A Just Transgression of AMR Governance? How Mexico City’s Informal Medicine Sellers Balance Antibiotic Care and Control by Bending the Rules

This article explores how informal medicine sellers (IMSs) in Mexico City “contest” and “reassemble” antibiotic control standards in ways that both challenge and respond to antimicrobial resistance (AMR) governance. Drawing on ethnographic fieldwork, we examine the “rationales”—moral, political, economic, technoscientific, and practical—that IMSs invoke to justify bypassing antibiotic prescription, dispensing and accounting regulations, and the “practical tinkering” they perform to make antibiotics available and “appropriately” used under conditions of scarcity and oversight failure. Rather than viewing IMSs as simply breaking official rules, we adopt a “social life of standards” perspective to argue that their actions reflect localized enactments of antibiotic control—versions shaped by community needs, corruption, poverty, and distrust in public health infrastructures. These practices are ambivalent, blurring boundaries between public service and profit and systemic subversion and informal regulation. By tracking how IMSs adapt, collectivize, and sometimes deliver treatments, we show how antibiotic governance is reworked from below—not only in response to AMR, but also to structural exclusions from formal care. We argue that rather than treating IMS rationales and practices as part of the problem, they should be studied as grounded responses to systemic failure—and potential sources of insight for context-sensitive regulatory design.