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Background

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

Methods

From June to August 2024, 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.

Results

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.

Conclusions

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.

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[version 2; peer review: 2 approved, 3 approved with reservations]

Journal Publisher
Wellcome Open Res 2026
Authors
Alice Siu
James S. Fishkin
Number
10:690
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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 behavior to make them work.

Ahead of UNGA, we asked citizens in six countries what they thought about different policy proposals across six themes: Equity, Access and Stewardship; Infection Prevention; Food Security; Awareness and Education; Target setting; and Surveillance.

Working with the Trinity Challenge, 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.

Learn more about the Deliberative Polling® methodology.

"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
Stanford 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

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 organizations 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 inquiries and further information about the research, please contact Louise Gough (Chief Operating Officer) at info@thetrinitychallenge.org.

Read our press release.

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The Deliberative Democracy Lab and the Trinity Challenge asked 2419 people in six countries through the first-ever deliberative poll on AMR.

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This article examines the consequences of the opium concession system in the Dutch East Indies—a nineteenth-century institution through which the Dutch would auction the monopolistic right to sell opium in a given locality. The winners of these auctions were invariably ethnic Chinese. The poverty of Java's indigenous population combined with opium's addictive properties meant that many individuals fell into destitution. The author argues that this institution put in motion a self-reinforcing arrangement that enriched one group and embittered the other with consequences that persist to the present day. Consistent with this theory, the author finds that individuals living today in villages where the opium concession system once operated report higher levels of out-group intolerance compared to individuals in nearby unexposed counterfactual villages. These findings improve the understanding of the historical conditions that structure antagonisms between competing groups.

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This article examines the consequences of the opium concession system in the Dutch East Indies—a nineteenth-century institution through which the Dutch would auction the monopolistic right to sell opium in a given locality.

Journal Publisher
World Politics
Authors
Nicholas Kuipers
Number
pp. 1–38
1
CDDRL Predoctoral Scholar, 2021-22
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Nicholas Kuipers is a Ph.D. candidate in political science at the University of California, Berkeley, studying comparative politics and political economy. Nicholas’ research has been supported by the Institute for International Studies, the National Science Foundation (NSF), the Southeast Asia Research Group (SEAREG), and the Weiss Family Fund. His research has been published in Asian Survey, British Journal of Political Science, Journal of Politics, and Journal of Experimental Political Science. A graduate of Oberlin College, he previously worked in Jakarta at Saiful Mujani Research & Consulting, a political consultancy specializing in public opinion surveys.

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In this talk, Wellington Shih will provide a historical and legal overview of the Republic of China’s territorial claims in the South China Sea. He will also review the latest developments in the ongoing dispute between the People’s Republic of China, the ROC on Taiwan, and other claimants in the region, including the Philippines, and discuss the South China Sea Peace Initiative proposed by the administration of President Ma Ying-jeou. 

The Possible Approaches for Defusing Tensions in the South China Sea: A Taiwanese Perspective
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Visiting scholar Ministry of Foreign Affairs, Republic of China (Taiwan)
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Abstract:

Authoritarian ruling parties are expected to resist democratization, often times at all costs. And yet some of the strongest authoritarian parties in the world have not resisted democratization, but have instead embraced it. This is because their raison d’etre is to continue ruling, though not necessarily to remain authoritarian. Put another way, democratization requires ruling parties hold free and fair elections, but not that they lose them. Authoritarian ruling parties can thus be incentivized to concede democratization from a position of exceptional strength. This alternative pathway to democracy is illustrated with Asian cases – notably Taiwan – in which ruling parties democratized from positions of considerable strength, and not weakness. The conceding-to-thrive argument has clear implications with respect to “candidate cases” in developmental Asia, where ruling parties have not yet conceded democratization despite being well-positioned to thrive were they to do so, such as the world’s most populous dictatorship, China.

 

Bio:

Joseph Wong is the Ralph and Roz Halbert Professor of Innovation at the Munk School of Global Affairs, University of Toronto, and Professor of Political Science and Canada Research Chair in Democratization, Health and Development. Professor Wong was the Director of the Asian Institute at the Munk School from 2005 to 2014. In addition to academic articles and book chapters, Professor Wong has published four books: Healthy Democracies: Welfare Politics in Taiwan and South Korea (2004) and Betting on Biotech: Innovation and the Limits of Asia’s Developmental State (2011), both published by Cornell University Press, as well as Political Transitions in Dominant Party Systems: Learning to Lose, co-edited with Edward Friedman (Routledge, 2008), and Innovating for the Global South: Towards a New Innovation Agenda, co-edited with Dilip Soman and Janice Stein (University of Toronto Press, 2014). He is currently working on a book monograph with Dan Slater (University of Chicago) on Asia’s development and democracy, which is currently under contract with Princeton University Press. Professor Wong earned his Hons. B.A from McGill University (1995) and Ph.D. from the University of Wisconsin-Madison (2001). 

Philippines Conference Room, 3rd Floor, Encina Hall

616 Serra St., Stanford, CA

Joe Wong Professor and Canada Research Chair in Political Science University of Toronto
Seminars
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*This event is free and open to the public.*

 

PANELISTS

Don Emmerson - Director of the Southeast Asia Forum, Shorenstein Asia-Pacific Research Center; Affiliated Scholar, Abbasi Program in Islamic Studies; Affiliated Faculty, CDDRL

Erik Jensen - Professor of the Practice of Law, Stanford Law School; Senior Advisor for Governance and Law, The Asia Foundation; Senior Research Scholar, CDDRL; Director, Rule of Law Program, Stanford Law School

Norman Naimark - Director of the Stanford Global Studies Division; Professor of History

Diane H. Steinberg (Panel Chair) - Visiting Scholar at Stanford's Program on Human Rights, Center on Democracy, Development, and the Rule of Law (CDDRL)

 

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The Act of Killing visits former Indonesian death squad killers who wreaked havoc in 1965 and 1966 in the aftermath of Indonesia's military coup and yet have never been held accountable for slaughtering between 200,000 to 2 million people in a genocide often forgotten.  The dramatic reenactments of the murders in the documentary catalyze an unexpected emotional journey for Anwar Congo from arrogance to regret as he confronts for the first time in his life the full implications of what he has done.
 
The Act of Killing is an award-winning documentary film directed by Joshua Oppenheimer with co-director Christine Cynn and and an anonymous co-director from Indonesia. It is a Danish-British-Norwegian co-production, presented by Final Cut for Real in Denmark and produced by Signe Byrge Sørensen. It was recently nominated for an Academy Award for Best Documentary Feature.

"Director Joshua Oppenheimer has made a documentary in which he interviews the leaders of Indonesian death squads, who were responsible, collectively, for the deaths of millions of Communists, leftists and ethnic Chinese in 1965 and 1966. But he doesn't just interview them. He has them re-enact their crimes and even invites them to write, perform and film skits dramatizing their murders." Mick LaSalle, San Francisco Chronicle, 8/8/2013
 
"The Act of Killing is a bold reinvention of the documentary form, as well as an astounding illustration of man's infinite capacity for evil." Rene Rodriguez, The Miami Herald, 8/15/2013
 
After the screening of the  Director's Cut of The Act of Killing (160 minutes), there will be a thirty-minute panel discussion.
 
For more information regarding the film, please visit: http://theactofkilling.com/.
 
This event is presented and sponsored by Stanford Global Studies, CDDRL's Program on Human Rights, and the Vice Provost of Undergraduate Education.

Cubberley Auditorium

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