Policy research
Managing risks associated with the environmental dimensions of antibiotic resistance requires appropriate institutional arrangements governed by effective policy.
Unfortunately, incentives (political, legal, economic etc) for reducing pollution with antibiotics and resistant bacteria are often lacking. This is true both for the release of municipal wastewater, as well as for direct discharges from drug manufacturing. A wide diversity of actors can potentially create incentives or counterincentives for effective measures. Understanding more about drivers for specific stakeholder groups is key in order to identify and implement efficient and cost-effective actions. We also do research on the allocation of responsibility to manage pollution, both from ethical and practical perspectives. Finally, our work on predicting non-selective concentrations of antibiotics is a foundation for several initiatives to mitigate drug pollution from manufacturing around the world. In addition to policy research, Larsson is also engaged in supporting various stakeholders with advice on how to implement incentives for pollution control (e.g. in procurement, in subsidy decisions, or as part of legally binding criteria).
Examples of recent papers
World Health Organization. (2024). Guidance on wastewater and solid waste management for manufacturing of antibiotics. 98 pp. Geneva. ISBN 978-92-4-009725-4. (Joakim Larsson was lead consultant).
Bertagnolio S, Dobreva Z, Centner CM, Olaru ID et al (283 coauthors including Larsson DGJ). (2024). WHO global research priorities for antimicrobial resistance in human health. The Lancet Microbe. 5:100902.
Malmqvist E, Fumagalli D, Munthe C, Larsson DGJ. (2023). Pharmaceutical pollution from human use and the Polluter Pays Principle. Public Health Ethics, phad012.
Larsson DGJ, Gaze WH, Laxminarayan R, Topp E. (2023). AMR, One Health and the environment. Nature Microbiology. . Read-only link:
脜gerstrand M, Josefsson H, Wernersson AS, Larsson DGJ. (2023). Opportunities to tackle antibiotic resistance development in the aquatic environment through the Water Framework Directive. Ambio 52:941-951. .Read-only link:
Larsson DGJ, Flach C-F. (2022). Antibiotic resistance in the environment. Nature Reviews Microbiology. Read-only link: .
Malmqvist E, Fumagalli D, Munthe C, Larsson DGJ. (2021). Pharmaceutical pollution from human use and the Polluter Pays Principle. Submitted. Preprint (DOI: 10.13140/RG.2.2.34475.98088) available at
脜rdal C, Baraldi E, Beyer P, Lacotte Y, Larsson DGJ, Ploy M-C, R酶ttingen J-A, Smith I. (2021) Supply chain transparency and the availability of essential medicines. Bulletin of the World Health Organization 99:319-320. doi:
Laxminarayan R, Van Boeckel T, Frost I, Kariuki S, Khan E, Limmathurotsakul D, Larsson DGJ, Levy-Hara G, Mendelson M, Outterson K, Peacock S, Zhu Y-G. (2020). The Lancet Infectious Diseases Commission on antimicrobial resistance: six years later. Lancet Infect Dis. 20: e51-e60.
Nijsingh N, Munthe C, Larsson DGJ. (2019) Managing pollution from antibiotics manufacturing: charting actors, incentives and disincentives. Environmental Health 18:95. .