Abstract
Antimicrobial resistance (AMR) is one of the latest issues to galvanise political and financial investment as an emerging global health threat. This paper explores the construction of AMR as a problem, following three lines of analysis. First, an examination of some of the ways in which AMR has become an object for action—through defining, counting and projecting it. Following Lakoff’s work on emerging infectious diseases, the paper illustrates that while an ‘actuarial’ approach to AMR may be challenging to stabilise due to definitional and logistical issues, it has been successfully stabilised through a ‘sentinel’ approach that emphasises the threat of AMR. Second, the paper draws out a contrast between the way AMR is formulated in terms of a problem of connectedness—a ‘One Health’ issue—and the frequent solutions to AMR being focused on individual behaviour. The paper suggests that AMR presents an opportunity to take seriously connections, scale and systems but that this effort is undermined by the prevailing tendency to reduce health issues to matters for individual responsibility. Third, the paper takes AMR as a moment of infrastructural inversion (Bowker and Star) when antimicrobials and the work they do are rendered more visible. This leads to the proposal of antibiotics as infrastructure—part of the woodwork that we take for granted, and entangled with our ways of doing life, in particular modern life. These explorations render visible the ways social, economic and political frames continue to define AMR and how it may be acted upon, which opens up possibilities for reconfiguring AMR research and action.
Highlights
Antimicrobial resistance (AMR) is one of the latest issues to galvanise political and financial investment as an emerging global health threat
An indicator of success of getting antimicrobial resistance (AMR) onto the political agenda was the high-level discussion of AMR at the United Nations Global Assembly in 2016, resulting in a political declaration (United Nations General Assembly, 2016), and the appointment of an Inter-agency Coordination Group (IACG) on AMR which seeks to generate a common direction across sectors, industry and nations globally
I have argued that AMR has been less easy to advocate for with an ‘actuarial’ approach and instead support has been galvanised in its formulation as a threat, through a ‘sentinel’ approach
Summary
There is a recipe for the rapid growth of pig and chicken farming in Uganda: smaller spaces, larger imported breeds, intensive cleaning, imported feed concentrates, and antibiotics. The focal point of medicalisation was the professional expert who could deal with health-related problems, and more recently pharmaceuticals have been observed to take their place (Samsky, 2015), the framing of hope of a disease-free humanity remains integral to biomedicine today In their history of acute bronchitis (cough) management in Britain through the twentieth Century, Macfarlane and Worboys (2007) illustrate how antibiotics enabled particular values in human productivity to develop, allowed for a more medicines-asprevention strand to develop within healthcare, as well as how antibiotics became entangled with the ways the pharmaceutical industry could engage with a nationalising health system. Following Dewey (1927) and Collier et al (2017), understanding antibiotics as infrastructure in these ways enables us to ask what sorts of publics, collectives, social forms and systems are brought into being by these substances?
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