policy-making is an obstacle that prevents a given policy instrument being implemented, or limits how it can be implemented. In the extreme, such barriers may lead to certain policy instruments being overlooked, and the resulting strategies being much less effective (Institute for Transport Studies, 2005).

Barriers to policy-making can be rooted in a variety of causes, including (Health Policy Project, 2014):

• opposition from key stakeholders
• inadequate human or financial resources
• a lack of clarity on operational guidelines or roles and responsibilities for implementation
• conflicts with other existing policies
• a lack of coordination and collaboration between parties responsible for implementation
• a lack of motivation or political will.

5.1 Common barriers

There are at least six main barriers to using research in policy-making:

• complexity of evidence
• absence of personal relationships
• not enough time
• apparently irrelevant research
• lack of analytical capacity
• budget constraints.

You should now read an article that includes more detail on these barriers (Fourie, 2017).

Regarding the ‘complexity of evidence’ barrier, the AMR briefings produced by the UK’s POST (Hall and Bunn, 2018; Evans and Border, 2018; Dowling and Border, 2019) are a good example of the breadth of evidence that can be drawn upon. The list of references at the end of the ‘Reservoirs of antimicrobial resistance’ policy brief includes technical reviews, government websites, government reports, independent inquiry reports and briefing papers, as well as numerous journal articles. But even using one form of evidence isn’t that easy; peer-reviewed research often comes from competing sources with varying methodologies, perspectives and ideologies.

5.2 Overcoming barriers

A good response to research barriers within policy-making circles would be to include building relationships that are based on both expertise and mutual respect.

Researchers must focus on building expertise as well as sharing research through networking and partnerships. Building relationships between researchers and policy-makers must go hand-in-hand with gathering research evidence. Strong relationships will lead to language being used that everyone can understand, as well as productive partnerships. They might even improve academic responsiveness, and lead to better and more usable results (Fourie, 2017).

The UN’s 2030 Agenda emphasises the importance of creating partnerships. It is now understood that the use of research evidence in the implementation of development goals isn’t merely a technical process.

6 End-of-module quiz

Well done – you have reached the end of this module and can now do the quiz to test your learning.

This quiz is an opportunity for you to reflect on what you have learned rather than a test, and you can revisit it as many times as you like. 

• End-of-module quiz

Open the quiz in a new tab or window by holding down ‘Ctrl’ (or ‘Cmd’ on a Mac) when you click on the link.

7 Summary

In this module you have learned how you can work effectively with policy-makers to help to ensure that policies are informed and evidence-based. You have explored how policy-making works, how to identify who policy-makers are, how policy-makers process evidence, and the environment in which they operate.

You have considered how, when and where you might engage with policy-makers, and you have seen examples of how to write for policy-makers and avoid common mistakes. Finally, you have learned about the challenges inherent in the policy-making process itself, and how these can be overcome. Throughout the module you have seen plenty of examples of AMR data informing policy-making.

You should now be able to:

• understand how AMR data can influence policy-making
• identify the relevant policy-makers and their roles
• use an engaging and accessible writing style for people who have major time constraints and who are not subject matter experts
• effectively deliver science advice to policy-makers
• recognise barriers to policy-making and how to overcome them.

Now that you have completed this module, consider the following questions:

• What is the single most important lesson that you have taken away from this module?
• How relevant is it to your work?
• Can you suggest ways in which this new knowledge can benefit your practice?

When you have reflected on these, go to your reflective blog  and note down your thoughts.

8 Your experience of this module

Now that you have completed this module, take a few moments to reflect on your experience of working through it. Please complete a survey to tell us about your reflections. Your responses will allow us to gauge how useful you have found this module and how effectively you have engaged with the content. We will also use your feedback on this pathway to better inform the design of future online experiences for our learners.

Many thanks for your help.

Now go to the survey.

References

Acknowledgements

This free course was collaboratively written by Alana Dowling and Clare Samson, and was reviewed by Sidharth Mookerjee, Claire Gordon, Joanna McKenzie, Adrienne Chattoe-Brown and Peter Taylor.

Except for third party materials and otherwise stated (see terms and conditions), this content is made available under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 Licence.

The material acknowledged below is Proprietary and used under licence (not subject to Creative Commons Licence). Grateful acknowledgement is made to the following sources for permission to reproduce material in this free course:

Images

Module image: © ahasoft2000/123RF.

Figure 1: Ghana National Drugs Programme, Ministry of Health, 2015.

Figure 2: © Coventry University, https://www.futurelearn.com/ info/ courses/ policy-formulation-and-analysis-in-healthcare/ 0/ steps/ 76113. This file is licensed under the Creative Commons Attribution-Noncommercial Licence http://creativecommons.org/ licenses/ by-nc/ 4.0/.

Text

Case Study 1: adapted from ReAct, n.d. 1.

Case Study 2: adapted from ReAct, n.d. 3.

Section 2.1: adapted from Oliver and Cairney, 2019. This file is licensed under a Creative Commons Attribution 4.0 International (CC BY 4.0) Licence https://creativecommons.org/ licenses/ by/ 4.0/.

Section 2.2: Safford and Brown, 2019.

Case Study 3: adapted from HM Government, 2019c. Reproduced under the terms of the Open Government Licence v3.0, https://www.nationalarchives.gov.uk/ doc/ open-government-licence/.

Links

NPAR, Section 1.3: NPAR.

AMR Stakeholder Mapping, Section 2.2: ReAct, 2016.

‘Reservoirs of antimicrobial resistance’, Case Study 3: Dowling and Border, 2019. Reproduced under the terms of the Open Parliament Licence, https://www.parliament.uk/ site-information/ copyright-parliament/ open-parliament-licence/.

‘Antimicrobial resistance’, Activity 6: OiE.

Every effort has been made to contact copyright owners. If any have been inadvertently overlooked, the publishers will be pleased to make the necessary arrangements at the first opportunity.