This rather interesting paper was brought to my notice earlier, but I could only read it today. Published in PLoS ONE this month by Australian authors using European data, Dr. Peter Collignon and his colleagues showed that the “quality of governance” (measured on a scale of 0-6 based on subjective assessment by experts on each country’s “control of corruption” from the Political Risks Services Group) correlated better with antimicrobial resistance rates than even gross antimicrobial usage itself. The two key graphs are shown below.

Correlation of antibiotic use and average antibiotic resistance in European countries. Chart from: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0116746

Strong negative correlation between control of corruption (quality of governance) and antimicrobial resistance in European countries. Chart from: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0116746

Intuitively, it seems logical that countries with poor control of corruption would have correspondingly poor control of antibiotic prescription and antimicrobial resistance. It would be nice if the analysis was done on a global level, but unfortunately the quality of antibiotic use and antimicrobial resistance data is poor (and the data are missing in cases) from countries outside of Europe. It would be interesting to see how Singapore fares here – Singapore has always been ranked highly as a “clean” (i.e. free from corruption) country, but her antimicrobial resistance rates are much higher than most of the European countries ranked lower on the corruption perception index.

As the authors suggested, improved quality of governance at a country level may be fundamental to the control of antimicrobial resistance, with the depressing understanding that we would not be able to contain this problem without overall improvement in the control of corruption.