Padiyara Ponnu, Inoue Hajime, Sprenger Marc
Yale School of Public Health, Yale University, New Haven, CT, USA.
UHC and Health Systems, World Health Organization, Geneva, Switzerland.
Infect Dis (Auckl). 2018 Apr 11;11:1178633718767887. doi: 10.1177/1178633718767887. eCollection 2018.
Since their discovery, antibiotics, and more broadly, antimicrobials, have been a cornerstone of modern medicine. But the overuse and misuse of these drugs have led to rising rates of antimicrobial resistance, which occurs when bacteria adapt in ways that render antibiotics ineffective. A world without effective antibiotics can have drastic impacts on population health, global development, and the global economy. As a global common good, antibiotic effectiveness is vulnerable to the tragedy of the commons, where a shared limited resource is overused by a community when each individual exploits the finite resource for their own benefit. A borderless threat like antimicrobial resistance requires global governance mechanisms to mitigate its emergence and spread, and it is the responsibility of all countries and relevant multilateral organizations. These mechanisms can be in the form of legally binding global governance mechanisms such as treaties and regulatory standards or nonbinding mechanisms such as political declarations, resolutions, or guidelines. In this article, we argue that while both are effective methods, the strong, swift, and coordinated action needed to address rising rates of antimicrobial resistance will be better served through legally binding governance mechanisms.
自抗生素以及更广泛意义上的抗菌药物被发现以来，它们一直是现代医学的基石。但这些药物的过度使用和滥用导致了抗菌药物耐药性的上升，即细菌以致使抗生素失效的方式发生适应性变化。一个没有有效抗生素的世界会对人口健康、全球发展和全球经济产生巨大影响。作为一种全球公共利益，抗生素的有效性容易受到公地悲剧的影响，即当每个个体为了自身利益而过度利用有限的共享资源时，一个社区会过度使用这种共享的有限资源。像抗菌药物耐药性这样的无国界威胁需要全球治理机制来减轻其出现和传播，这是所有国家和相关多边组织的责任。这些机制可以采取具有法律约束力的全球治理机制形式，如条约和监管标准，也可以是非约束性机制，如政治宣言、决议或指导方针。在本文中，我们认为，虽然两者都是有效的方法，但应对不断上升的抗菌药物耐药率所需的强有力、迅速和协调一致的行动，通过具有法律约束力的治理机制会得到更好的实现。
