Tackling the global challenge of antimicrobial resistance (AMR): Insights from rural China

The China Forum seminar on Thursday 8 February 2024 was delivered by Professor Helen Lambert (Professor of Medical Anthropology, Department of Population Health Sciences, Bristol Medical School, University of Bristol).

Professor Helen Lambert uses an interdisciplinary and ethnographic approach to analyse key global public health issues, including infectious disease and antimicrobial resistance (AMR). China is one of the world’s largest consumers of antimicrobials for humans and the largest user for animals. In 2004 the Chinese government launched a series of policies designed to stem the growing socioeconomic burden of AMR and control antibiotic use. National data shows a declining trend in antibiotic use, but this is largely confined to urban areas. Despite China’s rapid urbanisation, there are still around 500 million people living in the countryside. There has been a dearth of research into antibiotic use and AMR in rural settings, where there is limited implementation of antibiotic stewardship and widespread availability of antibiotics over the counter.

Professor Lambert’s research investigated the use of antimicrobials in rural areas in Anhui Province, in eastern China. Her fieldwork analysed the drivers of antibiotic use. At eight sites in Anhui province she investigated the types and sources of healthcare sought by patients suffering respiratory or urinary tract infection. The research included a feasibility study for microbial diagnosis and resistance rates. About half of the patients had received treatment prior to visiting the clinic, of whom about half had taken antibiotics over the counter. Antibiotics were prescribed in around 90% of the cases of respiratory and urinary infections treated at the rural clinics. Microbiological results showed no association between antibiotic prescriptions and patients’ pathological conditions. The antibiotics prescribed at the clinics were mainly broad-spectrum, often administered intravenously, due to economic incentives for the clinic. Doctors often prescribe antibiotics because of the patients’ perception that antibiotics are ‘anti-inflammatory,’ which is one of the main symptoms treated in traditional Chinese medicine.

Professor Lambert’s research included an evaluation of the potential for using patients’ electronic records to monitor antibiotic use. She concluded that the records were of limited use as a data source for designing and measuring the effectiveness of policy initiatives, since they were mainly used for obtaining reimbursement from medical insurance. Professor Lambert’s follow-on research investigates the effectiveness of intervention strategies to modify prescribing patterns and reduce AMR; measure indirect exposure to antibiotics from animal and water sources; estimate the economic burden of AMR in China; and evaluate the cost-effectiveness of different intervention strategies.

The Q&A session included discussion of the following issues: the role of government, health education and consumer pressure on doctors, in the decision to prescribe antibiotics; the relationship between China’s food system and AMR, including the drastic change in Chinese people’s diet and the growing role of large commercial farms within the value chain of China’s food supply; the extent to which veterinary use of antibiotics has an impact upon humans; the balance between quantitative and qualitative research in the investigation of AMR; the extent and nature of cooperation between Chinese and western researchers in the field of AMR; the role of fieldwork in shaping policy recommendations to address the issue of AMR.

Helen Lambert (D.Phil.) is Professor of Medical Anthropology in the Department of Population Health Sciences, Bristol Medical School, University of Bristol. Her work uses interdisciplinary and ethnographic approaches to transform understanding of key global public health issues including antimicrobial resistance (AMR) and infectious disease, building on longstanding research in Asia into medical plurality, treatment-seeking and inequalities in access to care.  She is an elected Fellow of the Academy of Social Sciences and has published over 100 peer-reviewed articles as well as two edited books, the latest of which is Abrams, S., Lambert, H. and Robinson, J (eds) How to live through a pandemic (Routledge, 2023).

Prof Lambert has been working on AMR for a decade and as ESRC Research Champion for AMR (2015-17), she led national initiatives to highlight the role of the social sciences in tackling AMR and build cross-disciplinary research capacity. She has led two Newton Fund-supported AMR projects in China including a UK-China AMR Partnerships Hub on Strategies to reduce the burden of antibiotic resistance in China, and leads the social science workstreams of ResPharm, a UK-India study on the impact of pharmaceutical waste on AMR in the environment and local community, and a recently completed interdisciplinary UKRI-funded project on One Health Drivers of AMR in Thailand. She has served on WHO’s Strategic Technical Advisory Group for AMR (2017-2020) and is a Faculty member for the Merieux Foundation’s AMR and One Health annual training course. She sits on the MRC Applied Global Health Research Board and on the Wellcome Trust Early Career Advisory Group, and was seconded for two years to UK Research and Innovation (UKRI) as Challenge Leader for Global Health. She is also a member of the UK-India Advisory Council to the Foreign, Commonwealth and Development Office, the Nesta Longitude Prize Advisory Panel and has held roles on numerous other AMR-related Scientific Advisory Committees and research initiatives including the EU Horizon 2020-funded SONAR-Global and the Chief Public Health Officer of Canada’s spotlight report on AMR.