Antibiotics as Global Climate: Kyoto vs. Montreal
Suppose we think of antibiotics like clean air. We all want to have access to them and we think future generations ought to have access as well. However, suppose a sustainable usage of antibiotics requires all nations to make minor sacrifices (from more expensive meat to not having quick access to broad-spectrum antibiotics). How do we motivate nations to cooperate (for instance, signing a treaty and being monitored for compliance)? One natural place to look for a possible solution to NPD at a global level is to adopt lessons learned from international treaties on pollution control. Looking to the Montreal and Kyoto Protocols as models of successful and unsuccessful international efforts, respectively, Jonny Anomaly outlines a number of features that make a treaty more likely to succeed (Anomaly 2010). They are:
1. Flexibility: goals must be adjustable on the fly and nations must be able to meet goals in a variety of ways (e.g., cap and trade, taxes, etc.).
2. Signatories must perceive the burdens as being distributed in a fair way and beneficial to all participants by effective use of carrots and sticks.
The Kyoto Protocol places a significant burden on industrialized nations to cut emissions of greenhouse gases while allowing nations with smaller per capita GDP (including China) exemptions. The result was the creation of free-rider states and the withdrawal of large industrialized nations who felt they were shouldering most of the burden of cutting emissions. The Kyoto Protocol also lacked the necessary flexibility. As Asian countries began to absorb migration of heavy industries from developed nations, the Kyoto Protocol could not adjust and restrict new emitters (e.g., China and India) of greenhouse gases who had been exempted from the treaty. The cuts by industrialized nations that remained parties to the protocols have been dwarfed by emissions from China and other parts of Asia, South America, and Africa. Worldwide emissions of greenhouse gases have gone up by 50% since 1990 even though US contribution has decreased from 66% to 50% (Schiermeier 2012).
Contrast the failure of the Kyoto Protocol with the success of the Montreal Protocol—a treaty strongly advocated by conservative political leaders like Ronald Reagan and Margaret Thatcher. The Montreal Protocol aimed to limit production of ozone-depleting gases and does so by first creating incentives for small nations to sign on (Gillis 2013). When a non-developed country becomes a signatory, it immediately receives subsidies to help it create non-ozone-depleting alternatives. The treaty also imposes trade restrictions between those countries that have signed on and those that have not. However, the restriction does not kick in until a critical mass of nations has signed on to the treaty. The result was that after the initial surge of small nations signing on (motivated by subsidies), larger nations had a disincentive to remain on the sidelines. The Montreal Protocol has been held up as a model of an international treaty that provides flexible carrots and sticks to all nations to sign on while minimizing free riders in a game of NPD.
As Anomaly rightly points out, however, controlling ozone-depleting gases presents a set of challenges different from instituting a sustainable antibiotic global policy. For starters, there are currently no effective alternatives to antibiotics that are of similar costs. In addition, unlike the elimination of ozone-depleting gases, restricting access to, say, broad-spectrum antibiotics can have immediate and serious implications to individuals’ welfare. Internal political pressure would be of a different magnitude: trade restrictions might not be sufficient to motivate a citizen to forgo beneficial antibiotics. Monitoring antibiotic usage (i.e., compliance with a treaty) might also present far more logistical problems. Unlike a blanket prohibition of ozone-depleting gases like chlorofluorocarbon (CFC), for example, detecting inappropriate use of antibiotics would require close monitoring at the clinical level to determine if a particular prescription of antibiotic is appropriate. Given the fact that even nations that have robust healthcare monitoring systems like the United Kingdom and the United States have had an exceedingly difficult time gathering data on antibiotic usage domestically, the mechanism necessary for a global monitoring of antibiotic usage would be tremendously complex and resource intensive.