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Anticipating World Health Day on April 7th, The Economist has tackled the issue of antibiotic resistance, finding the urgency of the problem largely a result of a "tragedy of the commons" and a lack of sufficient incentives for individual actors to conserve antibiotic therapies.  As in, patients looking for a quick fix do not have much of an incentive to think about the long-term consequences when they take antibiotics to treat viral illnesses.  Physicians either do not know or do not have sufficient incentives to enforce prudent antibiotic use in the face of patient demand.  Drug companies do not have sufficient incentives to invest in developing new short-course antibiotic therapies, when there is the potential for blockbuster drugs of the cholesterol-reducing or anti-depressant variety. 

In the absence of such motivations to conserve a common resource (antibiotic effectiveness), what is the panacea to antibiotic misuse?  The magazine cites the work of CDDEP director Ramanan Laxminarayan on the issue, suggesting that “the answer is a mixture of incentives and scourges,” including offering financial enticements to spur new drug development as well as implementing tools to make sure these new drugs are conserved, through more widespread adoption of diagnostic tests and/or antibiotic use guidelines, for example. 

But, as the authors note, thinking globally about antibiotics means not only focusing on the issue of overuse.  In low- and middle-income countries in particular, overuse exists in addition to underuse and barriers to antibiotic access.  Combating resistance needs to be balanced with the public health goal of expanding access to life-saving therapies for those who can’t afford them.  Addressing this tension in creating actionable, localized policies to govern antibiotics will be a major focus of the discussion at the 1st Global Forum on Bacterial Infections this coming fall.

Read more of The Economist’s take on antibiotic resistance.