Fluid onto-epistemology of human existence and antimicrobial resistance management: understanding and tackling the problem

Antimicrobial resistance (AMR) is usually framed as a technical problem of drug-resistant pathogens, yet for those living with it, AMR is an everyday condition of uncertainty that reshapes what it means to remain alive, treatable, and connected to health systems. This article develops a fluid onto-epistemology of human existence in the presence of AMR, asking how existence, risk and knowledge are co-produced across Thailand’s AMR landscape. First, it traces how AMR emerges from ordinary practices and infrastructures – from prescribing, dispensing and surveillance to water, sanitation and food systems – to conceptualise AMR as a slow-onset, super-wicked disaster nested within human lives rather than external to human existence. Second, it examines how human lives are valued, protected or left at risk within Thailand’s evolving AMR governance, including tensions between national indicators, everyday therapeutic practices and the position of refugees and migrants at the margins of entitlement. Third, it proposes a communicative-ecology lens for mapping how knowledge of AMR moves between actors, institutions and environments, and how these flows shape possibilities for anticipation, care and accountability. The resulting framework is designed to be transferable and empirically usable: it can be populated with quantitative and qualitative data, scaled between national profiles and local settings, and adapted as stakeholder configurations change. In the Thai context, this means reading AMR as part of the country’s disaster risk profile, especially in refugee- and migrant-affected settings where surveillance is challenging. Future research on AMR in Thailand – including along the Thai-Myanmar border and in refugee- and migrant-affected settings will collect and interpret data through this framework in order to better align everyday experiences of risk with policy, surveillance and intervention.