Last week’s spotlight reported on a newly published report highlighting the lack of restraint in global antibiotic usage, which has prompted a wide response. Much of this response underlines the relative poverty of data assembled to support the inferences about low and middle income country (LMIC) antibiotic usage, and its convergence with consumption patterns in Europe and North America. Indeed, many commentators point to the inadequacy of gross indicators of convergent consumption trends, while settings and drivers remain stubbornly rooted in local patterns of resource access and distribution, as well as socially determined risks which need closer investigation in order to understand how and why they play out in increased (and increasingly stigmatised) antibiotic use in resource-poor settings.

Thus, a pair of recent letters to The Guardian, from Margaret Batty of WaterAid, and Matt Ball of the Good Food Institute, encourage us to tease out some of the underlying factors concealed by a narrative of convergent use patterns, focusing on extraneous drivers of diarrhoeal disease in LMIC countries, on the one hand, and rich country protein supply on the other. As well as complicating the story of how drivers of antimicrobial overuse differ, intersect, and overlap, these letters remind us how the perceived gathering crisis of AMR is made available as a tool for infusing urgency into a wide range of popular agendas in development and public health.

John Manton, Humanities and Environmental Sciences Disciplinary Head.