Growing international attention and priority placed on AMR now articulate the need for collaborative action between multiple sectors (McEwen and Collignon, 2018; Robinson et al., 2016). Intersectoral collaboration can be difficult but is possible when political will and public pressure exist, when places to meet and discuss are available, and when there is a shared understanding of the problem (Wernli et al., 2017).

With complex health issues such as AMR, there is a need to balance critical outcomes needed today with solutions that are more challenging to initiate but are more likely to have a greater influence on the long-term outcomes. By engaging multiple stakeholders, we can start new conversations about roles and responsibilities, with a key goal of fostering trust among the players. Transparent discussions will provide a launching point to begin to work together on sustainable solutions with shared responsibility. Traditional scientific evidence about how AMU affects AMR is mounting and what is now needed is a process to share knowledge, recognize and include different perspectives and motivations, develop and support relationships, and appreciate how the different types of evidence, generated at smaller points within the system, relate and drive each other across the system as a whole.


AMR is a wicked health emergency that requires all our knowledge, experience, and resources to address sustainably and effectively. Recommendations in national action plans and reports for surveillance, infection prevention and control, stewardship, and research and innovation can all contribute to a better understanding of AMR, more effective interventions, better infectious disease prevention, changes in farm and animal management, and control of resistant organism spread. However, we need to go beyond these recommendations to incorporate health promotion and harm reduction principles that have proven effective for other formidable public health challenges (e.g. tobacco control and substance use). The AMR emergency is an exemplar of the value to One Health in action of the perspectives, methods, and knowledge presented in this book.

More and better implementation science will enable us to improve our understanding of how values and beliefs determine success of AMR interventions across the system (Wernli et al., 2020; World Bank, 2019). We will need to create spaces for ongoing dialogue at all levels of government as well as in nongovernment circles to successfully respond to AMR, to build healthier and more resilient populations and communities. We need to build on our shared experiences and advocate for release of emergency funds to bring people and organizations together for ongoing dialogue. Resources should create structured spaces for exchange of ideas and discussions between individuals, communities, organizations, and countries.


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