Regulating antimicrobial resistance in the environment: analysis of Thailand legal framework and areas for reinforcement

Background: Antimicrobial resistance (AMR) is a pressing global health issue, exacerbated by extensive antimicrobial use across human, animal, and plant sectors. The environment plays a crucial role in AMR emergence and spread due to the contamination from resistant bacteria, resistance genes, and antimicrobial residues from various sources. In Thailand, the regulatory framework that can reinforce AMR mitigation in environmental settings remains underdeveloped. This study aims to analyse the existing regulatory framework for environmental AMR control by identifying regulatory gaps and assessing the challenges of implementing these regulations. Methods: A qualitative approach was employed, combining a literature review and semi-structured interviews with 28 key informants from diverse regulatory sectors, including the ministries of health, agriculture, and environment. This included multi-level stakeholders at national, provincial, and local levels, as well as selected farmers. Content analysis of interview transcripts and regulatory documents was performed to triangulate findings on regulatory gaps and implementation barriers. Results: The study identified five regulatory categories governing water contamination across settings: rivers/canals, hospital wastewater, household wastewater, industrial waste (including pharmaceuticals), and animal farms. While the regulatory frameworks guide pollution standards, regulations lack provisions specific to AMR, highlighting a significant gap in AMR oversight and data on AMR pathogens in environmental wastewater. Key barriers include insufficient incorporation of AMR indicators in routine monitoring, limited enforcement, and inadequate technical and budgetary support. Conclusion: Thailand's current environmental AMR framework lacks comprehensive AMR-specific regulations and robust enforcement mechanisms. Addressing these gaps requires multi-sectoral coordination, enhanced funding, and capacity-building initiatives. By prioritizing indicator development and establishing AMR-focused policies, Thailand can enhance its environmental AMR control measures and contribute to global AMR mitigation efforts.