The Spectre of Superbugs: Waste, Structural Violence and Antimicrobial Resistance in India

Abstract

At first glance there may seem to be no clear connections between two of humanity’s most pressing problems: environmental waste and antimicrobial resistance (AMR). In fact, as we posit in this paper, there is an inevitable convergence across these medical and environmental domains that hinge on social and economic inequalities. Such intersections have not been given nearly enough emphasis. Here we offer a series of considerations regarding the potential nexus of environmental pollution, waste-work, poverty and the decreasing viability of antimicrobials. We suggest that AMR and environmental pollution will fundamentally shape one another over the course of the coming decades, with differential impacts across socio-economic divides. More perniciously, the coalescing of waste, environmental pollution and reduced potency of pharmaceutical infection management will in turn likely escalate cultural prejudices around hygiene, ‘untouchability’, exclusion and privilege. That is, this nexus of waste and bacterial risk will polarise and divide communities, disproportionately affecting poorer communities. This paper is intended to chart an agenda for the study of this increasingly critical site of bacterial-human-environmental relations. It does so by examining the cycle of infection, risk and vulnerability amongst the most disadvantaged sections of the population in India.