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OP59 Stakeholder narratives of ‘problems’ and ‘solutions’: analysing the 2018 Health and social care committee antimicrobial resistance submissions in the United Kingdom
  1. RE Glover1,
  2. NB Mays1,
  3. MP Petticrew1,
  4. C Thompson2
  1. 1Faculty of Public Health Policy, LSHTM, London, UK
  2. 2Health and Social Care, University of Hertfordshire, Hatfield, UK


Background Antimicrobial resistance (AMR) is an area of global policy attention. Antibiotic resistance is often characterised as a ‘wicked problem’, because it (i) affects, and requires simultaneous action by, public, private, and third sector stakeholders, (ii) requires local, regional, national, and supranational buy-in (and implementation of strategic change) across low, middle, and high-income countries, and (iii) spans human, animal, and environmental health. The corollary to AMR being described as a wicked problem is that ‘crisis’ narratives have been adopted by public health policymakers and practitioners to marshal resources, attention, and public engagement. This AMR narrative has been co-opted at times, in order to privilege solutions promoted by and involving the private sector; with the co-optation of these solutions comes the risk of sequestering public sector funds to subsidise private sector work – in particular, in the pharmaceutical and medical diagnostics industries.

Methods There were 72 written submissions made to the 2018 ‘Antimicrobial resistance’ House of Commons Health and Social Care Committee. The sectors represented in these submissions were industry, trade associations, non-governmental organisations, professional associations, academia, government, public private partnerships, and homeopathy proponents. We accessed these documents and extracted relevant data according to the theoretically-informed critical discourse analysis (CDA) framework that we developed. Once this was complete, two researchers collaboratively coded the findings. A third researcher randomly coded a sample of the documents in order to determine reliability.

We identified the dominant and biosecurity narratives that were used by the various actors who submitted evidence. We then compared the narratives, framing, and language used by the private sector with public and third sectors, and academia. We subsequently analysed the three main promoted ‘remedies’ to the AMR problem and categorised them within a ‘market paradox’ framework.

Discussion We found that, irrespective of sector, the submissions presented the problem of AMR similarly. The solutions, however, diverged dramatically. The relevant industries use particular discursive strategies to achieve their aims, including the development of market paradoxical positions; on the one hand, asking for subsidies and incentives, but on the other hand explaining that regulation would be detrimental to ‘innovation’. We expand on these paradoxes, and catalogue the tactics used to achieve them discursively, including: obfuscating funding sources, stake inoculation, and lobbying for influence. Learnings from the unhealthy commodities industry allowed us to critically appraise the framing of industries involved in AMR.

Conclusion Overall, our CDA demonstrates that commercial interests deploying the crisis narratives do so in order to lobby heavily for self-serving solutions, namely deregulation and public subsidies. Discursive choices shaped by a technocratic-industry complex are redefining the pathways to success, monitoring, and decision-making in the global AMR arena.

  • antibiotic resistance
  • commercial determinants of health
  • discourse analysis

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