Why can't scientists solve the crisis of antibiotic resistance alone, and we need economists?

June 6, 2019 / BIOON / - driven by the widespread use of antibiotics, bacterial infection is becoming more and more resistant to treatment, and the supply channels of new antibiotics are drying up The latest report estimates that by 2050, if no action is taken, resistance to antimicrobial drugs will cause up to 10 million deaths a year globally and reduce gross domestic product by 2-3.5% These dire warnings are similar to those of climate change The global average surface temperature is 2 ℃ higher than the pre industrial level, and the GDP will be reduced by about 3% However, unlike climate change, economic analysis contributes to the recommendations of the Intergovernmental Panel on climate change and to decisions taken by the international community, such as the Paris Agreement Photo source: http://cn.bing.com we believe that the debate on antibiotic resistance must also include such analysis Similarities between antibiotics and fossil fuels, the ultimate sources of carbon emissions, will bring future costs, such as life-threatening infections and extreme weather, respectively There is little incentive to reduce the use of antibiotics or fossil fuels, as the negative consequences of using these resources may occur in the distant future In addition, these future consequences may be inevitable unless many others also reduce their use The science of modelling antibiotic resistance levels or temperature rise and their impact on health and economy is complex and uncertain In a recent review published in the journal Science, we believe that, like tackling climate change, preventive measures need to set ambitious but pragmatic goals in order to reduce the use of antibiotics on a country by country basis without delay Like climate change, science alone cannot solve the crisis of antibiotic resistance In particular, the development of new antibiotics is more than a scientific issue Without the right incentives, pharmaceutical companies will not try to develop the new drugs we need Economic solutions a series of economic measures can help to solve the unnecessary use of antibiotics, while stimulating the development of new antibiotics Photo source: http://cn.bing.com is rarely profitable to develop new antibiotics In view of this, most large pharmaceutical companies have withdrawn from this field We need research grants and tax credits to help reduce the cost of drug development But the more fundamental problem is that pharmaceutical companies are required to produce a product that we will use as little as possible to maintain its service life The development of new antibiotics must be profitable, or pharmaceutical companies will have no incentive to develop them One solution might be to introduce a purchasable licensing scheme for newly developed antibiotics, in which medical institutions pay a fixed licensing fee for a certain dose of antibiotics each year The number of permissible doses may be related to the number of beds or the possibility of encountering certain microorganisms This will create a predictable revenue stream that decouples the profits of new antibiotics from their use Another solution is to pay insurance premiums to pharmaceutical companies to provide antibiotics when needed Premiums can be renegotiated on a regular basis We also need better incentives to develop interventions that can safely reduce antibiotic use In some countries, the same healthcare professionals, such as doctors and pharmacists, prescribe and market drugs, may have an economic incentive to prescribe antibiotics A system of medical practices that taxes every antibiotic they prescribe, or at the local or national level, may provide an effective incentive to reduce prescriptions In addition, the funds raised could be used to develop new antibiotics Another possible system is to provide medical practice permits or quotas for prescriptions, and then let the market decide the price This would be similar to the cap and trade scheme set up to reduce carbon emissions, such as the EU's emissions trading system This method can also provide a better incentive for the development of new antibiotics Photo source: http://cn.bing.com the widespread use of antibiotics in agriculture has also led to antibiotic resistance About 80% of antibiotics in the United States are used in agriculture and aquaculture These drugs are used to promote livestock growth or as a cheap alternative to health measures to prevent infection We can use taxes and quotas to stop the unnecessary use of antibiotics in animals, and then use that revenue to reinvest in research and development Finally, worldwide, the number of deaths from inability to pay for antibiotics continues to exceed antibiotic resistance It is difficult but important to strike a balance between reducing antibiotic use and expanding basic access If the cost of antibiotics increases, it will be crucial to develop ways to reduce the risk that these drugs will only be taken by people who can afford them, through taxes or quotas Reference materials: [1] Scientists alone can't solve the antigenic resistance crisis - we need economists too [2] Michael J Martin et al Antigenic overuse in animal agriculture: a call to action for health care providers Am J public health 2015 Doi: 10.2105/ajph.2015.302870 [3] EU emissions trading system (EU ETS) 【4】Laurence S J Roope et al The challenge of antimicrobial resistance： What economics can contribute Science DOI： 10.1126/science.aau4679 【5】 The Paris Agreement