# Understanding what citizens think about Antimicrobial Resistance: Deliberative Polling® in six middle-income countries

## TL;DR

This study used Deliberative Polling® in six middle-income countries to gauge public support for policies to combat antibiotic resistance, finding strong support after informed discussions.

## Contribution

This is the first use of Deliberative Polling® to assess public opinion on AMR policies in middle-income countries, revealing high support and increased knowledge post-deliberation.

## Key findings

- Support for 3/4 of the AMR-related policy proposals increased significantly after deliberation, with over 90% support for 2/3 of them.
- Proposals related to infection prevention received the most support across all six countries.
- Regional differences were observed in support for policies on informal antibiotic access and antibiotic use in food production.

## Abstract

The pandemic of antimicrobial resistance (AMR) will only be mitigated by policy action and innovation and importantly, supported by local and community action. Last year (2024) with the United Nations General Assembly high level meeting on AMR in September we decided to ascertain citizens’ understanding of the issues and prioritisation for action

Over the summer, while intergovernmental negotiations on the outcome document were taking place, we used Deliberative Polling
®, a methodology founded on deliberative democratic theory, in six middle income countries across three continents to explore people's understanding and support for 45 policies that were likely to feature in the political declaration.

In total 2419 participants were randomised to deliberation intervention (written and video information, facilitated online small group discussions, and expert plenary sessions) or control groups who only completed the pre- and post- deliberation surveys. Support increased significantly through deliberation for 3/4 of the proposals (>90% for 2/3), as well as on knowledge about AMR and internal political efficacy. Proposals relating to infection prevention were most heavily supported across all six countries. We found regional variation in support for proposals relating to informal antibiotic access and the use of antibiotics in food production, with less support for selected proposals from South America

Deliberative polling is a powerful method of large scale community engagement and this is new for AMR helping us to understand the views of the public relating to policies that will require their support to enact.

Understanding what citizens think about Antimicrobial Resistance: Deliberative Polling® in six middle-income countries

In 2024, increasing resistance of bacteria to antibiotics, which impacts on our health, food, and socioeconomic security was debated at the United Nations General Assembly. This led to a political declaration, which included commitments for action that require public adoption to be implemented successfully.

In this study, researchers examined the level of support/opposition for these policies from citizens of 6 middle-income countries. They used Deliberative Polling®, a method that assesses what a representative and informed sample would think about policy proposals after extended, evidence-based discussions.

There was a high level of collective support for the majority of proposals, which increased through the deliberative process. Antibiotic access and food security proposals showed regional variation in support. Deliberation also increased knowledge about antibiotic resistance and participants’ perception of their influence on public policy and ability to create changes in their government.

The importance of these findings is that there was high levels of public support for policies that could diminish antibiotic resistance in countries that suffer from a high burden of antibiotic-resistant bacterial infections, increasing the likelihood of their successful adoption. Polling countries with different socioeconomic resources would give a clearer picture of the global view.