The Problem
An Invisible, Yet Invaluable, Resource
When people think of natural resources, they think of forests, rivers, fish, and the air that we breathe—elements of the environment that belong to everyone. In reality, resources are not so easily shared.
Overuse often characterizes shared natural resources. In 1968, Garret Hardin called this the “tragedy of the commons,” because as people respond to natural incentives to exploit a resource that is shared freely with others, overuse ultimately ruins the resource. Without proper management, open access resources can become a free-for-all where individuals benefit from taking as much as they can while leaving the costs of depletion for others.
A shared resource framework helps us understand antibiotic resistance and suggests an incentive-based approach to conserving antibiotic effectiveness.
Calling antibiotic resistance a resource problem is not just a metaphor; the concept can help shape incentive-altering strategies that encourage drug companies to develop new antibiotics, and patients, doctors, and hospitals to use existing antibiotics sustainably.
Like oil or fish, antibiotic effectiveness is a shared natural resource: any doctor or patient can tap it. Even the maker of a patented antibiotic does not control its effectiveness, since other firms likely manufacture related drugs.
Misaligned Incentives
Use of an antibiotic both cures the patient and reduces the risk that the infection will spread. But it also “uses up” some measure of antibiotic effectiveness, increasing the likelihood that future infections may not be treatable. Unfortunately, stakeholders’ incentives work against a solution:
- A patient suffering from an ear infection wants immediate relief, and the physician wants to provide a cure. Neither may consider that antibiotic use by this one patient eventually reduces the drug’s effectiveness for everyone.
- A hospital may prefer treatment over prevention because antibiotics are often less expensive than other forms of infection control, and the hospital can even pass along the costs of antibiotic treatment to health insurers.
- A hospital has no incentive to ensure that the patients it discharges are not carrying a resistant pathogen to other institutions.
- A drug company wants its antibiotics to remain effective, but other firms have drugs that work in similar ways. Just like fishermen competing for today’s catch at the expense of tomorrow’s fishery, the company doesn’t care about resistance because the burden of ineffective drugs will be borne by all firms.
Those barriers to addressing antibiotic resistance involve conflict between the interest of individual decision-makers and the interest of society as a whole, now and in the future. Incentive-based policy options (pdf) can help patients, physicians, hospitals, insurers, and pharmaceutical companies consider the impact of their decisions on others and give them the opportunity to help the solution evolve.
