Social Science & Medicine xxx (xxxx) xxx Please cite this article as: Alex Broom, Assa Doron, Social Science & Medicine, https://doi.org/10.1016/j.socscimed.2021.114520 Available online 29 October 2021 Resistant bugs, porous borders and ecologies of care in India Alex Broom a, * , Assa Doron b a Sydney Centre for Healthy Societies, School of Social and Political Sciences, The University of Sydney, New South Wales, Australia b College of Asia & the Pacifc, The Australian National University, Australian Capital Territory, Australia A R T I C L E INFO Keywords: Antimicrobial resistance India Anthropology Behavioural change ABSTRACT As social science scholarship has routinely illustrated, professional practice is rarely as contained or coherent as it is often imagined to be. The increasing emphasis on the rise of antimicrobial resistance (AMR) has drawn renewed attention to the interconnectedness of clinic, community, environment and planet, and how proposed ‘solutions’ to major problems such as AMR require a broad, cross-cutting lens. In this study, set in Hyderabad, India, we draw on a series of interviews with hospital-based clinicians completed during 2019 and early 2020, to unpack the multidimensional, ecological acceleration of AMR and the implications for everyday practice. Their accounts make visible how practice operates in relation to industrial economies, community vulnerabilities, and ecologies. This in turn highlights the problem of epistemic bordering, where ‘sites’ of AMR are targeted but are prone to leakage and transgressions. We propose an ecological approach to conceptualising antimicrobial practices with implications for AMR interventions being rolled out in the sub-continent and beyond. 1. Introduction There is a burgeoning literature on AMR, across the medical, health and social sciences, with scholarship spanning analysis of practice (e.g. Broom et al., 2014), context (e.g. Costelloe et al., 2010), and governance (e.g. Broom et al., 2021), and how these spheres are productive of the accelerating problem of AMR (e.g. Chandler, 2019). Much of existing work, including that of the authors themselves (e.g. Broom et al., 2015; 2016; 2017, 2018), has sought to explore the social norms underpinning antimicrobial ‘misuse’ across contexts. Anthropologists in particular have sought to unpack the particularities of AMR beyond the global north (e.g. Chandler, 2019; Tompson and Chandler, 2021; Doron and Broom, 2019; Broom and Doron, 2020; Doron and Broom, 2021) including emphasising infrastructural vulnerabilities (e.g. Thakur and Gray, 2019; Broom et al., 2021; Doron, 2021). Yet there is considerable work needed to fully elucidate the complexities of microbial-human-environmental landscapes which are productive of AMR, and in contexts often viewed as ‘ground zero’ for the global AMR problem (see Khan et al., 2019; cf. Hinchliffe, 2021). Here we bring the emergent scholarship on the multidimensionality of AMR across time and place (Hinchliffe, 2021; Lorimer, 2020), into conversation with Indian- and Hyderabadi-specifc concerns, to consider what informs practice. That is, to begin to explore ecologies of resistance and practice, and as articulated in the lifeworlds’ of clinicians. We acknowledge that our participants offer only one set of perspectives in the broader, multiscalar and multistakeholder landscape of AMR. Yet these situated accounts are instructive for refocusing our attention on such things as vulnerable, porous borders (e.g. Turner, 2003); how bodies and bugs articulate socio-political landscapes (e.g. M’charek, 2013; M’charek, 2014, Doron and Broom, 2019); and, how local econ- omies are productive of intervention and care (e.g. Fine and Davidson, 2018; Dwyer, 2013). Porous borders in this context denotes tensions between imagined divisions (i.e. inside/outside; clean/dirty; clinic/street side) and the actual fows – of microbes, persons, goods and practices – that accelerate the evolution and spread of resistant bacteria. Such porous borders, as we shall see, are overlayed with a political economy that render them either mis-recognised or subsumed within a biopolitics. This biopolitics is sustained through connecting life to disciplinary power, of which medical practice is key (see Foucault, 1984). As we show, this mecha- nism of biopolitics drives knowledge-making and interventions, and yet it remains highly uneven across borders, for instance, in the adminis- tration and surveillance of antimicrobial use and the surveillance of the spread of resistance itself (see also Hinchliffe, 2021). A focus on ecologies of care, and porous borders therein, thus offers one instructive way of highlighting disruptions and illuminating * Corresponding author. Sydney Centre for Healthy Societies, School of Social and Political Sciences, Science Road, The University of Sydney, Camperdown, 2006, New South Wales, Australia. E-mail addresses: alex.broom@sydney.edu.au (A. Broom), assa.doron@anu.edu.au (A. Doron). Contents lists available at ScienceDirect Social Science & Medicine journal homepage: www.elsevier.com/locate/socscimed https://doi.org/10.1016/j.socscimed.2021.114520 Received 11 June 2021; Received in revised form 26 October 2021; Accepted 27 October 2021