Deliberative Polling on Antimicrobial Resistance with Stanford’s Deliberative Democracy Lab
What do citizens around the world really think about tackling Antimicrobial Resistance (AMR)?
About the Project
For the second time in history, UN Member States adopted a Political Declaration on AMR in 2024. This declaration outlines ambitious commitments to tackle one of the most pressing health challenges of our time. These commitments will only be successful if the public understands, supports, and ultimately changes behaviour to make them work.
Ahead of UNGA, we asked citizens in six countries what they thought about different policy proposals across six themes including Equity, Access and Stewardship, Infection Prevention, Food Security, Awareness and Education, Target setting, and Surveillance.
Working with Stanford University’s Deliberative Democracy Lab, we brought together 2,419 citizens from Brazil, Colombia, Nigeria, Tanzania, India, and Indonesia using Deliberative Polling®, a method that assesses what a representative and informed sample would think about policy proposals after extended, evidence-based discussions. Deliberations took place on the innovative Artificial Intelligence (AI)-assisted Stanford University Online Deliberation Platform across two days.
Citizens left the process not just more informed, but more engaged with the solutions required.
What is Deliberative Polling®?
Deliberative Polling® is a research methodology developed by Professor James Fishkin at Stanford University’s Deliberative Democracy Lab. Unlike standard opinion polling, it measures not just initial public opinion but informed public opinion – what people think after genuine engagement with the issues, trade-offs, and expert perspectives.
It has been applied in over 160 cases around the world, from national referendums to climate policy.
“Deliberative Polling® doesn’t just ask what people think – it asks what they would think if they had the chance to really engage with the evidence.”
Professor James Fishkin, Director of Stanford’s Deliberative Democracy Lab
Key Findings
The results were striking – and they matter for policymakers, health leaders, and the public alike.
- 2,419 citizens across six middle-income countries participated
- 43 out of 45 policy proposals saw increased support after deliberation
- The most popular proposals were those relating to infection prevention
- Regional differences emerged – particularly around attitudes to restricting antibiotic use in food production.
Antimicrobial resistance is not only a scientific challenge but a societal one. This project shows that when citizens are given balanced information, diverse perspectives, and the opportunity to deliberate, they can engage meaningfully with the complexity of AMR and support the action it requires. Building public trust and community engagement is essential to reducing the global impact of AMR. We hope these findings and resources will help advance public engagement on AMR and strengthen deliberative approaches across global health.
“Support increased for 43 out of 45 proposals following deliberation. Beyond the data, participants left better informed about AMR and more engaged with the solutions on the table. That is whole-of-society action in practice.”
Dame Sally Davies,
Master of Trinity College Cambridge and Executive Chair of the Trinity Challenge
Reports
Publications and reports are available to read or download here:
Deliberative Polling on AMR: Data-Driven Analysis
The statistical results – how opinions shifted across all 45 policy proposals, broken down by country and theme.
Deliberative Polling on AMR: Published Paper
The full academic paper, including methodology, findings, data repository and implications.
Deliberative Polling on AMR: Qualitative Analysis
Further analysis on opinion changes.
See below for country specific results.
Results by Country
Each country deliberation produced its own findings, shaped by local context, culture, and existing public attitudes to health and agriculture. Explore the results from each country below – view the videos and download the reports.
Brazilian participants strongly favoured a prevention-first approach – reducing infections before antibiotics are needed. On agricultural antibiotics, participants chose professional veterinary oversight over outright bans.
Their highest priorities were:
- Improving hand hygiene training for farm workers
- Expanding access to clean water and sanitation (WASH)
- Strengthening infection prevention and biosecurity on farms
- Increasing government investment in clean water, sanitation, and vaccination
- Encouraging flu vaccination for healthcare workers
Participants viewed prevention measures as both practical and effective, seeing clean water, sanitation, and vaccines as essential public health foundations that reduce disease and antibiotic use.
On antibiotic use in livestock, participants did not support outright bans. Instead, they preferred antibiotics to remain available under veterinary supervision and professional oversight, reflecting concern for both public health and Brazil’s agricultural economy.
Overall, the poll suggests Brazilian citizens support:
- Stronger infection prevention infrastructure
- Expanded vaccination programs
- More expert-led regulation of antibiotic use, rather than strict prohibitions that may be difficult to enforce.
Colombian participants prioritised preventing infections through clean water, sanitation, hygiene, and vaccination, viewing these as the most effective ways to reduce the need for antibiotics and slow antimicrobial resistance.
Their highest priorities were:
- Expanding universal access to clean water and sanitation (WASH)
- Increasing government investment in infection prevention measures
- Ensuring clean water access in hospitals and healthcare facilities
- Teaching hygiene and infection prevention in schools
- Expanding childhood vaccination coverage
Participants widely viewed water, sanitation, and vaccines as basic public health necessities and essential tools for controlling infections before treatment becomes necessary.
On antibiotic use in agriculture, participants did not support blanket bans. Instead, they preferred veterinary oversight and professional regulation of antibiotic use in livestock, aiming to balance public health goals with the realities of Colombia’s farming sector.
Overall, the poll suggests Colombian citizens support:
- Stronger public health infrastructure (water, sanitation, hygiene, and vaccines)
- Greater emphasis on infection prevention
- More expert-led regulation and policy frameworks to manage antibiotic use and reduce AMR, while avoiding measures seen as impractical.
Nigerian participants emphasised both preventing infections through hygiene and improving the country’s ability to measure, track, and respond to AMR through surveillance and data-driven policy.
Their highest priorities were:
- Adding hygiene and infection prevention education to school curricula
- Supporting a global target to reduce deaths from antibiotic resistance
- Integrating rapid diagnostic testing into national surveillance systems
- Strengthening farm biosecurity and infection control
- Establishing national One Health surveillance systems that monitor infections, antibiotic use, and resistance across humans, animals, and water systems
Participants also took a pragmatic approach to antibiotic access, particularly because informal medicine sales are common. Rather than supporting strict restrictions, they favoured regulating and monitoring informal antibiotic sellers to reduce misuse while maintaining access.
A notable outcome was that Nigerian participants recorded the largest increase in AMR knowledge among the six countries.
Overall, the poll suggests Nigerian citizens support:
- Stronger infection prevention and hygiene education
- Better surveillance, data collection, and accountability systems
- More managed and regulated access to antibiotics, rather than restrictive approaches that could limit availability.
Tanzanian participants became much more supportive of combining clean water, sanitation, hygiene (WASH), and vaccination as core strategies to reduce infections and lower reliance on antibiotics.
Their highest priorities were:
- Setting a global target to stop the use of medically critical antibiotics in the food chain
- Adding hand hygiene and infection prevention education to school curricula
- Increasing government investment in clean water, sanitation, and vaccination
- Ensuring healthcare facilities have reliable access to clean water
- Expanding universal childhood immunisation coverage
Participants also took a practical approach to antibiotic access. Rather than restricting informal channels, they supported expanding access through trained professionals such as pharmacists and veterinarians, reflecting concerns about healthcare access in areas with limited formal infrastructure.
On agriculture, participants showed some of the largest opinion shifts, becoming much more supportive of:
- Stronger farm infection prevention and biosecurity
- Greater restrictions on the use of antibiotics that are critically important for humans, from being used in food production systems
Overall, the poll suggests Tanzanian citizens support:
- Greater investment in infection prevention and vaccination
- Expanded but professionally managed access to antibiotics
- Stronger agricultural controls and One Health policies that connect human, animal, and environmental health to reduce AMR.
Indian participants overwhelmingly favoured investments in clean water, sanitation, hygiene (WASH), vaccination, and public education as the most effective long-term response to AMR.
Their highest priorities were:
- Expanding universal access to clean water and sanitation (WASH)
- Including hand hygiene and infection prevention in school curricula
- Increasing government investment in clean water, sanitation, and vaccination
- Ensuring healthcare facilities have access to clean water for hand hygiene
- Expanding universal childhood immunisation coverage
Participants viewed prevention measures as essential public goods, especially in the context of India’s ongoing challenges with infectious disease, sanitation, and healthcare access. They emphasised reducing infections at the source rather than relying primarily on antibiotic treatment.
Education and vaccination were also central priorities. Participants supported school-based hygiene education, childhood immunisation, and public awareness campaigns to address unnecessary antibiotic use and vaccine hesitancy.
Overall, the poll suggests Indian citizens support:
- Stronger infection prevention infrastructure (WASH and healthcare hygiene)
- Expanded vaccination and public education
- Complementary measures such as farm biosecurity, safe disposal practices, and awareness campaigns, while placing less emphasis on restrictive regulation alone.
Indonesian participants prioritised preventing infections through clean water, hygiene, and vaccination, with most of their top-supported policies focused on reducing infections before antibiotics become necessary.
Their highest priorities were:
- Expanding universal access to clean water and sanitation (WASH)
- Ensuring healthcare facilities have reliable access to clean water for hand hygiene
- Including hand hygiene and infection prevention in school curricula
- Increasing government investment in clean water, sanitation, and vaccination
- Expanding universal childhood immunisation coverage
Participants viewed hygiene, sanitation, and education as long-term solutions to reducing AMR and placed strong responsibility on government action to improve public health systems. Schools were seen as especially important for building lifelong prevention habits, particularly in rural and lower-income communities.
On antibiotic use in agriculture, participants supported awareness, oversight, and consumer transparency rather than strict bans. They favoured stronger infection prevention practices on farms and clearer identification of foods produced using antibiotics, while emphasising education and support for farmers.
Overall, the poll suggests Indonesian citizens support:
- Greater investment in public health infrastructure and infection prevention
- Expanded hygiene education and vaccination programs
- More practical, participatory, and awareness-based regulation of antibiotic use in agriculture rather than punitive restrictions.
From Understanding to Action
This study demonstrates something important: when citizens are given the chance to engage seriously with a complex global health challenge, they rise to it.
Across all six countries, deliberation moved public opinion towards greater support for ambitious AMR action – on prescription practices, agricultural use, access to medicines, and prevention. The 2024 UN Political Declaration set out what governments have committed to. This research shows that the public, when informed, is ready to support it.
The findings have direct relevance for:
- Policymakers designing national AMR action plans, particularly in middle-income countries
- Health communicators seeking evidence-based approaches to public engagement on AMR
- Researchers building the evidence base for deliberative approaches in global health
- Civil society organisations advocating for community-level AMR action
We are committed to sharing these findings as widely as possible – with governments, health bodies, and the communities that took part.
Thanks to our Funders
With thanks to the Novo Nordisk Foundation and Wellcome.
Contact and Media
For media enquiries and further information about the research, please contact:
Louise Gough
Chief Operating Officer
You can read our press release here.