Current accounts of antimicrobial resistance: stabilisation, individualisation and antibiotics as infrastructure

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.

Fig. 1

Antimicrobial Resistance in the Food Chain infographic from WHO. This figure is covered by the Creative Commons Attribution 4.0 International License. Reproduced with permission of World Health Organisation from “Infographics: Antibiotics in the Food Chain. WHO list of critically important antimicrobials (WHO CIA list)—5th revision” https://www.who.int/foodsafety/areas_work/antimicrobial-resistance/AMR-food-chain-infographics/en/ Copyright © WHO (2017), all rights reserved

Fig. 2

WHO Poster for World Antibiotic Awareness Week (2017). This figure is covered by the Creative Commons Attribution 4.0 International License. Reproduced with permission of World Health Organisation from ‘World Antibiotic Awareness Week 13–19 November 2017' https://www.who.int/campaigns/world-antibiotic-awareness-week/2017/posters/en/ Copyright © WHO (2017), all rights reserved