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.

中文翻译：

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抗微生物药物耐药性国家行动计划中的同构动态

本文研究了在 2015 年世界卫生大会通过抗菌素耐药性全球行动计划后，制定和实施抗菌素耐药性 (AMR) 国家行动计划 (NAP) 的同构动态。通过嵌套方法，我们进行了定量交叉研究。对该政策过程的国家分析，特别强调形式（国家行动计划的设计）和功能（其实施）。定性部分由来自日本、缅甸和丹麦的三个说明性示例组成，它们代表了对这一国际驱动的政策过程的不同类型的反应。分析揭示了同构模仿的趋势，其特点是国家行动方案的起草和实施之间存在明显分歧，特别是在低收入和中低收入国家。有趣的是，也有证据表明，在编制国家行动方案时，通常具有大量杠杆的高收入成员国偏离了全球指导方针——我们称之为“同构姿态”的趋势。我们认为，这两种类型的同构行为都阻碍了围绕最佳实践的全球协调，并得出结论，通过建立符合利益原则和个性化责任的具有法律约束力的国际协议，可以最好地解决 AMR 领域政策设计和政策实施之间的不匹配问题。