How user fees could help fight drug resistance

Ziana Ahmed, a graduate student pursuing her Master's in Economics, is the co-author of a paper published recently in the New England Journal of Medicine and attracting attention around the world for its simple proposal to combat the spread of drug resistance: user fees.

Ahmed, whose research interests centre around health, development and public economics, wrote the paper with University of Toronto alumnus Aidan Hollis, now a professor of Economics at the University of Calgary. And in the month since Preserving Antibiotics, Rationally was released, it has caused headlines throughout North America and Europe.

Ahmed spoke with U of T News about her research and her desire to use the knowledge gained at U of T to influence public policy and improve the standard of living and quality of life of Canadians.

What drew you to this field – and to U of T?
During my undergraduate career in the Arts & Science program at McMaster University I developed a strong interest in economics and health policy. After completing my degree, I was eager to continue cultivating this interest through research and further education. After hearing about Dr. Aidan Hollis’ work with Incentives for Global Health on the Health Impact Fund I was eager to collaborate with him to pursue my interest in health policy. I had little previous knowledge of issues to do with antibiotic resistance, but through extensive research with Dr. Hollis, I came to understand the critical importance of addressing this issue and opportunities for economic incentives and remedies.

I was attracted to U of T based on my desire to pursue my interest in economics. As one of the top graduate economics programs in Canada, I was confident that I would be surrounded by like-minded, ambitious students and faculty whom I could collaborate with and learn from. Specialization of many faculty members in health and development economics was also an attractive feature.

Tell us about this paper - why has it garnered so much attention?
The paper deals with the critical public health threat of antibiotic resistance. Most people are unaware that only 20% of all antibiotics consumed in the US are for humans. 80% of antibiotics are consumed in the agriculture and aquaculture industries to enhance growth.  Injudicious use of antibiotics in these industries has led to an antimicrobial resistance crisis for humans in which standard treatments are far less effective and infections persist, prolonging illness and increasing the risk of death. Thus, the focus of the paper is on how to cut down the consumption of antibiotics for non-human use in order to preserve this precious resource.

In contrast to previous proposals to ban agricultural growth promoters, we advocate a user-fee be implemented on antibiotics for non-human use. We believe this solution will be more effective than an outright ban as it is easier to administer, deters low-value uses of antibiotics, generates revenues that can be used to incentivize development of new antibiotics and finally, can be replicated on an international scale. The higher costs of antibiotics will encourage farmers to improve animal management methods and adopt substitutes for drugs, such as vaccinations.

We have been fortunate to receive international press coverage from Bloomberg, the Washington Post, South China Morning Post, Helsinki Times and various others. This topic has garnered so much attention because of its status as one of the most critical public health threats in the world. As the number of multidrug-resistant diseases increases and the stock of antibiotics continues to dwindle – urgent action must be taken for the health and welfare of society.

Why should students today study this area?
This is an important area of research given that it is affecting the health and welfare of all individuals around the world. On a daily basis we come into contact with produce that has been sprayed with antibiotics and meat that is fed with antibiotic food pellets. As we consume these foods, we are only perpetuating the resistance phenomenon. Students and consumers alike must be educated on the long-term effects of their consumption habits and how they can play a role in averting this health crisis.

What are the next breakthroughs or developments you hope or expect to see in this field?
While the Public Health Agency of Canada and FDA in the US have acknowledged the need to limit the use of antibiotics in agriculture, no concrete action has been taken. It is my hope that in the next few years, user fees and other tangible policies to combat resistance will be implemented and ideally, governments will start working together to create an international treaty as antibiotic resistance is a global phenomenon.

Government policy must be combined with increased public education and awareness of this issue. As consumers become better informed about the repercussions of their consumption habits they have a role in applying consumer pressure on farmers to adopt antibiotic-free farming practices.

More R&D to replenish the diminishing stock of antibiotics is also urgently needed. With government support and financial incentives from the user-fee revenue, I hope this becomes a reality.

Finally – it is important to acknowledge that agricultural use is only part of the problem perpetuating the antimicrobial crisis. Over-prescription of antibiotics for human use is very common and a larger effort needs to be made to educate doctors on conservation practices.

What's next for you?
My research with Dr. Hollis has shown me the important role economists can play in addressing the antimicrobial resistance crisis. After completing my Master's, I hope to continue research on this issue and work on making our proposal a reality. I am eager to use the knowledge I have gained at U of T to influence Canadian public policy on antibiotic resistance and other social issues, and advance the welfare of Canadians.