Applying Social Science Theory to the Problem of AMR

By Claire Chandler, Associate Professor in Medical Anthropology, Co-Director, Antimicrobial Resistance Centre at London School of Hygiene and Tropical Medicine

Where did the idea for your research come from?

AMIS Programme Research Team during their inception meeting, at the London School of Hygiene & Tropical Medicine, July 2017.

AMIS Programme Research Team during their inception meeting, at the London School of Hygiene & Tropical Medicine, July 2017.

AMR is understood as both a biological and social problem. Often when we talk about the social side of AMR, we think of the ‘irrational’ use of antibiotics by patients and prescribers. From my previous research, we knew that applying this lens – and somewhat pejorative term – to the problem could have unintended consequences – such as holding patients responsible for decisions out of their hands. So I wanted to see how else we might think about AMR and the realm of ‘the social’. With colleagues Coll Hutchison and Eleanor Hutchinson, we reviewed existing social theory to see how this could be applied to the problem of AMR. As well as producing a report to help lay the land for others in this space, we worked with a group of collaborators to develop a programme of research to apply some of these theories in practise through empirical studies.

What is your research programme?

The research programme we’re working on is called Anti-Microbials In Society (AMIS), and consists of two empirical projects – AMIS Thailand and AMIS Uganda – as well as an online resource, the AMIS Hub, which is due to be launched on the 17th November 2017.

How did you set about getting the AMIS programme off the ground?

Firstly, we are fortunate to be working with excellent collaborators in both Thailand and Uganda. For example, our Thai co-investigators both completed their PhDs in anthropology on the use of antibiotics in communities in Thailand in the 1990s, and are now senior members of the Ministry of Health and Mahidol University. We will be able to compare the rich ethnographic work that they did back then with what they do now and to apply different theoretical lenses to that research. Our Ugandan team also have a strong background in medicines use studies. We also assembled a group of 18 inspirational mentors with expertise in AMR from across different disciplines. In July, we held a two-week inception meeting for our whole project team, with specific sessions for inputs from our mentors, as well as time to discuss social theory whilst walking across Regent’s Park!

What is the main aim of the research?

The AMIS programme aims to stimulate engagement with social research that presents different ways of conceiving, responding to, and framing AMR. In our empirical work, we want to be able to describe the rich social-material roles of antimicrobials in societies around the globe. We bring this together with research from other groups and individuals on our AMIS Hub website, where we provide simple summaries that offer policy-makers, scientists and funders new ways to conceptualise and act upon AMR.

Where does it fit into the AMR challenge?

Our use of antimicrobial drugs, including antibiotics, has escalated. Now a part of everyday life, we often are unaware of how much of the way we live our lives is dependent upon these medicines. We propose that the ways antibiotics are used is deeply embedded in the way our societies and economies work. It is important to understand the extent and nature of the way we have become intertwined with these medicines in order to understand the consequences of resistance and the best ways to reduce the threat of resistance. We want to ask new questions and generate innovative ways of thinking about AMR and tackling it, social science is very good at this!

How do you go about it?

In Thailand our research involves the mapping of antibiotic use, and the networks that antibiotics travel within, including in farms, factories, laboratories and during medical practise. The research will also follow antibiotics, microbes and discourses to national and international arenas. In Uganda we have three sites, seeking to understand how antimicrobials shape and enable ways of life within health care facilities, for urban workers and in different scales of chicken and pig farms in peri-urban and rural areas.

Our methodological approach promotes participant observation, in other words, immersion in everyday life, to better understand how antimicrobials are intertwined in societies and individual lives. We also seek inputs from a range of experts from different fields. For example, we are undertaking archival analyses on the history of antibiotics in different settings, with support from archivists such as Ross MacFarlane at the Wellcome Collection. We are also working with microbiologists and clinicians to map our findings together with theirs.

What does your day job look like?

I do a lot of organisation at the moment! We are preparing our protocols and documentary analyses at the moment, and will be starting pilot research in our field sites in January. When I’m in the field, I will be going along to clinics and sitting in and seeing how patients are being managed, talking with the health workers to understand their daily patterns and realities. Similarly, I will be spending time in urban slum areas, attempting to draw connections between the practises and constraints of everyday life, such as factory working or sex work, and the use of antimicrobials. I will be tuning in to how people talk about medicines, reporting the discourse around the reduction in their use and discovering alternatives that people might talk about.

All in all, we want to trace how people in different places and spaces relate to antibiotics and what roles antibiotics appear to be having in the fabric of everyday life.