Paper short abstract:

Effectively addressing the assemblage of antimicrobial resistance requires an epistemic shift that not only considers the stakeholders’ lived realities, but also leaves space for uncertainty. An ethnographic study of a poultry farm in rural India exemplifies these dynamics in a multispecies context.

Paper long abstract:

Antimicrobial Resistance (AMR) is a living, mutating assemblage, consisting not only of the enzymes that trigger the actual resistances, but also of all the actors that stimulate and world it within situated ecologies. Stakeholders are enmeshed in ‘making things work’ under precarious conditions, where containment/unintended spill over, and long term/‘productive’ toxicity are not taken into consideration. Cross-scale regulatory efforts often stem from a point of epistemic fixity and disregard local complexities and everyday realities.

Based on ethnographic fieldwork in rural South India, this paper assesses local(ized) knowledge practices of antibiotic use in multispecies contexts. The case study is a medium-scale poultry farm with little biosecurity, where antimicrobials are deployed as a pharmaceutical jugaad (‘quick fix’) to address issues of a non-pharmaceutical nature and to maximize productivity. Villagers inadvertently become part of the assemblage: by using the barn bedding (with deposited antibiotic metabolites) as fertilizer in the nearby fields or by drinking the groundwater from below the farm after pharmaceutical remnants have seeped into the soil – thereby potentially perpetuating and intensifying the local resistome.

This research indicates that AMR not only has to be apprehended within a multispecies and planetary framework of health and well-being that takes living and non-living ecologies into consideration – it also requires an epistemic approach, which leaves operating space for local knowledge practices to make uncertainty analytically productive. Knowledge on resistances remains ex post emergence, and thus uncertain and speculative, which makes direct interventions difficult.

Paper short abstract:

Considering antibiotics and antibiotic resistant bacteria/genes as emerging contaminants in agricultural landscapes, this paper explores potential anthropogenic transformations of microbial ecologies in integrated agro-ecosystems and their toxic effects on both local and distant populations.

Paper long abstract:

In rural areas of eastern China, human and veterinary antibiotics are easily accessible to villagers through over-the-counter purchases from local drug stores. Antibiotic exposure to humans, animals and the environment could accelerate the emergence and dissemination of antibiotic resistant bacteria(ARB) and their antibiotic resistant genes(ARGs). These emerging contaminants circulate along with the material flows in the local integrated agro-ecosystems, creating "toxic environments" for the spread of antibiotic resistance infections. This paper explores how antibiotic resistant contamination can potentially transform microbial ecologies in villages where household livelihoods and small-scale agriculture are intertwined. Despite attempts by the local government to introduce the more hygienic flush toilets, villagers are more accustomed to using traditional dry toilets and recycling the excrement. Livestock manure is considered to have nourishing power for the land and vegetables, and is given as gifts to neighbours. The application of manure has the potential to introduce antibiotics and antibiotic resistant pathogens into the soil and water, and further contaminate microbes and other lifeforms in the environment. Vegetables, domesticated livestocks and wild caught fish and crabs eventually returned to the villagers' tables. Through leakage, circulation and transformation, anthropogenic antibiotic contaminants are dispersed into the environment and food chain, affecting the health of both local and distant populations.

Paper short abstract:

This paper explores scientific efforts and regulatory solutions proposed for measuring and controlling antibiotic pollution from pharmaceutical industries located in India, speculating on what would be required to reform these industries that are so crucial for our access to antibiotics.

Paper long abstract:

Understanding the linkages between the environment, animals, and humans for the development of antimicrobial resistance (AMR) has become an important concern for scientists involved in AMR research over the last decades. One area of concern has been how wastewater from pharmaceutical manufacturing is polluting environments with effluents containing antibiotics, potentially driving the growth of AMR. Scientists have been particularly interested in investigating this in pharmaceutical production sites located in India, for instance in the city of Hyderabad, known as India’s bulk drug production capital. This paper explores scientific efforts and regulatory solutions proposed for measuring and controlling antibiotic pollution from pharmaceutical industries located in Hyderabad, India. The paper is based on preliminary thoughts from recent ethnographic fieldwork in India on antibiotics manufacturing, regulation, and export. Paying attention to the production of knowledge on antibiotics and AMR in Indian water-bodies located around pharmaceutical production sites, and the solutions proposed for controlling these toxic “hot spots” of contamination, I explore the science and regulation of effluents as a challenge encountering the very infrastructure of globalised antibiotic production – a cost-shifting system that enables the flow of cheap antibiotics from ‘The World’s Pharmacy’. By doing so, I also speculate on what would be required to reform these pharma-industrial infrastructures that are so crucial for the circulation of antibiotics globally, and on what would be needed to restore human and ecological wellness in such globally connected spaces.

Paper short abstract:

How can the development of AMR be analysed within a political assemblage of antibiotic production, disposing pharmaceutical effluent waste and bureaucratic relationships in Baddi, India?

Paper long abstract:

Baddi, located by the banks of the Sirsa river in Himachal Pradesh, India, is one of Asia’s biggest pharmaceutical hubs. Effluents from pharmaceutical manufacturing industries and antibiotic residues from human and agricultural overuse have led to antibiotic pollution of local water bodies, raising concerns that this may be increasing Anti-Microbial Resistance (AMR) in both human and animal pathogens. This paper seeks to explore the politics of institutions in antibiotic manufacturing and the subsequent development of AMR. It will draw on ethnography and observation at the local manufacturing sites, and open-ended interviews with bureaucrats, drug inspectors, scrap dealers and pharmaceutical managers. The aim of the paper is to establish crucial linkages between antibiotics as substance and waste as material in a political assemblage of institutions and actors purportedly working towards a healthy environment. In course of tracing AMR pathways in Baddi, this paper will address the following questions. How are antibiotics manufactured and distributed in local markets? How is the effluent waste from the pharmaceutical industry treated and disposed in water bodies? What roles do bureaucratic corruption, pharma statistics and “not of standard quality” drugs play in this scenario?

Paper short abstract:

Considering microbiological research and religious rituals in the Ganges River I explore the infectious cycles connecting humans, microbes, and gods to speculate on the possibilities of cure coming from contaminated water.

Paper long abstract:

The Ganges River in North India is notorious for its sacred-yet-polluted waters. Whilst people pray, bathe, and drink Ganges water for subsistence and religious purposes, gallons of raw sewage and other waste materials flow into the river every day. This combination is the perfect breeding ground for antibiotic resistance and recent research has confirmed the presence of highly virulent resistant bacteria (ESKAPE pathogens) in the river. However, with these bacteria come their own viral predators—bacteriophages—that are being studied as treatment for bacterial infections called phage therapy.

Based on ethnographic research among microbiologists and Hindu priests in Varanasi, I follow interactions with the river and transformations of Ganges water in between science and religion to explore the current toxic assemblages in the Gangetic ecosystem. Looking at river water through the frame of the pharmakon, a substance that is both cure and poison, I propose thinking with rituals and phages in the Ganges allows to reconsider human relationships with microbes and toxic environments.

I argue phage therapy can be a useful tool in reconfiguring the complex issue of antibiotic resistance, but it is not by itself a solution to larger problems in biomedical practice, pharmaceutical industry, and waste management that have led to current ecological cycles of “unwellness”. Speculating with the experience of COVID-19, I suggest the relationship between laboratory, clinic and environment needs to be made more dynamic if phage therapy is to be successful in democratising feasible treatment of infections without becoming part of the problem.

Paper short abstract:

This paper looks into China’s biopolitical control of contagion under its zero-Covid mandate. Excessive measures of testing and disinfecting reinforce a sense of fear against a “toxic outside world” that’s virus-infested, thereby normalising and reproducing a defence discourse.

Paper long abstract:

In August 2022, stories and videos of freshly caught seafood being swabbed for Covid-19 went viral on Chinese social media and even made international news. Not only live fish and crabs are being PCR-tested and quarantined, from domesticated animals and house pets to frozen foods and international parcels, an all-round environmental testing (huanjing jiance) regime has been enforced with China’s staunch commitment to zero-Covid management. Rigid, and sometimes coercive, “xiaosha” (disinfectant) procedures take place when local outbreaks are identified, where hazmat-suited personnel come in troops and spray high-strength disinfectant on streets, in buildings, and in people’s homes. In the name of controlling contagion and containing transmission, China’s health authorities regard both the natural and densely populated urban environments as dangerous, contaminated by “imported virus”. This paper offers a preliminary examination on China’s biopolitical control of contagion under its zero-Covid mandate. Excessive measures of testing and disinfecting reinforce a sense of fear against a “toxic outside world” that’s virus-infested, thereby normalising and reproducing a defence discourse. Ironically, this defensive measure will likely leave behind heavy chemicals and extraordinary amounts of waste generated from used testing kits and protective gears, worsening a toxic environment for many with a possible future of unwellness.

Paper long abstract:

Antimicrobial Resistance (AMR) has come to garner immense attention in the contemporary global health arena as the next crisis-in-the-making. Although the causes and effects of Antimicrobial Resistance are varied and dissipated across scales and geographies the efforts at containing the growing rates of resistance have identified particular sites of intervention. The hospital has emerged as one such site of consternation and attendant intervention where Infectious Diseases (ID) doctors work to re-articulate the relationship that patients and doctors alike have with these therapeutic molecules. Cancer patients, whose immunities have been ravaged by chemotherapies and the cancer itself, are one particular subsection of patients who are especially susceptible to infections that need therapeutic after-care in the form of significant volumes of antimicrobials. By drawing on several months of ethnography in an oncology hospital in Southern India, where these chemotherapeutic toxicities came to the fore, this presentation seeks to understand how antimicrobials sit uncomfortably as fundamental therapeutic after-care and as molecules increasingly implicated in dynamics of triage under the sign of growing rates of AMR. By so doing the presentation seeks to ask questions about how we are to understand the implications of the heavily mediated accounts of dwindling antimicrobial efficacies, the complicated ecologies of their un-doing and the interventions we have come to imagine as most feasible.