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The COVID-19 pandemic has put behaviour change under the spotlight across the world. Every community touched by the virus has been forced to change their way of life. Where a person might have washed their hands five times in a day, they’ve been instructed and have adapted to be far more diligent, washing them much more frequently.

The pandemic has brought the battle against a deadly virus to millions and behaviour change has been at the forefront of the response, with many governments employing behavioural scientists to advise their measures. When the pandemic is over, there will be lessons learned from the experience. Insights from how human behaviour changed during this time could provide the basis for another global fight the world is being forced to react to: the emergence of antimicrobial resistance (AMR).

What is antimicrobial resistance and why is it a global concern?

Antimicrobial resistance (AMR) occurs when microorganisms that cause infections evolve ways to survive the drugs designed to kill them. A well-known example is the ability of bacteria to develop resistance against antibiotics.

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However, resistance also occurs in viruses, parasites and fungi. AMR arises naturally, but is accelerated by the inappropriate use of antimicrobials, such as the overuse or misuse of drugs.

In recent years, the spread of AMR has quickened and it now constitutes a major threat to global public health. Treating infections is becoming increasingly complex and sometimes impossible. Drug-resistant infections often require the use of less effective, more toxic and more expensive alternative drugs, which cause longer and more severe illness, more deaths and higher treatment costs. Without effective antimicrobials, crucial medical and societal developments at the heart of modern life would be under threat.

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The World Health Organization has referred to AMR as ‘a slow tsunami that threatens to undo a century’s worth of medical progress’[1]. Malaria Consortium’s Future Health series highlights antimicrobial resistance as one of the key threats that will face global health in the coming decade. Lessons learned from how human behaviour changed to confront the -19 pandemic could prove useful in persuading governments to confront the threat of antimicrobial resistance in a similar way.

Through Malaria Consortium research and implementation, we have found that social and behaviour change (SBC) activities at the community level can increase awareness and understanding of AMR while helping to shape related social norms and change contributory behaviours. Applying SBC interventions across the human health, agricultural and animal sectors, as part of a One Health approach, can increase communities’ understanding of the drivers of AMR and encourage them to play a significant role in developing and adopting sustainable solutions.

Crucially, we have demonstrated that these activities can be integrated into existing health systems, eliminating the need for costly new human resources and creating sustainability for the intervention.

In Bangladesh, where infectious diseases are in widespread circulation and drug resistance has been detected in most tested pathogens[2], our ‘Community Dialogue to Address Antibiotic Resistance’ project explored the feasibility and acceptability of an intervention to address antibiotic resistance that could complement the existing health system, community and the cultural context. 50 volunteers were trained on the appropriate use of antibiotics and on the skills to facilitate Community Dialogue meetings to spread this knowledge around their communities. By the end of the study, more than 200 Community Dialogue meetings had been conducted and almost all Community Dialogue volunteers and supervisors had held sessions in their communities. Following the sessions, participants reported examples of behaviour change including; not sharing antibiotics with family members, not buying antibiotics without a prescription, visiting a Community Clinic if unwell and increased handwashing.

This is a positive case study of how a sustainable, scalable and replicable approach to participatory community engagement can change within a community around a complex issue like AMR. However, this is only one case study. In order to build on this success and create lasting change, Malaria Consortium is calling on the international community to invest in further research to identify what drives behaviour and motivates behaviour change and how collective action approaches to preventing AMR can be scaled up and sustained.

You can learn more about Malaria Consortium’s position on antimicrobial resistance in our position statement.

[1] Wilson, J. (2020). Big drugmakers launch US$1B fund to develop new antibiotics. Available: Last accessed 08/09/2020.

[2] Ahmed, I., Rabbi, M. B., & Sultana, S. (2019). Antibiotic resistance in Bangladesh: A systematic review. International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases, 80, 54–61.

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