1 Combating Antimicrobial Resistance : Regulatory Strategies And Institutional Capacity

Amnesia is a common, important, but rarely noted side effect of antibiotics. Apart from medical historians, few recall the severe morbidity and mortality once associated with acute bacterial infection. However, decades of antibiotic overuse and misuse have compromised the long-term availability and efficacy of these life-saving therapies. If designed and implemented appropriately, regulation can reduce the risk of bacterial infection, reserve antibiotics for circumstances where they are necessary, and rationalize the use of the most powerful agents. Regulation of antibiotic resistance can be justified, and should be guided, by both efficiency and fairness. A range of regulatory options are available – some information-based, some incentive-based, some command-and-control – each of which has indications, strengths, and weaknesses. A desired set of regulatory strategies must then be matched with the appropriate legal and regulatory institutions. A renewed focus on regulatory and institutional design has significant potential to reduce antibiotic-resistant bacterial infections and increase the effective life of existing and new antibiotics. 1 Sage is Vice Provost for Health Affairs and James R. Dougherty Chair for Faculty Excellence in Law, The University of Texas at Austin. Hyman is Richard & Marie Corman Professor of Law and Professor of Medicine, University of Illinois. This paper was commissioned by the Center for Disease Dynamics, Economics and Policy at Resources for the Future for the Extending the Cure initiative and was funded in part by the Robert Wood Johnson Foundation. We appreciate the helpful comments of three anonymous