Negotiating authoritarian law and (dis)order: medicines, drug shops, and regulators in a poor Yangon suburb

Abstract

Global health policymakers have identified Myanmar as a source of high drug resistance and informal pharmaceutical markets in need of tighter state regulation. The World Health Organization drafted a Global Action Plan on antibiotic resistance (often referred to as antimicrobial resistance) that seeks to address it. Myanmar is one of over a hundred countries that has followed the World Health Organization's prescription and drafted its own National Action Plan. Through participating in the everyday life of a family pharmacy, we observed that in practice the outcomes of global plans for AMR, such as regulating access to antibiotics, are shaped by people's limited access to affordable health care, low salaries, and the military's authoritarian role in Myanmar politics. We followed how negotiations between state officials and drug vendors evolved towards a mutual understanding (as opposed to following written rules) after a Food and Drug Administration raid, intended to enforce the regulation of the sales of illegal medicines. Rather than uncritically pushing statecentric action, those working to promote the regulation of medicines must attend more carefully to how different modes of political authority and governance, combined with histories of health provision, shape drug policy in practice. Otherwise, they risk contributing, if not intensifying, already existing health and social injustices, whilst also failing to generate their intended outcomes, such as meaningful changes to antibiotic sales and reductions in resistance.

Wars and sweets: microbes, medicines and other moderns in and beyond the(ir) antibiotic era

“…Lacking access to sufficient antibiotic arsenals and medical expertise, while being subject to structural adjustment programmes, national debts, corrupt governments and privatisation of their already underfunded and under-resourced state infrastructures ( MacPherson et al 2021 ; Manyau et al 2022 ), they struggled to materialise our aseptic dream. As such, we increasingly diagnosed their states ( Khine Zaw, Bawk, and De Lima Hutchison 2021 ), the movement of their bodies ( McInnes and Lee 2006 ; Relman, Choffnes, and Mack 2010 ; Ibrahim 2005 ), their governments, markets, cultures and behaviours, as a major sources of invasive—bacterial—resistance movements ( Collignon et al 2018 ). Their very existence was a constant threat to not only to our antibiotic bullets and medicine, but also the security of our nations and realisation of our dream for our global aseptic order ( Gürcan 2020 ; Richardson 2020 ; Fishel 2017 ).…”