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Björn Rönnerstrand Dr. in political science and researcher at the SOM Institute, University Gothenborg Sweden.

Data from Transparency International show that corruption (defined as “abuse of entrusted power for private gain”) is widespread globally. Moreover, corruption in the medical sector is prevalent as well: “1 in 5 people worldwide (17%) report they were forced to pay a bribe when dealing with the medical sector.” Other research shows that there is a negative correlation between indicators of corruption and healthy life expectancy.

With regard to the role of corruption in antibiotic resistance, the former Romanian Health Minister, Vlad Voiculescu, has said: “Corruption generated antibiotics resistance! In societies where there is corruption, rules are broken, therapy guides and protocols are not respected, pharmaceutical drugs are released without prescription, measures to isolate patients infected with multi-resistant germs are not respected.” A study on the correlation between regulatory conditions and antibiotic consumption within the WHO European Region by Mueller and Östergren (2016) has shown that “regulatory aspects may very well be only existent on paper but not properly implemented at all, or the adherence to specific aspects might not be enforced.” This makes the option of corruption regarding antibiotic resistance conceivable. A study by Collignon, e.a. (2015) confirms this link. It shows that there is a clear correlation between antibiotic resistance and corruption.

Björn Rönnerstrand Dr. himself, together with Viktor Lapuente (2017), has done research into regional variations of corruption and the use of antibiotics in Europe. They found that in the regions where corruption in the healthcare sector is higher, there is more antibiotic consumption. Likewise, in regions where bribery is used for obtaining public services, antibiotic consumption is also higher.

Thus, in numerous studies a relationship between corruption and antibiotic resistance has been found. However, the exact factors behind this relationship are not yet clear. Borg and Camilleri (2020) speculate about those factors. They have asserted that it might have to do with an environment in which norm-deviant behaviour is accepted. Björn Rönnerstrand concludes that if you want to implement active stewardship policies, it is very difficult to do that in a context where non-compliance is the norm. Therefore, this needs to be taken into account when implementing those policies in regions where there is a large frequency of corrupt practices in general.

Written by: Christine de Zwart