Quick fix for care, productivity, hygiene and inequality: reframing the entrenched problem of antibiotic overuse

Abstract

Antimicrobial resistance (AMR) is a major challenge of our time. A key global objective is to reduce antibiotic use (ABU), in order to reduce resistance caused by antimicrobial pressure. This is often set as a ‘behaviour change’ issue, locating intervention efforts in the knowledge and attitudes of individual prescribers and users of medicines. Such approaches have had limited impact and fall short of addressing wider drivers of antibiotic use. To address the magnitude of antibiotic overuse requires a wider lens to view our relationships with these medicines.This article draws on ethnographic research from East Africa to answer the question of what roles antibiotics play beyond their immediate curative effects. We carried out interviews, participant observation and documentary analysis over a decade in northeast Tanzania and eastern and central Uganda. Our findings suggest that antibiotics have become a ‘quick fix’ in our modern societies. They are a quick fix for care in fractured health systems; a quick fix for productivity at local and global scales, for humans, animals and crops; a quick fix for hygiene in settings of minimised resources; and a quick fix for inequality in landscapes scarred by political and economic violence. Conceptualising antibiotic use as a ‘quick fix’ infrastructure shifts attention to the structural dimensions of AMR and antimicrobial use (AMU) and raises our line of sight into the longer term, generating more systemic solutions that have greater chance of achieving equitable impact.

Rural community perceptions of antibiotic access and understanding of antimicrobial resistance: qualitative evidence from the Health and Demographic Surveillance System site in Matlab, Bangladesh

“…Healthcare seeking is embedded in social, economic, political and institutional structures and belief systems. Individuals in resource-poor settings have limited capacity to make the same evidence-based choices that are available in more advantaged populations [ 13 , 17 , 41 ]. ‘Structural violence’ in government facilities inhibits access to the public sector for antibiotic medicines [ 42 ].…”

“…References to the informal sector, whether in housing, the labour market or healthcare are often made in a normative context, imposing unfair judgment and discrimination on disadvantaged and marginalised populations for whom these services offer the most affordable and suitable option [ 46 ]. In this study, informants reported self-medicating with antibiotics because they believed, in good faith, that these medicines would alleviate symptoms and lead to recovery [ 17 ]. Our findings illustrate how the acceptability of village pharmacies as providers of antibiotic medicines is embedded within the social and cultural fabric.…”

“…Antibiotic use in Matlab villages reflects a fractured public healthcare system that remains out of touch with the issues that determine health seeking behaviours and oblivious to the erosion of trust in public infrastructure and services. Future research in Matlab might include ethnographic methods such as participant observation to explore further lines of enquiry regarding the way underlying social, economic and political determinants underpin behaviours [ 17 ].…”

“…A study of AMR in rural Thailand concluded that the results of educational programs in high-income countries cannot be generalised to LMICs where impoverished populations endure precarious existence under fragmented under-resourced health and social support systems [ 16 ]. In many countries antibiotics are a ‘quick fix’ medicine [ 8 , 17 ]. Balancing access and excess in LMICs poses precarious ethical questions about the roles and responsibilities of users and prescribers [ 18 ].…”

Setting the standard: multidisciplinary hallmarks for structural, equitable and tracked antibiotic policy

“…105 However, in the main, present needs have overridden future-focused stewardship concerns. While there is no reason not to use antibiotics to save and improve lives, they have often been used as a 'quick fix' 106 to symptomatically control rather than eliminate underlying drivers of infection in human, animal health and plant production systems. The tendency to see antibiotics as 'quick fixes' has helped drive AMR and often distracted from investment in more sustainable forms of infection prevention like effective and affordable health, Water, Sanitation and Hygiene (WASH), and Infection Prevention Control (IPC) systems (see also Inequality below).…”