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.

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.

Motivation and Summary

Modern states depend upon bureaucracies effectively delivering services and enforcing regulations, from public health to environmental protection and postal services. When bureaucracies are plagued by inefficiency and incapacity and are unable to “deliver the goods,” elected representatives suffer. This can open the door for citizens to throw their support behind authoritarian leaders who promise to deliver more effectively.

A central question of bureaucratic design concerns the degree of autonomy that ‘principals’ — political actors like legislators — should delegate to bureaucratic ‘agents.’ Calibrating autonomy is crucial because principals cannot perfectly monitor or control agents, whose preferences often diverge from their own. On the one hand, highly autonomous bureaucrats may become unaccountable to their principals. Think of national security agencies that create secretive dissident watchlists or even authorize assassinations. On the other hand, bureaucracies with little autonomy will find their decision-making hamstrung by “red tape.” If public health agencies required extensive legislative approval for every aspect of vaccine delivery, infection rates would skyrocket. How, then, can bureaucracies be designed to achieve their goals, creatively respond to new problems, and minimize corruption, all while being perceived as legitimate?

In “Calibrating autonomy,” Katherine Bersch and Francis Fukuyama disaggregate the concept of autonomy into two facets (independence and discretion), present hypotheses concerning how each facet relates to capacity and quality, and then test these hypotheses, primarily using survey data from Brazilian bureaucrats. Their findings caution against overly blunt efforts to calibrate autonomy across multiple bureaucracies, suggesting instead that policymakers should understand a given agency’s capacity to perform.

Argument and Hypotheses

The article builds on earlier research by co-author Francis Fukuyama, who in 2013 hypothesized a key moderating role for bureaucratic capacity in the relationship between autonomy and quality. Briefly, low-capacity agencies — lacking expertise and resources — will likely struggle to utilize their autonomy and deliver, whereas high-capacity bureaucracies will deliver effectively for opposite reasons. However, autonomy is itself a complex concept that ought to be disentangled before one can begin to spell out how it is linked to delivery.

Independence, the first “face” of autonomy, concerns the degree to which bureaucrats are constrained by actors who are close to politics, such as elected leaders or politically-appointed agency heads. More independent bureaucrats might allocate waste management contracts on the basis of cost-effectiveness or service quality records. Less independent bureaucrats might allocate according to the whims of politicians who wish to reward their allies. The degree of independence is oftentimes a function of the number and extent of political appointees in a given agency. 

The second face of autonomy is discretion, or rather, the extent to which agencies are constrained by laws, rules, or protocols. Waste management agencies with limited discretion may struggle to respond to sporadic garbage pile-ups, whereas those with high discretion may set unpredictable collection schedules. 

These two faces of autonomy lead to different expectations about how they are connected to quality. The authors hypothesize that independence and quality stand in a linear and positive relationship: agencies that are more unconstrained by political actors will deliver more effectively. By contrast, discretion and quality stand in a non-linear or “Goldilocks” relationship: too few and too many constraining rules will reduce quality. Following Fukuyama’s earlier research, capacity moderates these relationships; for example, less independence in specifically low-capacity agencies may strengthen quality, perhaps in cases where legislative actors are able to appoint highly qualified experts.

Methods and Findings

The authors select Brazil as their case, in part because it exhibits considerable internal variation in bureaucratic quality: some agencies are professional while others are incompetent. By focusing on one country, they avoid comparing fundamentally different national bureaucratic contexts. Further, selecting Brazil — with both strong and weak bureaucracies — reduces ‘selection biases,’ i.e., mistaking characteristics of only high- or low-quality agencies as causes of overall performance. From a global standpoint, Brazilian bureaucracies are solidly middle-ranged, neither outstanding nor abysmal. 

The main empirical part of the paper involves a 2018 survey of over 3200 Brazilian federal bureaucrats. About 60% of the respondents are political appointees and 40% are civil servants, which enables looking at bureaucrats who stand in different relationships to political actors. The authors exclude military personnel, teachers, nurses, and local police officers.

As hypothesized, respondents’ perceptions of agency independence increase their perceptions of quality in a linear way. This finding likely reflects Brazil’s coalitional style of government: politicians benefit electorally from strong government performance; without bureaucratic independence, political pressure and influence from the many coalition partners would likely hinder bureaucrats and weaken performance. Meanwhile, perceptions of discretion align with the authors’ non-linear expectations.
 

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Figure 3: (a) Impact of independence on quality at varying levels of capacity. (b) Impact of discretion on quality at varying levels of capacity.
 

These findings are mediated by capacity, which the authors measure in terms of resources, career length, salaries, and the proportion of agents in core or expert careers. The findings hold even when controlling for political factors like party membership or appointment type (political vs. civil servant), individual characteristics such as gender or years of service, and agency differences, including budget or size. These controls are based on administrative data from over 326,000 bureaucrats across Brazil’s 95 most important federal agencies.
 

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Figure 4: Quality at varying levels of capacity.
 

Contributions and Implications

“Calibrating autonomy” makes important conceptual and empirical contributions to our understanding of bureaucratic performance. By disaggregating the concept of autonomy into independence and discretion, it helps make sense of seemingly contradictory empirical findings, namely that both minimally and highly autonomous bureaucracies perform well. And by evaluating their hypotheses about the two faces of autonomy using Brazilian data, the authors guard against selection biases or problems from comparing countries with quite different bureaucratic landscapes.

The paper serves as a caution against overly simplistic or blunt “solutions” to poor bureaucratic performance. Merely limiting discretion or increasing legislative oversight can make matters worse if the relevant bureaucratic culture is not properly understood, especially when it comes to capacity.

*Research-in-Brief prepared by Adam Fefer.

Motivation

Retaliation (or the threat thereof) is a central component of human behavior. It plays a key role in sustaining cooperation — such as in international organizations or free trade agreements — because those known to retaliate come to acquire a reputation of being hard to exploit. But how does the use and function of retaliation vary across cultures, and how does it interact with formal forms of punishment?

In “Cross-cultural differences in retaliation: Evidence from the soccer field,” Alain Schläpfer tackles these questions using data on retaliation from association football. Retaliation is simply defined in terms of fouling: player B retaliates against player A if and only if, after A fouls B, B then fouls A. Among other findings, Schläpfer shows that players from cultures emphasizing revenge are more likely to retaliate on the football field. This form of ‘informal punishment’ by players also interacts with ‘formal punishment’ by referees: retaliation by B is less likely when A is sanctioned with a yellow card. Schläpfer’s paper increases our knowledge of the causes and consequences of retaliation, while showing how informal cultural norms interact with the formal rules of football.  

Data

Schläpfer creates a data set of fouls committed over three football seasons (2016-2019) in nine of the world’s top professional men’s leagues. This includes the European leagues of Premier League (England), Serie A (Italy), Bundesliga (Germany), LaLiga (Spain), and Ligue 1 (France), as well as Série A (Brazil), Liga Profesional (Argentina), Liga MX (Mexico), and Major League Soccer (United States). The dataset comprises 9,531 games, 230,113 fouls committed by 10,928 unique perpetrators from 139 countries against 11,115 unique victims from 137 countries.

Because Schläpfer hypothesizes that being from more revenge-centric cultures explains on-field retaliation, the key independent variable is measured using a dataset from Stelios Michalopoulos and Melanie Meng Xue that identifies revenge motifs in a culture’s folklore. Examples of this include supernatural forces avenging human murders or animals avenging the death of their friends by humans. Schläpfer uses a host of other independent variables, such as country-level survey data about the desire to punish — as opposed to rehabilitate — criminals, which is also theoretically linked to revenge. As stated above, retaliation is measured in terms of fouls committed. Schläpfer shows that there is substantial variation in retaliation rates among players from different countries, from Gabon (8%) to Iceland (31%). Can the folklore in the country of origin explain the behavior of players on the field?
 

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Fig. 1. The share of fouls retaliated in soccer games (top) and the prevalence of revenge motifs in folklore (bottom). Both variables tend to have higher values for players and folklore from the Middle East, Central Africa, Eastern Europe, and parts of South America.
 

Findings

Retaliation:

Schläpfer finds evidence that players from cultures that value revenge are indeed more likely to retaliate for fouls. However, they are not more likely to commit fouls overall, cautioning us against conflating the concepts of retaliation and violence. Indeed, Schläpfer demonstrates that motifs of violence in a culture's folklore do not predict retaliation. Players are also found to be more retaliatory early on in a game, which is consistent with its use as a signal or aspect of one’s reputation. In other words, retaliation serves to deter future fouls. Victims of fouls also retaliate quickly. Indeed, retaliation rates are stable or slightly increasing during the first 30 minutes of a game, but then fall consistently thereafter.
 

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Evidence is also provided to show that retaliation deters future transgressions: perpetrators are less likely to foul again if victims retaliate for the initial foul. However, this deterrence finding is only observed when the perpetrator is from a revenge culture. In other words, for retaliation to support cooperation (the absence of fouls), players must share a similar cultural background.

Schläpfer’s findings hold even when soccer-related or socioeconomic factors are taken into account. Further, the paper considers, but finds little support for, alternative explanations of why retaliation varies. These include that some teams encourage players to retaliate more or employ more players from revenge cultures. Further, retaliation does not appear to be driven by emotions; otherwise, it would be less likely to occur after halftime when players have had a chance to cool down, but this is not the case.
 

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Informal and Formal Sanctioning:

Finally, Schläpfer analyzes the interaction between player retaliation and refereeing. Most importantly, retaliation is significantly less likely if a foul is sanctioned with a yellow card. This illustrates the theoretical principle of formal punishment “crowding out” informal punishment, such as religious excommunication, which carries greater weight than social shunning or police fines compared to peer pressure. Both retaliation and referee sanctioning are shown to reduce the frequency of repeated offenses by perpetrators, especially among players from revenge cultures. However, Schläpfer finds that formal sanctioning is roughly three times more effective than retaliation. This suggests that football referees are doing a better job managing conflict between players than players themselves. 

Schläpfer concludes by mentioning a few of the paper’s limitations. First of all, retaliation is measured only by what referees sanction. However, referees may miss crucial incidents for which retaliation is a response, such as Zinedine Zidane’s 2006 World Cup headbutt after a verbal insult (that was not sanctioned). This is important because individuals from revenge cultures are likely to be particularly offended by verbal insults. Second, the paper does not capture retaliation that occurs across games played by the same teams over time, particularly when rivalries and hostilities have intensified. Similarly, it does not account for preemptive retaliation that does not follow a foul. Ultimately, Schläpfer deepens our understanding of retaliation in a domain where many would expect it not to operate or to do so with minimal significance. The article impressively marshals large-scale data from both sports and cultural history to clarify the causes and consequences of retaliation.

*Research-in-Brief prepared by Adam Fefer.

Motivation & Contribution

Over the past 10-15 years, both longstanding and relatively new democracies have suffered from backsliding and erosion, including India, the United States, Brazil, Turkey, and many others. Many social scientists have explained this wave of backsliding in terms of either (a) elected autocrats who undermine democracy from within or (b) declining popular support for democrats who have failed to deliver economic growth and prosperity. However, recent scholarship by Thomas Carothers and Brendan Hartnett has questioned the wisdom of the latter. For example, India enjoyed strong economic growth prior to its backsliding under Narendra Modi.

In “Delivering for Democracy,” Francis Fukuyama, Chris Dann, and Beatriz Magaloni set out to more systematically evaluate the evidence connecting popular support for democracy with delivery, examining both backsliding and non-backsliding countries. After finding preliminary evidence for the democracy-delivery relationship, they offer an explanation of why delivery is simultaneously so important and so elusive under democratic governance.

Evidence

Using ten data sources covering 650,000 people in both old and new democracies, the authors find a strong, positive correlation between satisfaction with democracy and economic performance. This relationship holds not only for many countries at one point in time but for pairs of countries over time. In two developing democracies — Argentina and Brazil — as well as in two developed democracies — Greece and Spain — satisfaction and delivery have been closely connected since 2005, plummeting during economic crises and rising during periods of prosperity. These patterns call for an explanation for why voters care so much about delivery, such that they may be willing to sacrifice their democratic freedoms for it.
 

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The Argument

Delivery is Important

The authors begin from the axiom that stable political life depends upon citizens perceiving their governments as legitimate. Legitimacy can be thought of in terms of both performance — the effective delivery of goods and services — and procedure, which encompasses policies that reflect the democratic will of the people. As the examples of China, Turkey, Saudi Arabia, and Singapore show, however, plenty of autocracies and backsliding democracies have not only delivered, but have also arguably outperformed their democratic peers. From China’s Belt and Road Initiative to Turkey’s Yavuz Sultan Selim Bridge, authoritarian leaders and ruling parties have achieved remarkable performance legitimacy. 

Although autocracies, by definition, cannot be procedurally legitimate, this may carry little weight for democratic citizens who experience prolonged unemployment or must deal with dilapidated infrastructure. Indeed, public engagement through procedural channels — such as voting or jury service — has steadily declined across the democratic world. Democratic voters are increasingly willing to support outsider candidates who build new infrastructure or promise to fight crime, but who nonetheless restrict their political freedoms. Many citizens of El Salvador — which now claims the world’s highest incarceration rate — continue to view Nayib Bukele’s administration as the surest way of delivering security, despite a years-long state of emergency that has seriously eroded democratic freedoms. 

Meanwhile, established democracies built much of their infrastructure decades ago, so investments primarily maintain these systems, rather than showcasing new projects that can garner public support. In some cases, democracies have struggled to even maintain their existing infrastructure, perhaps best exemplified by the collapse of Baltimore’s Francis Scott Key Bridge. All of this creates the conditions for voters to support far-right, anti-democratic parties, which often blame immigrants for economic problems and propose illiberal solutions.

Yet Democratic Delivery is Difficult

Elected democrats seeking to deliver may find themselves hamstrung in ways that autocrats are not. For one, democratic institutions are composed of ‘veto players’ who can stymie the introduction of badly needed policies: national and subnational governments, multiple legislative chambers, judges who review and overturn executive action, and so on. At the same time, democrats must worry about election cycles and term limits, decreasing their incentives to deliver for the long term when later politicians may take credit. Meanwhile, legal and regulatory systems, such as those intended to protect the environment, may prevent the building of critical infrastructure. Property rights prevent the forcible displacement of communities for development, while civil liberties prevent the repression of those who refuse to be displaced. Rules meant to prevent regulatory capture often become arenas where powerful interest groups block and delay government action. 

Independent news media present another potential impediment to delivery, as criticism from journalists can make incumbents wary of undertaking new projects. In addition, media bias can convince voters to remove politicians who do, in fact, deliver. By contrast, autocrats who censor media and arrest journalists can focus on delivery alone, even while their development schemes often rest on corrupt and nepotistic practices. Popular discontent with democratic government ultimately creates a damaging feedback loop: voters are unwilling to fund government projects, in turn leading government to function worse, generating further discontent.
 

Prospects

Autocrats have figured out ways to deliver the goods and services their citizens want, but this does not make autocracy a just political system. By the same token, democracies may struggle to deliver, but their procedural legitimacy — especially voters’ ability to hold representatives to account — entails a powerful means of generating fair and inclusive delivery. As such, the authors call on democracies to examine their past and that of their peer countries — both developed and developing — for inspiration. For example, the U.S. New Deal was exemplary in building ambitious and popular infrastructure, as well as providing broad social and economic protections. (Of course, most of these projects would be hamstrung by modern-day regulatory frameworks.)

Meanwhile, Australia’s citizens have both benefited from a recent infrastructure boom and have demonstrated strong support for democracy. Finally, many Latin American countries have implemented popular and effective programs like conditional cash transfers. For the authors, addressing the issues most pressing to voters — such as job creation, which is especially salient to young people, who are most dissatisfied with democracy — will require democratic governments to strike the right balance between democracy and delivery.

*Research-in-Brief prepared by Adam Fefer.