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Stockpiling Antibiotics and the Prisoner’s Dilemma

Antibiotic resistance is a serious health concern, now and for the future. This article, by John Allen Paulos, discusses the phenomenon of stockpiling antibiotics, something he argues is due to anxiety about the future. When people fear not being able to access antibiotics (perhaps because others have been stockpiling it), they begin to stockpile antibiotics themselves. Paulos claims that this is not a rational action, because there is a minimal risk of the public health system not being able to combat an unexpected sudden emergency. In this article, though, he primarily discusses anthrax, an bacterial infection that can be serious; this logic is not necessarily transferrable out of this context. He ultimately argues that stockpiling antibiotics is “dangerous and counter-productive” for society. But why would people then do it, when weighing the costs and benefits? That leads us to the concept of the prisoner’s dilemma.

As discussed in class, the prisoner’s dilemma is the scenario where two prisoners are isolated and faced with the choice to confess or not to confess. If one confesses and the other doesn’t, the one who confessed gets off with no prison time, and the one who didn’t gets a lot of prison time. If neither confess, they still both go to prison for a short time, and if both confess, they go to prison for a medium amount of time. We can predict that both will choose to confess, because regardless of what the other prisoner chooses to do, confessing is the best option. So we predict that both will make this rational decision and confess. How does this relate to antibiotics? Paulos writes about the link between the prisoner’s dilemma model and many people’s decisions in the context of “having the choice whether to make a very small contribution to the public good or a much larger one to his or her own private gain.” These small contributions to the public, when made my many, create significant impact. Paulos calls this the “many-party’s prisoner’s dilemma”: if everyone makes small contributions to society, everyone benefits, and if others aren’t making contributions to society, you’re better off working for your private interest. With this logic in mind, if we refrain from buying antibiotics to stockpile them in case of a statistically unlikely emergency, we are contributing positively to the public by making it more available to the public in an emergency, and also reducing antibiotic resistance that comes as a result of overuse of antibiotics.┬áBy the same logic used above in discussing the prisoner’s dilemma, we can predict that people will generally choose to make contributions to society. If people are stockpiling antibiotics, others will follow suit for reasons of self-preservation, and if people are not stockpiling antibiotics, others will follow suit to improve the public good, according to the logic of the prisoner’s dilemma. In general, this logic is followed, and people don’t stockpile antibiotics, but some are doing so anyway, as a preventative measure. It’s interesting to speculate about what the threshold number of stockpilers is that would prompt the majority of people to stockpile, and thereby make it most favorable for everyone to stockpile (this would be terrible!).


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