Isomorphic dynamics in national action plans on antimicrobial resistance

The article investigates isomorphic dynamics in the development and implementation of national action plans (NAPs) on antimicrobial resistance (AMR) following the World Health Assembly's adoption of a Global Action Plan on AMR in 2015. Through a nested approach, we conduct a quantitative cross-country analysis of this policy process with particular emphasis on form (the NAP design) and function (their implementation). The qualitative component consists of three illustrative examples from Japan, Myanmar, and Denmark, which represent different types of responses to this internationally driven policy process. The analysis reveals tendencies of isomorphic mimicry characterized by a clear rift between the drafting of NAPs and their implementation, particularly in low-income and lower-middle-income countries. Interestingly, there is also evidence of typically high-income member states with substantial leverage deviating from global guidelines when compiling their NAPs—a trend we term “isomorphic posturing.” We argue that both types of isomorphic behaviors inhibit global harmonization around best practices and conclude that the mismatch between policy design and policy implementation in the AMR field can best be solved by establishing international, legally binding agreements that adhere to the benefit principle and individualized responsibilities.