Not long ago, infections often spelled death. During the 1930s, Americans had a one in 10 shot of dying from simple skin infections. Bacteria in cuts could rampage through the body with few medicines to hold them in check. That changed as antibiotics become available in the 1940s turning lethal diseases into annoyances. Yet at the same time, it created a “ticking time bomb.”
As evolution has selected more resilient bacteria, bugs are now better defended than ever. Bacterial infections resistant to multiple antibiotics tracked by the CDC rose from less than 20% in 1987 to more than 60% in the early 2000s. The the rise has continued around the world (despite a few bright spots in places such as the U.K.).
We now live in a world where a U.S. task force on antimicrobial resistance says treatable diseases may once again become killers without ready cures.
But what if antibiotics were like fish and forests: a shared resource we managed collectively? Every time we use an antibiotic, its effectiveness declines ever so slightly as more microbes evolve resistance. It’s a classic tragedy of the commons: shared resources are overused because everyone’s best strategy (as an individual) is to take more. Eventually, the group loses out. Resources simply fade away whether it’s a low carbon atmosphere (global warming), fish populations (overfishing)–or antibiotic resistance.
So researchers are using economics and ecology to fight back. Programs such as Extending the Cure (see their video here) are designing ways to reduce both the supply and demand for antibiotics. The three keys are discouraging doctors from over-prescribing antibiotics, prodding pharmaceutical companies to release new drugs, and reducing overall demand to slow the evolution of new resistant strains. It’s a wicked problem–one Congress seems unwilling to tackle–but we are making progress.
A 2013 study published found hospitals immediately slowed the spread of resistance by imposing restrictions on antibiotic prescriptions–using roadblocks such as expert sign-off–and then a combination of persuasion and education programs. Yet as with any common problem, national legislation may still be needed that designate antibiotics as a valuable national resource to be conserved just like any natural resources, argues Extending the Cure (PDF).
The alternative is bleak. An analysis published in BMJ predicts we are now at risk of antibiotic resistance with the potential to bankrupt health care systems, as the cost of growing resistance is likely to soar far above today’s estimates of $55 billion per year.
Finding health solutions from the lessons of economics and ecology may prove to be the right diagnosis.