Global epistemic authority and its limits: Evidence from the WHO’s efforts to preserve antibiotic efficacy

Many of the problems addressed by international organizations (IOs) are caused by the activities of myriads of individuals, companies, and other societal groups. IOs tackle such problems by facilitating state action or by targeting these societal actors directly. To what extent are IOs able achieve their goals without the active involvement of governments? We argue that the epistemic authority of IOs puts them in a position to influence societal practices, but this authority needs to be supported by the political authority of governments when the practices entail severe collective action problems. This argument is assessed empirically through an analysis of the World Health Organization (WHO)’s action on one of the most important global cooperation problems: the effort to slow down the rise in antimicrobial resistance. Specifically, we assess the ability of the WHO to shape antibiotic consumption through publishing the AWaRe classification—a list aimed at guiding antibiotic prescription practices globally. We test the impact of this classification through pre-registered analyses of highly disaggregated drug-level data on antibiotic consumption of 274 drugs in up to 96 countries between 2014 and 2023. We show that the WHO’s epistemic authority has only been effective in shaping antibiotic use where the WHO could leverage its member states' political authority.