Widespread antimicrobial resistance (AMR) poses a threat to public and animal health, and has consequences for the structure and sustainability of food production. The problem is often framed as one of inappropriate antimicrobial use, which drives emergence and selection of resistant microbes. The answer to this framing of the problem is to lower disease incidence and transmission rates, regulate antimicrobial uses and to educate prescribers and users of medicines. In this paper we argue that this seemingly straightforward programme of action is beset by at least two difficulties. First, in many parts of the world, disease dynamics and antimicrobial uses are embedded within biosocially demanding settings. Second, antibiotic use is one among many possible drivers of resistance. We focus on the aquatic environment and aquacultural food production where resistance drivers may relate to a variety of processes. Using interviews, survey data, and participatory modelling exercises with competency groups in Bangladesh's shrimp and prawn aquaculture sector, we demonstrate the need to understand economic and biological drivers of disease, farmer adaptations to disease risks and the potential paradox of pursuing pathogen-free food production as a means to reduce AMR risks. We argue that the AMR problem needs to be framed as an adaptive rather than technical challenge, and involves ownership, change and experimentation across a range of relevant sites.

Disease burdens threaten future food production, particularly so in the case of aquaculture. Reducing disease burden needs to consider not only the incidence of disease but also the socio‐economic effects of changing farming practices. Employing a multi‐method approach to farms in SW Bangladesh, we argue that understanding disease risk practices are central to any attempt to reduce disease burdens and unsustainable treatments of disease.

Global policy for managing antimicrobial resistance (AMR) is underpinned by a standardised and coherent global framework for reducing antibiotic use in clinical health, veterinary health, and food production sectors. Within the framework, problematic antibiotic use (a significant driver of AMR) is treated as a knowledge deficit on the part of users and prescribers, which can be remedied by educating them to make better informed treatment decisions. This narrow approach to AMR management conceals the socioeconomic and material drivers of antibiotic decision-making, creating challenges for low resource regions that rely on antibiotic therapies to manage uncertainty and precarity. Thus, there is a need for a global AMR policy that acknowledges the diversity of sociomaterial arrangements and practices that antibiotics form part of, if their use is to be reduced without undermining productivity or the attainment of poverty reduction indicators. Drawing upon research of antibiotic use in West Africa’s livestock sector, this article analyses the interrelation of antibiotics, AMR action plans, and production management strategies in ecologies of livestock breeding practices. We apply the STS-influenced perspective of noncoherence to analyse how seemingly contradictory practices and institutional logics productively coalesce. We argue that observing noncoherent practices increases our understanding of antibiotic use in relation to local breeding conditions that are frequently not of the producers’ making, whilst drawing attention to context-specific possibilities for improving livestock management capacities and reducing reliance on antibiotic therapies in low-resource settings. The article concludes by calling for an AMR global policy that is more responsive to local specificity rather than enforcing universal standardisation.

In August 2010 the Himalayan Region of Ladakh, Northwest India, experienced severe flashflooding and mudslides, causing widespread death and destruction. The causes cited were climate change, karmic retribution, and the wrath of an agentive sentient landscape. Ladakhis construct, order and maintain the physical and moral universe through religious engagement with this landscape. The Buddhist monastic incumbents-the traditional mediators between the human world and the sentient landscape-explain supernatural retribution as the result of karmic demerit that requires ritual intervention. Social, economic, and material transformations have distorted the proper order, generating a physically and morally unfamiliar landscape. As a result, the mountain deities that act as guardians and protectors of the land below are confused and angry, sending destructive water to show their displeasure. Thus, the locally-contextualized response demonstrates the agency of the mountain gods in establishing a moral universe whereby water can give life and destroy it

Antimicrobial resistance (AMR) is often framed as a One Health issue, premised on the interdependence between human, animal and environmental health. Despite this framing, the focus across policymaking, implementation and the ethics of AMR remains anthropocentric in practice, with human health taking priority over the health of non-human animals and the environment, both of which mostly appear as secondary elements to be adjusted to minimise impact on human populations. This perpetuates cross-sectoral asymmetries whereby human health institutions have access to bigger budgets and technical support, limiting the ability of agricultural, animal health or environmental institutions to effectively implement policy initiatives. In this article, we review these asymmetries from an ethical perspective. Through a review and analysis of contemporary literature on the ethics of AMR, we demonstrate how the ethical challenges and tensions raised still emerge from an anthropocentric framing, and argue that such literature fails to address the problematic health hierarchies that underlie policies and ethics of AMR. As a consequence, they fail to provide the necessary tools to ethically evaluate the more-than-human challenges that the long list of actors involved in managing AMR face in their everyday practices. In response to such shortcomings, and to make sense of these challenges and tensions, this article develops an ethical framework based on relationality, care ethics and ambivalence that attends to the more-than-human character of AMR. We formulate this approach without overlooking everyday challenges of implementation by putting the framework in conversation with concrete situations from precarious settings in West Africa. This article concludes by arguing that a useful AMR ethics framework needs to consider and take seriously non-human others as an integral part of both health and disease in any given ecology.

The burden of antimicrobial resistance (AMR) is unequally distributed across the globe. Low-income countries face a more severe AMR situation and have fewer means to solve the problem.

In Ladakh, north-west India, a popular narrative of the region’s inhabitants as spiritually and ecologically enlightened combines with national sustainable and participatory development policies to produce a distinctive character that underpins the local administration’s development strategies. These strategies emphasise ‘traditional’ values of cooperation, simplicity, and ecological and spiritual harmony as the way to achieve culturally sustainable development and emotional well-being. However, obstacles to development appear when normative principles of sustainability and ecological wisdom encounter local cosmology, hierarchy and perceptions of expertise in society. In this article, I reflect upon my fieldwork and previous regional ethnographies to consider possible frameworks for evaluating well-being as an indicator of culturally sustainable development that include concepts of cosmology and expert protection.

No abstract