The AMR problem: demanding economies, biological margins, and co-producing alternative strategies

Abstract

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.

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

“…These reforms move from merely sanctioning inappropriate antibiotic use to identifying the sociostructural factors driving antibiotic use and devising targeted incentives for locally tailored shifts to more appropriate antibiotic use. [121][122][123] However, it remains unclear whether relying on local or even regional solutions will be able to solve the global challenge posed by AMR. Calls for behavioural change, industry reform and individualised policymaking have often been ineffective.…”

Qualitative Research for One Health: From Methodological Principles to Impactful Applications

“…Examples of Grounded Theory in veterinary research include studies on how pastoralists make decisions about sick chronically sick animals in Cameroon (42); the effect of compensation on farmer attitudes to exotic disease reporting (43); the politics of veterinarians and feed-store vendor control of access to antibiotics in dairy farms in rural Peru (44); and accounting for variation in people's responses to the death of their animal companions (45). In addition, veterinary economists and veterinarians might wish to compare a Framework Analysis of aquaculture in Bangladesh (37) with an inductively-based analysis, also of aquaculture in Bangladesh (46), that resembles Clarke's take on Grounded Theory (41).…”

Identifying hotspots for antibiotic resistance emergence and selection, and elucidating pathways to human exposure: Application of a systems-thinking approach to aquaculture systems

“…Moreover, there is a general lack of knowledge and clarity about how aquaculture systems operate and how changes to the drivers of ABU would affect ABR in the system as a whole (Berendonk et al, 2015; Bengtsson-Palme et al, 2018). This reflects a wider failure of existing ABR research to adequately address the challenge from an ecosystems perspective (Berendonk et al, 2015; Hinchcliffe et al, 2018). Using an ecosystems approach to identify the possible human exposure points to antibiotics, antibiotic-resistant bacteria and ARG in aquaculture production is key to reducing human health risks from aquaculture, though data and evidence are lacking in this regard (Miranda et al, 2013; Berendonk et al, 2015; Chuah et al, 2016; Phu et al, 2016; Watts et al, 2017).…”