Policy Webinar 3
Linking the ‘technical’ and the ‘social’
Dr Will Parks, UNICEF, introduced the first presenter, Professor Olivier Ruben, Professor of Global Studies at Roskilde University, Denmark. Prof. Ruben is a disaster researcher from a social science perspective. His presentation was entitled ‘Why should we care about the social stuff?’ He provided a perspective of the health sciences and social sciences and the tension between the two paradigms. He stressed the importance of synergies and interdisciplinary interaction in relation to addressing AMR. He also highlighted the disparity in research in these sciences, arguing that more social science research is needed:
“It is not very comforting for social sciences trying to work in the field of AMR because…. it’s very, very miniscule what has been produced of social sciencess social science inputs, both on the global level, and the meso level and the local level.”
Prof. Ruben highlighted four social science prisms through which to view AMR through, and that which makes it a challenge to address as a global issue: the transboundary/’One Health’ nature of AMR making it an issue of collective action; the elusive nature – neither spatially or even temporarily fixed in time – which makes it difficult for politicians to prioritise; a crisis of modernity in that it is a symptom of medical progress – in terms of antibiotic use – but difficult to find solutions; and a crisis of distributive justice, in that the agenda is mostly driven by high-income countries.
The challenge is to mobilise and build networks, coalitions outside of the medical community:
“…. in order to really get our footing in the global political agenda, we need to begin to build bridges to others: the public, NGOs, lobbyists, that are much more flexible and knowledgeable about how to actually put issues on the political agenda, because that’s not the forte of health experts.”
Dr Parks introduced the second speaker, Professor Claire Chandler, a medical anthropologist and Co-Director of the Antimicrobial Resistance Centre at the London School of Hygiene and Tropical Medicine. Professor Chandler described her work social research on antibiotic use, and the importance of social research for AMR, bringing together the different ways of working and thinking. She highlighted an important dilemma concerning antibiotic use or overuse: in some LMICs particularly, it is more difficult to get essential medicines to people, whilst in some settings antibiotics have previously been promoted in marketing campaigns. But in fighting AMR:
“One thing that I would say, that from our analysis, it promotes this question of are we wanting to protect people or to protect medicines….a warning I would put out is that let’s be careful not to shift our entire kind of effort towards just saving the medicines. The reasons we’re saving medicines is still for the same end, which is to protect people and to provide the best quality care.”
Professor Chandler described how important the framing of AMR is and to “follow the science and the policy objective of AMR”. AMR has become stabilised as a political object, as it became an economic issue, and also a security issue, in addition to being a health issue. This focus helps to better understand the use of antibiotics and spread of AMR. The LSHTM has developed a framework that can be used to see how social scientists are contributing to thinking about how to change antibiotic use. The framework describes: practices; structures and infrastructural reasons why antibiotics are used; and networks which require antibiotics. The framework emphasizes the context of antibiotic use, rather than the individual user, and the importance of improving communication, information and knowledge.
Dr Parks introduced a Q and A with the two presenters. An important issue with AMR is how to communicate with policy-makers. The difficulty of their role was recognized and their need to balance competing priorities. They need information, including on the economic case for addressing AMR. Professor Chandler thought that there had been a “change in the appetite of scientists to work together across different disciplines”, and moreover, an increasing recognition of the importance of social research, including by funders of research.
Professor Rubin further highlighted the importance of the framing AMR in putting it higher on the global agenda. This also depends on network and coalition-building:
“Health experts are very good at framing or understanding an issue and understanding what are the problems with the issue and communicating that. But that’s the first step. The second step is to actually make it to the political agenda, and here I think we have a problem, and it shouldn’t be the health experts, or indeed social science experts that push the agenda, but a much more broader coalition of actors, and you see it with climate change”
Dr Parks summarized the key takeaways from the presentations and Q and A. He added, from the perspective of UNICEF, how concerned we should be about AMR and how prioritizing children within the AMR agenda is required to protect every child’s right to health:
“40% of the deaths globally among children under five are caused by diseases whose treatment is and will continue to be affected by the growing threat of AMR…. So drug resistance is one of the greatest threats to child survival and global health from UNICEF’s perspective, and it really threatens the continued progress on child health”.