10 May 2016

Running the wrong race: antimicrobial resistance

Lauke writes:*

Already in 1945, Alexander Fleming, the Nobel Prize winner for co-discovering penicillin, warned of limits to the use of antibiotics in the fight against bacterial infectious diseases. He predicted that eventually due to the large scale usage of antibiotics, they would become ineffective, since the bacteria they are supposed to fight would have become resistant. Now, 70 years later, Fleming must turn in his grave, knowing that he was right; the Golden Era of antibiotics has elapsed and we are now on a frantic hunt for new kinds, against which the targeted bacteria have not developed resistance yet.

In this hunt for new antibiotics, governments are increasing investments in research clinics. However, a new problem emerges. The amount of money governments reserve for Antimicrobial Resistance (AMR) research is fairly small, such that this branch of research is chronically underfunded and clinics are incentivised to compete with each other. The competition scheme could be visualised as follows:

If two clinics cooperate and share their knowledge of which antibiotic has been tested against which bacteria, the chances of either of them finding a new one soon are quite high. The acknowledgement for this innovation would also be shared equally, which could possibly affect future funding and business. If however, within this collaboration, one of two clinics shares all its findings, but the other one holds back valuable information, the chances of the latter finding a new antibiotic earlier are much higher. They will still have to acknowledge the other clinic’s contribution to the research, but in a repeated game setting such as this one, the clinic who finds the most new antibiotics will eventually be more renowned. The interesting feature of this is that the two players do not necessarily have to know whether the other person cooperated or competed, since the outcomes are still based on probabilities. Lastly, if both clinics decide to refrain from the collaboration, the chances of each individual clinic finding a new antibiotic in the near future are quite small, but if they succeed, the individual name gain will be very large. Interestingly, we can derive from the fact that clinics are now incentivised to compete rather than cooperate, that they generally value possible future name gain over the increased probability of quickly finding a new medicine.

Governments could take multiple courses of action to prevent this type of unproductive, competitive environment from emerging. They could either invest more money in research, which would take away the incentive to compete, or implement policies that tackle AMR on the longer term, for example by tightening regulation laws or normalising vaccinations that prevent some bacterial infections from occurring in the first place. However, the problem with these long-term solutions is that they also create a collective action problem, since regulation laws and vaccinations only take effect when implemented on a large scale, i.e. by different countries, with different legislative systems and cultural values.

Bottom Line We are running a race against the clock; at this rate, protection against bacterial infections by antibiotic treatments will soon become a luxury good. The government could increase funding in order to discourage research clinics from competing; yet, all that would do is buy us more time before we actually run out. For a long-term solution, we have to start looking outside the lab and into policies such as large scale vaccinations and the restriction of distribution laws. However, seeing the collective action problems these solutions bring about, we will need every extra minute the government can buy us before we can successfully implement them.

* Please comment on these posts from my environmental economics students, to help them with unclear analysis, alternative perspectives, better data, etc.

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