Social-Cultural Approaches to Microbial Life in an Era of Antimicrobial Resistance

We live in a moment where newly emerging infectious diseases, multi-drug resistant infections and new scientific fields and practices such as synthetic biology are unravelling long held assumptions about how we think about and engage with microbial life forms. Antibacterial resistance in particular, is one of a number of contemporary health challenges which is unravelling the taken-for-grantedness of modern medicine and modern life (Hutchinson, 2016). By 2050 it is predicted that increasing rates of drug reistant infections may contribute to as many as 10 million deaths per year (O'Neill, 2016).

Antibacterial resistance is often thought of in scientific or technical terms (Smith, 2015). But ABR is as much of a social and cultural issue as it is a technical and biological one. In the 1970s the sociologist Tanya Stivers pointed to the ways in which patient pressure and cultural norms of prescribing shape antibiotic use and health outcomes in the GP clinic (Stivers, 2007). More recently, anthropologists and sociologists have moved beyond the GP clinic and have examined the role of medical culture in shaping ABR in hospital settings and the social-cultural dynamics that drive ABR in low income countries (cf Broom et al, 2016; Roess et al, 2015). The aim of this fellowship is to build upon the knowledge and isnights that I have gained during my PhD and postdoctoral research and to develop of a conceptual account of, as well as a methodological agenda for engaging with, the social dimensions of this contemporary moment of biosocial complexity and change.

As part of this fellowship I will trace the shifting contours of the contemporary biosocial moment. I will map out how and why social innovation matters. Predominating approaches to tackling ABR often focus on technological solutions including new and better drugs as well as improved diagnostics. But this approach fails to recognise that technical innovations are always put to work in a social contexts. We are beginning to see, for example, that diagnostic tests - key technological tools designed to result in better diagnosis and the more judicious use of antibiotics - are intersecting with different care models and social pressures in ways which facilitate their overuse and which can compound, rather than help to tackle, the ABR challenge (Ledingham et al, 2018).

Through the development of a science-facing report I will also outline how different social science methods can be brought to bear on the ABR challenge. There is still a tendency to position social science as being primarily concerned with accessing beliefs and social opinions. But beliefs and opinions are rarely translated seamlessly into practice. This is because beliefs and opinions are diffracted as they encounter the thickness of social and cultural norms and contexts.

This is an engaged programme of work and throughout the course of the fellowship I will engage with research end users and diverse stakeholders including WHO Europe and scientists working to address the challenge of ABR. I will organise a day event drawing together scientists and social scientists from across the SWDTP as well as non-academic bodies in order to explore how social scientsts and scientists might work together and collaborate in experimental and new ways on the challenge of ABR.