Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-11-29T16:58:28.062Z Has data issue: false hasContentIssue false
  • English
  • Français

Antibiotic Resistance is a Tragedy of the Commons That Necessitates Global Cooperation

Published online by Cambridge University Press:  01 January 2021

Aidan Hollis  and
Peter Maybarduk
Get access Rights & Permissions [Opens in a new window]

Extract

Antibiotic resistance presents a classic example of the “tragedy of the commons.” In this eponymous tragedy, the commons — shared, public access lands — are overgrazed because farmers can send their livestock onto the land at a zero price. The “tragedy” occurs because overgrazing destroys the land and reduces its ability to provide fodder. The application to antibiotics is obvious: the use of antibiotics creates selection pressure leading to increased proportions of resistant bacteria in the patient and the environment. The increase in frequency of resistant organisms diminishes the effectiveness of antibiotics in treating future infections; thus, the long-term value of the antimicrobial resource is reduced.

Type
JLME Supplement
Information
Journal of Law, Medicine & Ethics , Volume 43 , Issue S3 , Autumn 2015 , pp. 33 - 37
Copyright
Copyright © American Society of Law, Medicine and Ethics 2015

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Barlam, T. F. Gupta, K., “Antibiotic Resistance Spreads Across Borders,” Journal of Law, Medicine & Ethics 43, no. 2, Supp. (2015).Google Scholar
Balasegaram, M. Clift, C. Røttingen, J.-A., “A Pathway towards an Alternative Business Model for Antibiotic Innovation: A Framework, Fund and Institutional Mechanism,” Journal of Law, Medicine & Ethics 43, no. 2, Supp. (2015): Available via aslme.org.Google Scholar
Grabowski, H. Mortimer, G. L. R., “Recent Trends in Brand-Name and Generic Drug Competition,” Journal of Medical Economics 17, no. 3 (2013): 207–214.Google Scholar
Daulaire, N. Bang, A. Tomson, G. Kalyango, J. N. Cars, O., “Universal Access to Effective Antimicrobials: An Essential Feature of Global Collective Action against Antimicrobial Resistance,” Journal of Law, Medicine & Ethics 43, no. 2, Supp. (2015): Available via aslme.org.Google Scholar
Coase, R. H., “The Problem of Social Cost,” Journal of Law and Economics 3, no. 1 (1960): 1–44.CrossRefGoogle Scholar
A five-year extension has already been implemented in the U.S. under Title VIII of the 2012 Food and Drug Administration Safety and Innovation Act. For a proposed indefinite exclusivity extension, see Kades, E., “Preserving a Precious Resource: Rationalizing the Use of Antibiotics,” Northwestern University Law Review 99, no. 2 (2005): 611–674. Kades' proposal is effectively rebutted in Outterson, M. K., “The Vanishing Public Domain: Antibiotic Resistance, Pharmaceutical Innovation and Global Public Health,” University of Pittsburgh Law Review 67, no. 1 (2005): 67–123.Google Scholar
See Hollis, A. Ahmed, Z., “Preserving Antibiotics, Rationally,” New England Journal of Medicine 369, no. 26 (2013): 2474–2476, and So, A. D. Shah, T. A. Roach, S. Chee, Y. L. Nachman, K. E., “International Agreement to Address the Contribution of Animal Agriculture to Antibiotic Resistance: A One Health Approach,” Journal of Law, Medicine & Ethics 43, no. 2, Supp. (2015): Available via aslme.org.Google Scholar
For examples of potential policies, see: Behdinan, A. Hoffman, S. J. Pearcey, M., “Some Global Policies for Antibiotic Resistance Depend on Legally Binding and Enforceable Commitments,” Journal of Law, Medicine & Ethics 43, no. 2, Supp. (2015): Available via aslme.org.CrossRefGoogle Scholar
The low number of health workers in some African countries is particularly troubling. See, for example, the WHO African Health Workforce Observatory, available at <http://www.hrh-observatory.afro.who.int/en/hrh-country-profiles/profile-by-country.html> (last visited May 7, 2015).+(last+visited+May+7,+2015).>Google Scholar
Nga, D. et al., “Antibiotic Sales in Rural and Urban Pharmacies in Northern Vietnam: An Observational Study,” BMC Pharmacology and Toxicology 15, no. 6 (2014), available at <http://www.biomedcentral.com/2050–6511/15/6> (last visited May 15, 2015).CrossRefGoogle Scholar
See Balasaegaram, , supra note 3; Outterson, K. Powers, J. H. Daniel, G. W. McClellan, M. B., “Repairing the Broken Market for Antibiotic Innovation,” Health Affairs, 34, no. 2 (2015): 277–285; and points 30 and 31 of the Antibiotic Resistance Coalition – Civil Society Declaration on Antibiotic Resistance, available at <http://www.reactgroup.org/uploads/ARC-declaration/ARC-declaration-May-22-2014.pdf> (last visited May 7, 2015).Google Scholar
See Outterson, K., “New Business Models for Sustainable Antibiotics,” Centre on Global health Security Working Group Papers, Chatham House (The Royal Institute of International Affairs), Working Groups on Antimicrobial Resistance, Paper 1 (2014): 14–10; Outterson, K. Pogge, T. Hollis, A. “Combating Antibiotic Resistance through the Health Impact Fund,” in Cohen, I. G., ed., The Globalization of Health Care (New York/Oxford: Oxford University Press, 2013); and WHO, Research and Development to Meet Health Needs in Developing Countries: Strengthening Global Financing and Coordination, Report of the Consultative Expert Working Group on Research and Development: Financing and Coordination (2012), available at <http://www.who.int/phi/cewg_report/en/> (last visited May 13, 2015).Google Scholar
See Multilateral Fund for the Implementation of the Montreal Protocol, available at <http://www.multilateralfund.org/default.aspx> (last visited May 7, 2015) and PAPER 7.+(last+visited+May+7,+2015)+and+PAPER+7.>Google Scholar
Ostrom, E., Governing the Commons: The Evolution of Institutions for Collective Action (Cambridge: Cambridge University Press, 1990).CrossRefGoogle Scholar
Id.Google Scholar