02 Oct 2019
– Laurie Denyer Willis – University of Cambridge
Co-authors: – Clare Chandler –


Behaviour change interventions are often advocated to lower antibiotic use globally. An analysis piece by researchers Dr. Laurie Denyer Willis and Dr. Clare Chandler at the London School of Hygiene and Tropical Medicine, shows why behaviour change interventions often have limited impact. They reveal that antibiotics are often used as a ‘quick fix’ – they paper over underlying structural issues related to marginality, inequality, violence, health systems, and infrastructures. Antibiotics can be understood as a quick fix for care and, by extension, a quick fix for productivity. Antibiotics have become a quick fix for hygiene in some settings and more broadly a quick fix for inequality on local and global scales.The researchers call for an approach to lowering antibiotic use that is broader than an individual-behaviour change model.

  • A key global health objective related to antimicrobial resistance (AMR) is to reduce antibiotic use. Many interventions aimed to lower antibiotic use are based on models of behaviour change;
  • Understanding antibiotic use in low-income and middle-income countries requires shifting attention to the structural dimensions of antibiotic use that tend to be obscured when following an individual behaviour change approach;
  • Antibiotics function as a ‘quick fix’. They are a quick fix for care in fractured health systems; a quick fix for productivity at local and global scales, for humans, animals and crops; a quick fix for hygiene in settings of minimised resources; and a quick fix for inequality in landscapes scarred by political, economic and post-colonial violence.
  • Recognising many of our AMR solutions as quick fixes allows us to raise our line of sight into the longer term, generating more systemic solutions that have greater chance of achieving equitable impact.

Published in the medical journal BMJ Global Health, this analysis draws on over a decade worth of research in East Africa. The analysis showswhy attempts to reduce antibiotic prescribing and use to date have had mixed effects, by focusing on the wider problems that these medicines have become solutions for. The authors reveal the structural issues that contribute to widespread antimicrobial use that often go unaddressed when antibiotic use is described in the language of good’ and ‘bad’ behaviour.

This is particularly true in LMICs, where antibiotics function as a ‘quick fix’ infrastructure, put to work to correct the fractured infrastructures of care, water and sewage, hygiene and demands for ever increasing productivity. We can connect this entrenched use of antibiotics to neoliberal reforms, the legacies of structural adjustment programmes and the marginalisation of the poor and vulnerable. Antibiotics have made life liveable in contexts of scarcity, uncertainty and inequality.

Researchers Dr. Laurie Denyer Willis and Dr. Clare Chandler, interpret this as a failure to think beyond individual behaviour change in public health: “the ways antibiotics are used are deeply embedded in the way our societies, politics, and economies work. This is not about individual behaviours, but about how antibiotics are a quick fix solution that obscures the larger structural factors that are needed for good health, like inequality, care, hygiene and increasing demands for productivity. It is important to understand the extent to which daily life has become intertwined with antibiotic use to understand the consequences of resistance and the best ways to reduce the threat of AMR

Low-income and middle-income countries (LMICs) have been identified as a specific target for AMR and antibiotic use policies due to a range of factors that locate them as particularly vulnerable to the effects of AMR, as well as the perception of them as posing a risk to other countries through the connectivity rendered so apparent in previous pandemic scares.

This analysis is part of the Antimicrobials in Society (AMIS)project, a long-term study of the ways that antibiotics are part of every day life. The AMIS Programme also includes two empirical research projects in Thailand and Uganda. Drawing on novel research tools from anthropology, the mapping of antibiotic roles in society, and collaborations with our diverse stakeholders across these countries, the AMIS projects in Thailand and Uganda seek to open the field of AMR research beyond its traditional boundaries. Funding is provided by The Antimicrobial Resistance Cross Council Initiative supported by the seven research councils in partnership with other funders. The lead funders are the Economic and Social Research Council with the Department of Health and the Arts and Humanities Research Council.

The research is published in BMJ Global Health:

Denyer Willis L, Chandler C. (2019) Quick fix for care, productivity, hygiene and inequality: reframing the entrenched problem of antibiotic overuse. BMJ Global Health; 4:e001590. doi:10.1136/ bmjgh-2019-001590. Available at https://gh.bmj.com/content/4/4/e001590

* Image by Dulce Pedroso, https://athousandwordsconsulting.com