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- Convenors:
-
Justin Dixon
(LSHTM)
Eleanor MacPherson (Malawi-Liverpool-Wellcome Trust)
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- Format:
- Panel
- Sessions:
- Thursday 20 January, -
Time zone: Europe/London
Short Abstract:
In light of concerns around antimicrobial resistance, there is need for anthropological perspectives on how and why antibiotics are used in humans and animals. This panel calls for papers that engage with methodological challenges and innovations for studying antibiotic use in low-resource settings.
Long Abstract:
Anthropologists have long held an interest in pharmaceuticals, exploring diverse themes including their social lives and biographies, the processes and effects of pharmaceuticalisation, and their continuous reconstitution through material semiotic practices. Recently, in response to global concerns around antimicrobial resistance (AMR), particular attention has been drawn to the use of antibiotics, with calls for anthropological research into how these ‘threatened’ commodities are being used around the world in human and animal populations. In responding to these calls, there is a need for anthropologists to produce accounts of local use that speak to ‘global’ categories for antibiotics, including classes like ‘penicillins’, ‘cephalosporins’ and ‘fluroquinolones’, and the WHO’s new stewardship categories of ‘Access’, ‘Watch’ and ‘Reserve’. This is challenging given then that antibiotics and brands are often numerous and variable, and people may not use biomedical terms like ‘antibiotic’. Yet bridging local and global categories is important for making a compelling case, both within and between different settings that, despite appearances of widespread ‘misuse’ and ‘overuse’, these are rooted in persistent inequalities in access to medicines and care as well as enduring colonial legacies.
This panel calls for papers that engage with methodological challenges and innovations for studying antibiotic use in low-resource settings. Themes that papers might address include but are my no means restricted to: the strengths and limitations of ‘traditional’ ethnographic approaches; the role of surveys and novel methodologies in anthropological research; opportunities for and challenges of using quantitative data; and challenges of analysing, interpreting and presenting antibiotic use data.
Accepted papers:
Session 1 Thursday 20 January, 2022, -Paper long abstract:
"Optimizing antibiotic use" is an increasingly visible terminology used in policy documents to refer to interventions to improve antibiotic prescription in clinical settings. Often understood in contraposition to or going beyond antibiotic "stewardship" interventions, optimization intervention projects are increasingly finding support by policymakers across Spanish-speaking contexts particularly, where these clinical interventions are referred to as "Programas de Optimización de Antimicrobianos" or by their acronym, PROA. In Spain, hospital PROAs are a major AMR national policy priority; to this day, it remains without a state budget.
Whilst the principle of optimization drug use seems straight-forward when found in policy documents, grappling with how it is achieved, its subtle meanings, how it might (or not) be different from "stewardship", or what (human and material) resources it requires (and currently lacks) are at the heart of the online interviews I have carried out with Spanish PROA leaders based in public hospitals (of all sizes in a wide range of geographies in Spain) during 2021.
In this paper, I will address the gratifying moments, awkward silences, seemingly ready-made blurbs and repetitions, and subtle denouncements I have encountered when asking clinicians (mostly based in hospital infectious disease services), nurses, hospital pharmacists, and clinical microbiologists about the notion of optimization in PROAs. I will show some hints to the complex politics of hospital PROAs that have arisen when analyzing these PROA leaders' accounts of optimizing antibiotic use, including aspects such as the lack of public resources, or the ongoing nationalising and standardising processes of PROA interventions.
Paper short abstract:
This paper considers Chinese-manufactured antibiotics as scientific and neoliberal commodities and shares the experience of tracing them by attending online trade fairs. It explores how the ‘digital frontier’ of pharmaceuticals transform virtual space and labor in the global commodity chain.
Paper long abstract:
A frontier is a zone beyond which further expansion and forward movement is possible in the capitalist system. Traditional commodity frontiers such as plantations have been profoundly transformative of space and labor. This paper considers Chinese-manufactured antibiotic drugs and Active Pharmaceutical Ingredients (APIs) as scientific and neoliberal commodities circulating across the globe. It discusses how pharmaceutical commodities are advertised and promoted on a Chinese digital trade fair. In recent years, online trade fairs and networks have become an indispensable commercial infrastructure to facilitate the transnational flow of Chinese-manufactured antibiotic drugs and APIs, especially during the pandemic. By showcasing their products online and networking with potential foreign buyers through online platforms, Chinese pharmaceutical companies carve out what I call a ‘digital frontier’ of pharmaceuticals. Taking inspirations from the literature of traditional commodity frontiers, this paper focuses on how such ‘digital frontier’ transform virtual space and the forms of labor involved in the global commodity chains of pharmaceuticals. By sharing the experience of attending online trade fairs, this paper also reflects on the challenges faced by anthropologists engaging in active fieldwork during the pandemic, the potentials for taking advantage of the digital platforms available to conduct ethnographic research, and the possibilities of methodological innovations in the anthropological study of antibiotics.
Paper short abstract:
In this communication we will present how we develop a research methodology to address the challenges of studying the pervasiveness of antibiotics in Ghana from a one health perspective. That is, investigating how health, social, economic, and environmental issues interact.
Paper long abstract:
In this communication we will present the methodology of a project on AMR in Ghana from a one health perspective that is investigating how health, social, economic, and environmental issues interact, that is, how we developed a research methodology to address the challenges of studying the complexity and pervasiveness of antibiotics. We aim at studying the circulation and perception of products used as antibiotics in human and animal health, which include a wide variety of prescribers both professionals and lay actors in the human and animal health fields. As anthropologists we aim at studying what medicines are used as antibiotics (both phytomedicine and allopathic medicine). It implies making exhaustive inventories, a relevant method to support ethnographies, but encompassing a wide variety of actors distributing antibiotics. These include not only pharmacies, chemical shops, herbal shops or veterinary shops. But, being on the field, we discovered that it may also be relevant to study the use of antibiotics in agriculture. Products which are sold in the numerous agrochemical shops one can find in the Ashanti region (a region very much characterized as a major agricultural area in the country). Furthermore, antibiotics circulate everywhere. This involves waste in the environment: domestic waste but also waste from farmers, hospitals, or pharmaceutical producers. It questionned us on the appropriate methodologies to tackle the infinite presence of antibiotics within our research field, complex methodological problems associated with a one health perspective.