The Centre for Pandemics and One-health Research (P1H) aims to conduct a series of interviews, “P1H Coffee Break”, with researchers to raise understanding and awareness regarding the field of pandemics and One-health.
How would you describe your research in three words?
For this project we wanted to emphasise one word: translation.
We have been working a lot with the concept of translation in medicine, where translation of knowledge from research to practice is often talked about as ‘knowledge translation’ or implementation. When these processes fail, it is often attributed to «resistance» in the implementation setting.
Our idea with this project was to re-think translation by empirically investigating what actually happens when global directives enter local antibiotic practices. The concept of friction allowed us to view «resistance» to implementation not as a barrier, but as a productive translational process of negotiation between the global directive and the local setting.
The concept of translation is used both in medicine and within the humanities and social sciences, and it is therefore useful to navigate different domains. We thought that working with this concept would help us to understand better how ideas to prevent or tackle AMR are being translated into practice, but also how we could translate this back to different scholarly fields.
What motivated you to do research on this topic?
Today, key health governance agendas such as the UN SDGs and the Global Action Plan on AMR are fundamentally built on models of local implementation of science-based, standardised and centralised knowledge.
Our motivation to do research on this was to better understand the foundational thinking that were shaping current governance agendas and their consequences. We were also intrigued to explore if there are more productive ways of understanding resistance in implementation than just calling it failure.
We found that the policies discussing how we tackle our relationship with microbes, were very narrow and did not consider all these other implications of microbial life. We wanted to look not only if policies are being properly implemented or not, but also what they are actually doing: Can we see people resisting implementation in the same way the microbes resist the things that we use to kill them?
We had this idea of also taking something from the empirical study e.g. understanding how we can reconceptualize resistance and understand something in nature better. Often, we take theories from nature, and we make it into something social, but we wanted to see if we could also do it the other way. To take something from the social and think more creatively about how we understand microbial agency for instance and to foster disciplinary exchange, a translation.
What is the aim of the research?
The aim of this research was to reconceptualise translation based on empirical investigation and broader ideas of the global/local divide – we were aiming for a more nuanced understanding of what happens when local settings «resist» global science-based directives.
Evidence is often taken for granted and often thought of as something that is predefined, an applicable product to be put into practice. If it does not work, it is because people are resistant, or the system is resistant. That is the sort of implementation science basic model. We wanted to think differently, both about barriers to implementation (what actually happens to the implementation setting), but also to the knowledge that is being translated.
So, the main goal was to look at resistance empirically without having a predefined understanding of what it is by having microbial resistance as some sort of case. We wanted to explore practices of resistance, and hopefully to get inputs and insights that can contribute to improve it.
Why is this topic important?
Evidence based global directives are shaping the world's global agendas and our approach to solving current grand challenges. We are concerned that dominating theories of implementation prevents us from seeing important processes. Perhaps global directives are not producing the changes that we are measuring, but that does not mean they do not do anything. It is important that we also try to understand resistance as something potentially productive.
It might be that the way we measure implementation impacts the way we understand this, and maybe they are not doing what we are measuring but something else, that we are not counting as improvement. That is why we think it is important to sort of expand on these ideas of knowledge translation, implementation, barriers and resistance to implementation.
If you look at the history of global health and all the plans and goals that have been established and implemented – depending on how you look at it, you could say, it is not really working. We must question if our models do not work because they themselves are problematic. We wanted to investigate if there are alternative ways of thinking and improving health – to see if we could find alternative ways of understanding improvement.
We are also interested in the distinction between global and local. AMR looks extremely different in different places in the world. The drug-bug combinations look different, the diseases look different, the politics of the country looks different, the health system etc.
The standardised, evidence-based guidelines and directives enter extremely different settings.
So, that is also something that we have been interested in: How we re-conceptualize and challenge current models’ idea of implementing standardized, centralized and global directives into the local environments. Can we get more nuanced ideas about what the global and local can look like? Can we influence the distinction between the two in the literature as separate domains?.
How are studies on pandemics or One-Health related to your field of research?
One-Health is important when we talk about AMR because microbes are everywhere – they are in us humans, in animals, and they inhabit any environment that we operate in; both human-made environment and natural environments. Levels of resistance will somehow reflect the total amount of antimicrobials that enter the environment of microbes because they will adapt to these environments by becoming resistant. Resistance can also spread without any interest in human made categories, boundaries or borders. Viewing AMR in a One-Health framework can support a better understanding of the role of microbes within the global ecology and thus promote less compartmentalised policies to reduce resistance.
AMR is a topic within the One-Health agenda which means it has been described as something that should be tackled with One-Health approaches and that is obvious. Some of the criticisms or challenges to the One-Health approach found in the literature, is that this approach is very human-centred. This means that it is framed in a way that the overall aim benefits human health. When you take AMR seriously as a human-driven issue in terms of pollution, scaling up and industrialization of microbial products, an optimization of farming, one has to problematize human-centred actions. How do we take all this complexity into account into One-Health approaches that also benefits other beings on the planet?
It is important to not just endorse a concept as it is, but to challenge it and to offer different and alternative ways that can help to improve it or help to bring new ways of thinking forward. When we are talking about AMR, we are seeing more and more people talking about microbial life and how humans are depending on healthy relationships with microbes. We hope finding ways of thinking about microbial-human relations as coexistence, instead of simply endorsing logics of control, which relates back to many of the ecological issues we are trying to tackle as a society, as humanity.
Thank you to Carolina and Ida for participating in this interview. Check out our Instagram at @pandemicscentre.uio to see snippets of the interview.