A Biohistorical Perspective of Typhoid and Antimicrobial Resistance

Claas Kirchhelle, Zoe Anne Dyson, Gordon Dougan

Research output: Contribution to journalArticleOtherpeer-review

14 Citations (Scopus)


We combine methodology from history and genetics to reconstruct the biosocial history of antimicrobial resistance (AMR) in the bacterium Salmonella enterica serovar Typhi (S. Typhi). We show how evolutionary divergence in S. Typhi was driven by rising global antibiotic use and by the neglect of typhoid outside of high-income countries. Although high-income countries pioneered 1960s precautionary antibiotic regulations to prevent selection for multidrug resistance, new antibiotic classes, typhoid's cultural status as a supposedly ancient disease of "undeveloped" countries, limited international funding, and narrow biosecurity agendas helped fragment effective global collective action for typhoid control. Antibiotic-intensive compensation for weak water and healthcare systems subsequently fueled AMR selection in low- and middle-income countries but often remained invisible due to lacking surveillance capabilities. The recent rise of extensively drug-resistant typhoid bears the biosocial footprint of more than half a century of antibiotic-intensive international neglect.

Original languageEnglish
Pages (from-to)S388-S394
Number of pages7
JournalClinical Infectious Diseases
Issue numberSupp 5
Publication statusPublished - 1 Nov 2019
Externally publishedYes


  • international health
  • antimicrobial resistance
  • biosecurity
  • typhoid
  • vaccination

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