Why AMR Control Needs Social Scientists, Communities, and Intersectional Thinking

Antimicrobial resistance (AMR) is increasingly recognized as one of the most urgent global health threats. The burden of AMR continues to rise disproportionately in low- and middle-income countries, where fragile health systems, poverty, weak regulatory enforcement, and limited access to diagnostics collectively accelerate inappropriate antimicrobial use and the spread of resistant pathogens¹. Despite significant investments in surveillance systems, laboratory strengthening, stewardship programs, and clinical management, the global AMR response remains heavily biomedical in orientation. The social realities that shape antibiotic use, health-seeking behavior, and exposure to resistant infections remain insufficiently addressed.

This imbalance has created a critical gap between policy-level AMR strategies and meaningful community engagement. National Action Plans on AMR consistently emphasize awareness raising, advocacy, and public engagement as key pillars of AMR control². However, the actual scale and quality of community-centered interventions remain limited, particularly in LMICs. Existing awareness campaigns often fail to account for literacy barriers, local belief systems, economic constraints, and cultural realities that shape how communities understand illness and medicines. As a result, AMR messages frequently do not reach or resonate with the populations most affected. There is therefore an urgent need to reposition social scientists at the center of AMR prevention and control efforts. Social scientists bring critical expertise in understanding human behavior, social systems, structural inequalities, communication, and community dynamics. Their contributions are essential not only for improving awareness campaigns, but for fundamentally reframing how AMR is understood and addressed.

AMR Beyond a Biomedical Problem

Over the past decade, the importance of surveillance systems, laboratories, genomics, and antimicrobial stewardship has rightly gained global attention. These components remain essential for detecting resistance trends, informing treatment guidelines, and strengthening outbreak response. However, biomedical solutions alone cannot resolve a problem that is deeply rooted in social and structural determinants.

In many LMIC settings, individuals rely on informal healthcare providers, purchase antibiotics without prescriptions, or discontinue treatment prematurely due to financial hardship. These behaviors are often framed narrowly as “lack of awareness” or “irrational use.” Yet such explanations oversimplify the realities people face. Antibiotic use is shaped by poverty, limited healthcare access, gender roles, employment insecurity, educational inequities, and distrust in health systems. The continued spread of AMR therefore reflects not only microbial evolution, but also systemic inequities. Addressing these inequities requires approaches that move beyond laboratory and clinical frameworks toward deeper engagement with the social contexts in which antimicrobial use occurs.

The Importance of an Intersectionality Lens

Intersectionality offers an important framework for understanding AMR in a more comprehensive and equitable manner. Intersectionality examines how overlapping social identities and structural factors—such as gender, class, geography, occupation, education, and socioeconomic status—interact to shape unequal health outcomes³. Applying this lens to AMR helps reveal why certain populations are more vulnerable to resistant infections and inappropriate antimicrobial exposure than others. For example:

• Poverty may force individuals toward self-medication and over-the-counter antibiotic purchases.
• Low literacy levels may limit understanding of antimicrobial resistance concepts and treatment adherence.
• Rural communities may lack access to trained clinicians and diagnostic facilities.
• Women, often primary caregivers, may use antibiotics pragmatically to maintain household functioning.
• Agricultural and livestock workers may face repeated exposure to antimicrobials and resistant organisms.
• Weak governance and poor regulatory implementation allow unregulated antibiotic sales and misuse to continue.

These factors do not operate independently. Rather, they intersect and compound one another, producing unequal vulnerabilities across populations. Understanding these intersections is essential for designing interventions that are realistic, effective, and socially responsive.

Are Current AMR Messages Reaching Communities?

Although AMR advocacy has expanded globally, important questions remain regarding the effectiveness of current communication strategies. Are campaigns delivering messages that communities can understand? Are they designed for populations with limited literacy? Are they culturally contextualized? Are communities themselves involved in shaping these messages? In many LMICs, AMR awareness materials continue to rely heavily on technical language and generalized messaging that may not align with local realities. Messages often focus narrowly on “do not misuse antibiotics” without addressing why misuse occurs in the first place. For communities struggling with poor healthcare access, economic insecurity, or inadequate sanitation, such messaging may appear disconnected from daily lived experiences. This disconnect highlights the need for community-friendly communication strategies that move beyond top-down awareness campaigns. Social scientists, communication experts, anthropologists, and behavioral researchers are uniquely positioned to help develop messages that are locally relevant, culturally sensitive, and actionable. Importantly, community engagement should not be treated as a secondary component of AMR programs. It must become a core pillar of AMR governance and implementation⁴.

The Essential Contributions of Social Scientists

Social scientists can strengthen AMR responses across multiple domains.

1. Understanding Community Realities

Anthropologists and sociologists can help explain how communities perceive illness, medicines, healthcare providers, and risk. Such understanding is essential for designing interventions that align with local beliefs and practices rather than contradict them.

2. Improving Behavior Change Strategies

Behavioral scientists can develop communication and stewardship interventions grounded in real-world decision-making processes. This includes designing messages appropriate for different literacy levels, gender roles, and cultural contexts.

3. Identifying Structural Drivers

Economists, political scientists, and policy researchers can analyze how pharmaceutical markets, private healthcare systems, informal providers, and regulatory weaknesses contribute to antimicrobial misuse.

4. Strengthening Surveillance Systems

Current AMR surveillance systems focus predominantly on microbiological data. Integrating social and demographic variables—such as occupation, socioeconomic status, education, and geographic vulnerability—would allow for more targeted and equitable interventions.

5. Supporting Equitable Policy Development

Intersectional and social science approaches help ensure that AMR policies reflect the realities of marginalized populations rather than solely institutional priorities. This improves the inclusiveness, acceptability, and sustainability of AMR interventions.

AMR as an Equity Issue

AMR is increasingly surpassing many other infectious diseases in global health importance. Recent estimates suggest that the burden associated with AMR rivals or exceeds that of tuberculosis, HIV/AIDS, and malaria combined. Yet responses often remain fragmented, with investments concentrated heavily in technical domains while community and social dimensions receive comparatively little attention. Focusing on one component while neglecting others is unlikely to produce sustainable outcomes. Surveillance without community trust, stewardship without healthcare access, or regulation without implementation capacity will have limited impact. AMR must therefore be addressed as both a biomedical and societal challenge⁵. An effective AMR response requires integration across disciplines, sectors, and levels of society. Laboratories, clinicians, epidemiologists, veterinarians, policymakers, behavioral scientists, educators, and communities must all be viewed as equally important actors within the AMR ecosystem.

Conclusion

AMR cannot be controlled through biomedical interventions alone. The drivers of antimicrobial use and resistance are deeply embedded within social structures, economic realities, governance systems, and lived community experiences. An intersectionality lens provides a critical framework for understanding how overlapping vulnerabilities shape AMR risks and outcomes, particularly in LMICs. Social scientists are therefore not peripheral contributors to AMR control—they are essential partners in designing effective, equitable, and sustainable responses. Their expertise is vital for improving community engagement, strengthening communication strategies, understanding structural determinants, and ensuring that AMR interventions are grounded in local realities.

Moving forward, AMR policies, funding mechanisms, surveillance systems, and research agendas must meaningfully integrate social science perspectives alongside biomedical expertise. Without such integration, global AMR efforts risk remaining technically strong but socially disconnected. Sustainable AMR control will depend not only on understanding microbes but on understanding people, systems, and the inequities that shape antimicrobial use worldwide.

Written by Dr. Afreenish Amir