The Problem
Incentives to Preserve Antibiotic Effectiveness
Death from a drug-resistant pathogen is not yet a concern for most Americans. Many infections that are resistant to common antibiotics typically respond to other, more expensive drugs. But running out of the cheapest antibiotics is like running out of oil. Today, oil is relatively cheap and convenient but not our only energy source; similarly, generic antibiotics are inexpensive and available but not the only way to treat infectious diseases.
Congressional action to declare antibiotics a valuable societal resource may be helpful in resolving the commons problem inherent in antibiotic use, as it has been for fisheries.
By using antibiotics today, we may inadvertently encourage resistance and thereby limit our ability to use them tomorrow. Balancing the use of antibiotics with the need to conserve their effectiveness over time requires a policy approach that recognizes antibiotic effectiveness as a shared societal resource.
Extending the Cure encourages incentive-based policies (pdf) to control resistance by both reducing demand for existing antibiotics and increasing the supply of new antibiotics.
Reduce demand
- Discourage inappropriate antibiotic use by changing how patients are reimbursed for antibiotic prescriptions and how physicians are paid for prescribing them.
- Lessen the need for some uses of antibiotics by improving infection control and vaccinating against common infections.
- Design antibiotic use strategies, such as combination therapies and cycling, that delay the emergence of resistance.
Increase supply
- Encourage research and development for new antibiotics.
- Reduce incentives for drug makers to oversell their antibiotics.
Unfortunately, those strategies can undermine one another because the incentives of patients, doctors, hospitals, insurers, and drug companies are not aligned. For example, if we limit demand for antibiotics, we reduce the manufacturers’ returns from—and thus their incentives for—developing new antibiotics. Conversely, new antibiotics reduce incentives to extend the life of existing antibiotics.
Thus partial solutions—those that focus only on supply or only on demand—are likely to be less effective than solutions that are mindful of their interrelatedness. A comprehensive strategy for the near- and long-term stewardship of antibiotics should consider all possible incentive-based tools. And it should involve everyone with a stake in the outcome: patients, doctors, government and private health insurers, hospitals and other health care facilities, and pharmaceutical companies.
