Addressing antibiotic use: insights from social science around the world

Antimicrobial resistance (AMR) is a major threat to global health and economies, the harmful effects of which are disproportionately experienced by those living in Low- and Middle-Income Countries (LMICs). Tackling this complex problem requires multidisciplinary and multisectoral responses. In the last few years, there has been a growing acknowledgement of the vital role of social science in understanding and intervening on antibiotic use, a key driver of AMR. Existing reviews summarise evidence of specific aspects of antibiotic use and specific intervention types. The growing concern that our off-the-shelf toolkit for addressing antibiotic use is insufficient in the face of rising use across humans, animals and plants, requires that we take a fresh look at the ways we are understanding this problem and possibilities for solutions. The ambition of this report is to provide a timely intervention into this global debate, by formulating a conceptual map of the insights from the growing body of social science research on addressing antibiotic use conducted in a diverse range of economic, social, and health system settings around the world. A series of panel presentations and discussions was held in 2020 with leading social scientists working on antibiotic use in different settings. Analysis of the proceedings of these panels, together with a literature review which snowballed from the work of the 76 researchers profiled through the antimicrobialsinsociety.org community of practice, led to a grouping of the key points of entry for recommendations to act on antibiotic use. The report identifies three main areas of focus of social science recommendations to address antibiotic use: Practices, Structures and Networks. The Practices grouping, in which the majority of the social research on antibiotic use has been carried out over the years, focuses on addressing end user antibiotic use. It shows how scholarship has moved away from knowledge deficit models to embracing an ‘ecological’ approach and to considering practice as embedded in lives and livelihoods. This body of work emphasizes the centrality of the local context to identify possible targets for intervening to change practice. The Structures grouping assembles the growing body of work that understands antibiotic use as a product of economic and political conditions. This research draws from political economical perspectives to identify the ways antibiotics have taken on critical roles in modern societies. Based on research investigating water, hygiene, sanitation (WASH), health systems and the political economy, the report considers how interventions that target these societal structures might reduce recourse to antibiotics as a ‘quick fix’. The Networks grouping collates recent work that draws attention to the mundane networks of logics, classifications and flows within which antibiotics are entangled. Research exploring agricultural and development imperatives, global health architectures, and circulating discourses has revealed the material and meaningful connections between human and non-human actors – animals, medicines, microbes, technologies, for example – that extend through time and space far beyond the moment of antibiotic use. These studies help render visible for action the apparatus such as clinical guidelines, delivery chains and models of care that have previously been overlooked when studying and addressing antibiotic use. The domains for action on antibiotic use presented in this report raise important questions for the AMR community. First, how can we move from standardised approaches to developing, refining, and monitoring impacts of interventions locally? Second, what time horizons should we set for interventions that aim to address AMR, and what other impacts should we expect of efforts to optimise antibiotic use? Third, what forms of evidence are most relevant, and what professional and infrastructural investment is required for this to support meaningful and responsive evaluation? The analysis in this report suggests new forms of transnational and intranational engagements to address this pressing bio-social-political issue could provide a platform for widening the options for addressing antibiotic use and its associated challenges.