Histories of Antibiotics: A One Health account of the arrival of antimicrobial drugs to Zimbabwe, Malawi and Uganda. Report for the Improving Human Health Flagship Initiative, Agriculture for Nutrition and Health research programme, CGIAR

The overall aim of this short project is to uncover some of the socio-historical roots of antibiotic use in both humans and non-humans outside of the European and American histories that are now well understood. We provide an historical account of the arrival and generalisation of use of antibiotics in three Eastern African countries: Zimbabwe, Malawi and Uganda. Drawing upon historical and ethnographic data, we describe when, how and in what context antibiotics arrived in these countries, providing an account of their early uses – both human and non-human. This project follows antibiotics as commodities, investigating how they were inserted within broader markets and the channels through which they were introduced in the African continent. The project pursues four distinct but interrelated objectives. First, to establish when and which antibiotics were first introduced in each country of focus. We find that this was not so different from Europe: the earliest mentions of antibiotics in Africa date from the mid-1940s, and refer to the same antibiotics that were being discovered and used in the rest of the world. Second, to investigate the context in which antibiotics arrived. We describe this as a set of already-functioning healthcare and veterinary systems, which were established by the colonial governments and missionary organisations throughout the first decades of the twentieth century. Third, to gain insight into the supply chains through which antibiotics were procured and distributed in each country. This was primarily through pharmaceutical companies from the UK and the US, which saw the market opportunities that drugs (and particularly antibiotics) offered in the colonised African territories. Finally, our fourth objective is to explore the actors behind the introduction of antibiotics, and the interests motivating them. We identify these as colonial governments, medical practitioners (private, colonial officers and missionaries) and pharmaceutical companies, who variously worked to ease the healthcare burden, and improve productivity and profit. Understanding the arrival and further spread of antibiotics in the focus countries can provide important insights about their current use. These findings show how antibiotics and biomedicine came to be associated together. Considering the interests that brought and kept antibiotics in African settings reveals how antibiotics have come to exist in the intersection between health, political agendas, economic interests, cultural identities and international relations. We intend this report to contribute to the development of initiatives to tackle AMR under a One Health framework, expanding the scope to include a diachronic perspective on the health of humans, animals and the environment.