Matt Schrage

There are few technologies that have had as significant an impact on the human condition as the discovery of antibiotics. In a very fundamental way, antibiotics enabled the modernization of healthcare. In the twenty years following the discovery of penicillin, dozens of other antibiotics were uncovered. However, in the last twenty years the number of new antibiotics can be counted on a single hand. If the rate of evolved resistance in bacteria stays the same while the rate of discovery of new antibiotics continues to slow, we will soon find ourselves in a world were the field of medicine is thrown back to the barbarism of the 1800s — where any simple surgery is once again life threatening. Antibiotic resistance is an example of a globalized commons problem. Unlike localized commons problems which have been discussed extensively in academic literature, globalized commons problems, ones that ones that occur in domains that lie outside of the political reach of any one nation, such as global warming and antibiotic resistance, are relatively new phenomenon.

In “Revisiting the Commons: Local Lessens, Global Challenges,” Elinor Ostrom examines the nature of common pool resources and suggests alternative institutions for their management, seeing the evolution of cooperative norms as a potential solution. Globalized commons problems are highly difficult to solve — regardless of whether through Ostrom’s proposed evolved norms or through traditional mechanisms, such as increased regulation. In this paper, I will argue that antibiotic resistance is an example of a globalized commons problem and the inability to deal with it, either through state intervention or through the evolution of norms, signals biologically derived principles of cooperation are insufficient and that new supranational organizational structures are needed in order to prevent such problems from metastasizing.

Antibiotics usage exhibits the two features Ostrom suggests characterize commons problems, (1) difficulty of exclusion and (2) subtractability, meaning the “exploitation by one user reduces resource availability for others.”[1] The difficulty of exclusion comes from antibiotics’ ubiquity. They are relied on in hospitals and for medical care more broadly, but also as a supplement in the diet of livestock. A ban on antibiotics would be highly controversial and would have far reaching consequences. Though it could be done, the institutional challenges would be unprecedented and push back would be fierce.

The question of subtractability is more interesting. Antibiotics are not a finite resource in the classic sense. The active ingredients can be synthesized relatively easily. Some knowledge of how antibiotics work is required in order to understand why they should be thought of as subtractable. Antibiotics kill bacteria by targeting specific features, such as the structure of cell walls or the cellular machinery used to build proteins or copy DNA, that differ between bacteria (prokaryotic cells) and the eukaryotic cells that make up multicellular organism like humans.[2] However, when exposed to antibiotics over an extended period of time, with a concentration that doesn’t kill the entire population outright, bacteria can evolve resistance. The bacteria that have a slight natural resistance survive and reproduce, while those that lack the adaptation perish. As a result, anytime an antibiotic is used, its overall theoretical effectiveness decreases as more exposure equates to more potential for a mutation that confers resistance to occur. Antibiotics are a naturally occurring resource that is indirectly made more scarce though human consumption. Unlike with traditional natural resources, the usage of antibiotics doesn’t tax some finite supply, however it does potentially reduce the effectiveness of the drug, globally.

The case of antibiotic resistance demonstrates the limitations of biologically derived principles of cooperation. Evolved norms tend to be more effective on smaller scales and when dealing with lower stakes. At smaller scales, the currency of trust and reputation and the pull of an in-group can serve to force individuals to act more altruistically and think on a longer time horizon, rather than optimize for short-term gains. However, when applied to a more abstract problem like antibiotic resistance, the principles of cooperation seem to incentive short-term thinking. Kin selection is a prime example, showing how what is cooperative on a small scale is actually uncooperative on a larger scale. Parents want their children to have access to antibiotics because (from an evolutionary perspective) they want to see their genes passed on and keeping their child healthy is necessary for that to happen.

Furthermore, the notion of evolved norms implicitly assumes the failure of models that didn’t effectively deal with the problem. On a localized scale, this is acceptable. However, when a failure case has potentially global impacts, even a single error is one too many. To give somewhat of a contrived example, nobody would suggest that evolved norms be applied to the safeguards of nuclear weapons, as a single evolutionary dead-end would have cataclysmic effects. As the scope of the commons problem increases, the consequences of inaction or faulty action increase as well.

Traditional regulatory solutions, that require a centralized arbiter who can allocate the resource optimally, are also insufficient. Regulatory frameworks for localized common problems are usually tied to sovereign nations. Globalized commons problems, on the other hand, are large enough that they fall outside the scope of traditional, unilateral government regulation. Unlike most localized common resource problems, a single government cannot regulate a solution here. Even if the United States severely restricted the supply of antibiotics tomorrow, developing countries like India and China could still use continue their overuse. And when resistance develops anywhere, the interconnectedness of today’s society allows the mutation to spread rapidly.

The scope of the globalized commons dwarfs the regulatory scope of any single nation and thus requires extensive cooperation between multiple nations. Such problems require novel organizational structures that operate on the supranational level. Indeed, these challenges may serve as a critical impetus for breaking through to the next level of cooperation.

[1] E. Ostrom, “Revisiting the Commons: Local Lessons, Global Challenges,” Science 284, no. 5412 (1999): 278-279, doi:10.1126/science.284.5412.278.

[2] “What is an Antibiotic?” What is an Antibiotic? Accessed February 17, 2017. http://learn.genetics.utah.edu/content/microbiome/antibiotics/.