Why We Should Reexamine the “Golden Age” of Antibiotics in Social Context

Economics is the primary discipline used to understand supply chain design, scale-up, and management.For example, antibiotics can be compared to other forms of "tragedy of the commons," whereby a common good (effective treatment of infections) is jeopardized by individual consumption and lack of community oversight and stewardship.While economic analysis can explain innovation decline in terms of market failure, one pitfall of an early-stage focus on research and development is a failure to challenge the discovery narrative.Ethics also has a distinct place in helping us envision alternatives to what markets can produce.This article advances a more contextualized view of how science and technology policy has shaped antibiotic supply chains over many years, emphasizing how shifting the story we tell about past successes is central to securing a reliable antibiotic supply chain in the future.Effectiveness Paradox Antimicrobials are treatments for microbial infections caused by bacteria, viruses, and fungi.Antibiotics are medicines especially used to treat bacterial infections.Penicillin was the first antibiotic and effective treatment developed for bacterial infections encompassing pneumonia, gonorrhea, and rheumatic fever. 1 Penicillin's reduction in human suffering is neither qualitatively nor quantitatively simple to capture, but the medicine has saved millions of lives and improved human life expectancy for many.However, antibiotics present an "effectiveness paradox": the more they are used, the less effective they become.Repeat exposure of bacteria to an antibiotic can generate the conditions that select for resistance, or the capacity of colonies to survive despite treatment.One recent study estimated that over 1.27 million deaths in 2019 were attributable to bacterial antimicrobial-resistant infections. 2 As antibiotic resistance is increasing globally, so, too, is demand for last-resort medicines that can effectively treat resistant infections. 3The effectiveness paradox can be compared to other forms of "tragedy of the commons," whereby a common good (eg, effective treatment of infections) can be jeopardized by individual consumption. 4However, as Hardin recognized, ethics has a distinct place in helping us envision alternatives to the tragedy of the commons. 5This article advances a more contextualized view of how value-driven