I am an ardent defender of people being free to choose what they do with their own life, even when I would not make the same decision. Partly this is because studying economics gave me an appreciation of how individual decision making is surprisingly effective at producing good outcomes, and partly it is me following the golden rule: I don’t like people telling me what to do so I try to refrain from telling others what to do.

I make an exception when it comes to antibiotic use.

The difference being that most health choices that people make primarily affects themselves. However, when people misuse antibiotics this presents a direct threat to my health. Misuse increases the risk of bacterial resistance to antibiotics which compromises the effectiveness of treatments I may need in the future. In economics, we call this an externality – when the choice an individual makes has a direct flow on effect to a third party. When externalities are present the result of individual decision making is not likely to be the best possible outcome.

When it comes to antibiotics there are a number of ways in which individual decision making is clearly causing bad outcomes. When people demand antibiotics to treat illnesses that do not require it, they are not considering the contribution their unnecessary use will make to future resistance. One more person taking antibiotics won’t make much of a difference, right? And if it helps this pesky cold go away then so be it!

Thankfully, in New Zealand we do have safeguards in place to mitigate overuse. Antibiotics are only available by prescription from a medical professional. This is a major step in combatting overuse that could occur if patients were able to self-medicate. Sadly, many countries do not have these responsible safeguards in place and overuse is rampant.

Doctors who are too willing to prescribe antibiotics to placate patients are part of the problem. The Center for Disease Control and Prevention estimates that one in three prescriptions for antibiotics in the US are unnecessary. Monitoring prescribing behaviour by doctors is important to ensure responsible prescription behaviour is taking place.

Incorrect usage after prescription is another issue. For example, people who stop taking antibiotics before finishing the prescription increase the risk of bacteria developing resistance to antibiotics. It is not easy to prevent this from happening but the government can take an active role in education campaigns to inform and persuade the public to use antibiotics correctly.

Agricultural usage is also a major concern. Antibiotics can play an important role in reducing bacterial disease in farm animals, especially important for animals living in cramped conditions which are particularly susceptible to outbreaks. However, the use of antibiotics at the farm contributes to growing resistance. Regulation to monitor agricultural usage is critical. So too is regulation to ensure farm conditions are suitable to limit the risk of disease. Consumers can also help here by choosing to purchase free-range eggs and meat, or reducing their consumption of animal products.

Antibiotic resistance is a looming threat that could have far-reaching and deadly consequences. A world where we cannot rely on antibiotics to treat infections is a very scary thought but a very real possibility if we do not take action. We take antibiotics for granted at our peril.

There are many things that both the public and the government can do to combat antibiotic resistance, but the first step is to raise awareness. Campaigns like Antibiotic Awareness Week and InfectedNZ are crucial to addressing this growing problem.

So when it comes to most health choices individuals make, I’m happy to live and let live, even when the choices may not seem like a good idea to me. But when it comes to antibiotics, I want a firm regulatory hand of government to ensure responsible use. My future health may depend on it.


Dr Rachel Webb is a research fellow at the New Zealand Initiative. She has a PhD in economics from the University of Canterbury, specialising in the area of health economics.

What is InfectedNZ?

Hey, Aotearoa. It’s time we had a chat about infectious diseases and what we’re going to do about the looming antimicrobial armageddon. That’s why we’ve asked leading health, social and economic researchers, and people with personal stories, to help us get real about our vulnerability and discuss solutions. Follow their blogs right here at tepunahamatatini.ac.nz and watch the conversation spread across social media with #infectedNZ.

Backing it all up, wherever possible, is data from the good folk at Figure.NZ. Their super duper charts are based on data sourced from public repositories, government departments, academics and corporations. Check out their #infectedNZ data board and sign-up to create your very own data board on any topic that floats your boat.