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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]

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Wellcome Open Res 2026
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Alice Siu
James S. Fishkin
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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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Emily Russell is the Gerhard Casper postdoctoral fellow at CDDRL. She received her Ph.D. in political science at Stanford University, focusing on comparative politics.

Emily’s dissertation project examined the role of the police in enforcing economic order through the function of labor repression in unequal enclaves in democracies, with a focus on the tea plantation economy in northeast India. In other ongoing research, she focuses on carceral institutions, the intersection of development and contention, and land and labor politics. To study these topics, Emily takes a mixed-methods approach, leveraging administrative data, open-source environmental and text data, archival materials, in-depth interviews, and participant observation. Regionally, Emily often focuses on India with broader interest in South Asia and the Americas.

At Stanford, Emily was a Knight-Hennessy Scholar and a National Science Foundation Graduate Research Fellow. Prior to graduate school, Emily received her B.A. in Political Science and Environmental Science from the University of Michigan.

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The Stanford Deliberative Democracy Lab, based at the University’s Center on Democracy, Development and the Rule of Law, today released the findings from two national Community Forums on the evolving expectations around privacy and governance of AI-powered wearable devices. In collaboration with Meta, the forum engaged a representative sample of 550 participants — 300 from the United States and 250 from India — to solicit people's perspectives on user controls and societal expectations. The Community Forums were conducted as national Deliberative Polls.

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The Stanford Deliberative Democracy Lab, based at the University’s Center on Democracy, Development and the Rule of Law, today released the findings from two national Community Forums on the evolving expectations around privacy and governance of AI-powered wearable devices. In collaboration with Meta, the forum engaged a representative sample of 550 participants — 300 from the United States and 250 from India — to solicit people's perspectives on user controls and societal expectations. The Community Forums were conducted as national Deliberative Polls.

As AI wearables see rapid adoption worldwide, understanding public attitudes can help to ensure these technologies are developed and deployed responsibly. Three key themes emerged from the forum. Participants in both the U.S. and India indicated the highest levels of support for users having controls over when their wearables passively process environments and actively capture data. U.S. participants consistently favored individual agency over how wearables are used, both in public and private settings, whereas in India, there was a slight preference for governments to decide wearable usage rules in public spaces. Additionally, U.S. participants supported workplaces and schools having the primary authority to decide how AI-powered wearables should be used in those environments, while Indian participants also saw a significant role for governments in these settings.

The forum also revealed important nuances in public perspectives. For example, participants expressed a preference for AI wearables that are tailored to cultural and regional contexts, rather than standardized global designs. There was also broad support for AI agents capable of responding to emotional cues, underscoring the public's desire for personalized, human-centric wearable experiences.

"This global forum provided invaluable insights into how the public's expectations around privacy and governance of wearable AI are evolving," said Alice Siu, Associate Director of the Stanford Deliberative Democracy Lab. "The findings will be essential for policymakers, technology companies, and other stakeholders as they work to ensure these powerful technologies empower users while respecting fundamental rights."

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People Shaping AI: Groundbreaking Industry-Wide Forum Invites Public Input for the Future of AI Agents Through Public Deliberation

In an unprecedented collaboration, Stanford's Deliberative Democracy Lab has spearheaded the first-ever Industry-Wide Forum, a cross-industry effort putting everyday people at the center of decisions about AI agents.
People Shaping AI: Groundbreaking Industry-Wide Forum Invites Public Input for the Future of AI Agents Through Public Deliberation
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National community forums in the U.S. and India highlight differences in preferences for privacy, user control, and governance of emerging technologies.

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  • Stanford’s Deliberative Democracy Lab convened national forums in the U.S. and India to examine public attitudes toward AI-powered wearable devices.
  • Participants in both countries strongly supported user control over data collection, with differences in preferences for government and institutional oversight.
  • Findings highlight demand for culturally tailored designs and personalized, human-centered AI features as adoption of wearables grows.
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Daniel Hadi is an Economics and Art History double major from Portland, Oregon, completing an interdisciplinary honors thesis with CDDRL for the 2026–2027 academic year. His research bridges microeconomic evaluation with questions of institutional design, governance, and the politics of place-based development. Daniel has conducted research at the Council on Foreign Relations, the Stanford Technology Ventures Program, and the Hoover Institution. He is a U.S. Department of State Critical Language Scholar who studied Arabic in Oman. After Stanford, he hopes to pursue development economics focused on cultural preservation and entrepreneurship in low- and middle-income countries.

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Anusha Nadkarni is a B.A./M.A. student in Public Policy ('27) focusing on Development and Growth Policies. She is also a double minor in Global Studies and Human Rights, with a particular focus on issues related to South Asia, gender-based violence, international human rights law, and comparative democratic development. Her prior experience working as a nonprofit leader in student-led antiracist education implementation informs her restorative, culturally responsive, and empirically-informed approach to international equity issues.

Anusha's past engagement with these interests includes spending a summer working in Mumbai's courts, an internship analyzing development bank violations of human rights at the Accountability Counsel, and a Student Fellowship with the Huntington Program for Strengthening U.S.-India Relations at the Hoover Institution. In her personal life, Anusha loves to hike, spend time with her loved ones (including a very cute cat), and play the guitar.

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In an unprecedented collaboration, Stanford's Deliberative Democracy Lab has spearheaded the first-ever Industry-Wide Forum, a cross-industry effort putting everyday people at the center of decisions about AI agents. This unique initiative involving industry leaders Cohere, Meta, Oracle, PayPal, DoorDash, and Microsoft marks a significant shift in how AI technologies could be developed.

AI agents, advanced artificial intelligence systems designed to reason, plan, and act on behalf of users, are poised to revolutionize how we interact with technology. This Industry-Wide Forum provided an opportunity for the public in the United States and India to deliberate and share their attitudes on how AI agents should be deployed and developed.

The Forum employed a method known as Deliberative Polling, an innovative approach that goes beyond traditional surveys and focus groups. In November 2025, 503 participants from the United States and India engaged in an in-depth process on the AI-assisted Stanford Online Deliberation Platform, developed by Stanford's Crowdsourced Democracy Team. This method involves providing balanced information to participants, facilitated expert Q&A sessions, and small-group discussions. The goal is to capture informed public opinion that can provide durable steers in this rapidly evolving space.

As part of the process, academics, civil society, and non-profit organizations, including the Collective Intelligence Project, Center for Democracy and Technology, and academics from Ashoka University and Institute of Technology-Jodhpur, vetted the briefing materials for balance and accuracy, and some served as expert panelists for live sessions with the nationally representative samples of the United States and India.  

"This groundbreaking Forum represents a pivotal moment in AI development," said James Fishkin, Director of Stanford's Deliberative Democracy Lab. "By actively involving the public in shaping AI agent behavior, we're not just building better technology — we're building trust and ensuring these powerful tools align with societal values."

"This groundbreaking Forum represents a pivotal moment in AI development. By actively involving the public in shaping AI agent behavior, we're not just building better technology — we're building trust and ensuring these powerful tools align with societal values.
James Fishkin
Director, Deliberative Democracy Lab

The deliberations yielded clear priorities for building trust through safeguards during this early phase of agentic development and adoption. Currently, participants favor AI agents for low-risk tasks, while expressing caution about high-stakes applications in medical or financial domains. In deliberation, participants indicated an openness to these higher-risk applications if provided safeguards around privacy or user control, such as requiring approval before finalizing an action.

The Forum also revealed support for culturally adaptive agents, with a preference for asking users about norms rather than making assumptions. Lastly, the discussions underscored the need for better public understanding of AI agents and their capabilities, pointing to the importance of transparency and education in fostering trust in these emerging technologies.

"The perspectives coming out of these initial deliberations underscore the importance of our key focus areas at Cohere: security, privacy, and safeguards,” said Joelle Pineau, Chief AI Officer at Cohere. “We look forward to continuing our work alongside other leaders to strengthen industry standards for this technology, particularly for enterprise agentic AI that works with sensitive data."

The perspectives coming out of these initial deliberations underscore the importance of our key focus areas at Cohere: security, privacy, and safeguards. We look forward to continuing our work alongside other leaders to strengthen industry standards for this technology.
Joelle Pineau
Chief AI Officer, Cohere

This pioneering forum sets a new standard for public participation in AI development. By seeking feedback directly from the public, combining expert knowledge, meaningful public dialogue, and cross-industry commitment, the Industry Wide Forum provides a key mechanism for ensuring that AI innovation is aligned with public values and expectations.

“Technology better serves people when it's grounded in their feedback and expectations,” said Rob Sherman, Meta’s Vice President, AI Policy & Deputy Chief Privacy Officer.  “This Forum reinforces how companies and researchers can collaborate to make sure AI agents are built to be responsive to the diverse needs of people who use them – not just at one company, but across the industry.”

Technology better serves people when it's grounded in their feedback and expectations. This Forum reinforces how companies and researchers can collaborate to make sure AI agents are built to be responsive to the diverse needs of people who use them.
Rob Sherman
Vice President, AI Policy & Deputy Chief Privacy Officer, Meta

Through Stanford’s established methodology and their facilitation of industry partners, the Industry-Wide Forum provides the public with the opportunity to engage deeply with complex technological issues and for AI companies to benefit from considered public perspectives in developing products that are responsive to public opinion. We hope this is the first step towards more collaboration among industry, academia, and the public to shape the future of AI in ways that benefit everyone.

“We have more industry partners joining our next forum later this year”, says Alice Siu, Associate Director of Stanford's Deliberative Democracy Lab. “The 2026 Industry-Wide Forum expands our discussion scope and further deepens our understanding of public attitudes towards AI agents. These deliberations will help ensure AI development remains aligned with societal values and expectations.”

The 2026 Industry-Wide Forum expands our discussion scope and further deepens our understanding of public attitudes towards AI agents. These deliberations will help ensure AI development remains aligned with societal values and expectations.
Alice Siu
Associate Director, Deliberative Democracy Lab

For a full briefing on the Industry-Wide Forum, please contact Alice Siu.

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DoorDash and Microsoft join Industry-Wide Deliberative Forum on Future of AI Agents

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Industry-Wide Deliberative Forum Invites Public to Weigh In on the Future of AI Agents
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In an unprecedented collaboration, Stanford's Deliberative Democracy Lab has spearheaded the first-ever Industry-Wide Forum, a cross-industry effort putting everyday people at the center of decisions about AI agents.

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We propose an improved theoretically-grounded method to test for efficient risk pooling that allows for intertemporal smoothing, non-homothetic consumption, and heterogeneous risk and time preferences. Applying this method to recent panel data from Indian villages generates important new insights while confirming some earlier findings. Year-to-year smoothing of consumption takes place much more at the village level than at the individual level and occurs primarily through financial assets. While there is proportionally more smoothing of food than non-food consumption, accounting for differences in income elasticities between the two statistically eliminates this difference, indicating that risk pooling does not distort consumption choices in our study area. Finally, we find that consumption smoothing is affected jointly by income and liquid assets, and that there is no excess sensitivity to earned income.

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Marcel Fafchamps
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February 2026, 103685
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Motivation & Overview


India’s services sector is internationally renowned and has helped propel the country’s economic growth. Indeed, in recent years, a majority of the value added to India’s GDP has been concentrated in services. Especially noteworthy are India’s software and computing services, which include large multinational conglomerates like Infosys and Tata Communications Services. 

Yet as Indian software has flourished, the growth of its computer hardware and manufacturing has been sluggish. Tellingly, India is still a net importer of hardware and other electronics. At first glance, this divergence is puzzling because both the software and hardware sectors should have benefited from India’s educated labor pool and infrastructure. How can these different sectoral outcomes be explained?
 


 

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Fig. 1: Electronics production value compared to software and software service revenues

 

Fig. 1: Electronics production value compared to software and software service revenues.
 



In “Comparing Advantages in India’s Computer Hardware and Software Sectors,” Dinsha Mistree and Rehana Mohammed offer an explanation in terms of state capacity to meet the different functional needs of each sector. Their account of India’s computing history emphasizes the inability of various state ministries and agencies to agree on policies that would benefit the hardware sector, such as tariffs. Meanwhile, cumbersome rulemaking procedures inherited from British colonialism impeded the state’s flexibility. Although this disadvantaged India’s hardware sector, its software sector needed comparatively less from the state, building instead on international networks and the efforts of individual agencies.

The authors provide a historically and theoretically rich account of the political forces shaping India’s economic rise. The paper not only compares distinct moments in Indian history but also draws parallels with other landmark cases, like South Korea’s 1980s industrial surge. Such a sector-based analysis could be fruitfully applied to understand why different industries succeed or lag in emerging economies. 

Different Sectors, Different Needs


In order to become competitive — both domestically and (especially) internationally — hardware manufacturers often need much from the state, what the authors call a “produce and protect regime.” This can include the construction of factories and the formation of state-owned industries (SOEs), as well as tariffs to reduce competition or labor laws that restrict union strikes. Perhaps most importantly, manufacturers need a state whose legislators and bureaucrats can coordinate with each other in response to market challenges. Such a regime is incompatible with excessive “red tape” or with the “capture” of regulators by narrow interest groups. Because customers tend to view manufactured goods as “substitutable” with each other, firms will face intense competition as regards price and quality.
 


 

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Fig. 2: Inter-agency coordination required for sectoral success

 

Fig. 2: Inter-agency coordination required for sectoral success.
 



The situation is very different for service providers, whose success depends on building strong relationships with customers. States are not essential to this process, even if their promotional efforts can be helpful. Coordination across government agencies is similarly less important, as just one agency could provide tax breaks or host promotional events that benefit service providers. Compared with manufacturing, customers tend to view services as less substitutable — they are more intangible and customizable, which renders competition less fierce. Understanding India’s computing history reveals that the state’s inability to meet hardware manufacturers’ needs severely constrained the sector’s growth. 

The History of Indian Computing


Although India inherited a convoluted bureaucracy from the British Raj, the future of its computing industry in the 1960s seemed promising: political elites in New Delhi supported a produce-and-protect regime, relevant agencies and SOEs were created, and foreign computing firms like IBM successfully operated in the country. 

Yet by the 1970s, some bureaucrats and union leaders feared that automation would threaten the federal government’s functioning and India’s employment levels, respectively. Strict controls in both the public and private sectors were thus adopted, for example, requiring trade unions — which took a strong anti-computer stance — to approve the introduction of computers in specific industries. The authors make special mention of India’s semiconductor industry. It arguably failed to develop due to lackluster government investment, the need for manufacturers to obtain multiple permits across agencies, decision makers ignoring recommendations from specialized panels, and so on.

Meanwhile, implementing protectionist policies proved challenging. For example, decisions to allow the importation of previously banned components required permission from multiple ministries and agencies. After India’s 1970s balance-of-payments crisis, international companies deemed inessential were forced to dilute their equity to 40% and take on an Indian partner. IBM then left the Indian market. At the same time, SOEs faced growing competition over government contracts and workers, owing to the growth of state-level SOEs.

The mid-1980s represented a partial turning point as Rajiv Gandhi became Prime Minister and liberalized the computing industry. Within weeks, Rajiv introduced a host of new policies and shifted the government’s focus from supporting public sector production to promoting private firms, which would no longer face manufacturing limits and would be eligible for duty exemptions. Changes to tariff rates and import limits would not require approval from multiple agencies. Meanwhile, international firms reengaged with Indian markets via the building of satellite links, facilitating cross-continental work, such as between Citibank employees in Mumbai and Santa Cruz.

However, this liberalizing period was undermined and partially reversed after 1989, when Rajiv’s Congress Party (INC) lost its legislative majority and public policy became considerably more fragmented. Anti-computerization forces, especially the powerful Indian trade unions, worked to stymie Rajiv’s reforms. Pro-market reformists were forced out of their positions in Indian bureaucracies. Rajiv was assassinated in 1991, after which Congress formed a minority government with computer advocate P. V. Narasimha Rao as PM. Yet all of this occurred at a delicate time, as India was at risk of defaulting and had almost completely exhausted its foreign exchange.

By the late 1990s, both the hardware and software sectors should have benefited from the rising global demand for computers, yet India’s history of poor state coordination hindered manufacturers. Meanwhile, software firms were able to take advantage of global opportunities given their comparatively limited needs from state actors and political networks — for example, helping European Union banks change their computer systems to Euros. Ultimately, the Indian state has powerfully shaped the fortunes of these different sectors.

*Research-in-Brief prepared by Adam Fefer.

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