Governance of collective action: The case of antibiotic policy in Europe
Short description
Antibiotic resistance, caused by overuse of antibiotics in health care and veterinary medicine, is an acute global threat to public health. Curbing the use of antibiotics is a classic collective action (CA) governance challenge. In theory, the EU can limit misuse of antibiotics by institutions promoting CA, but it may be tempting for individual member states to ignore such efforts. However, contemporary CA research displays two contending theories of CA; one theory based on rational choice and another theory departing from rules and social norms advocating collective behavior.
The project concludes that policymakers can do the most good by ensuring that the financial resources are in place to address these complex issues, but should otherwise leave the responsibility for reducing antibiotic use to experts in the field. The results have been published in 14 papers in leading journals, including a doctoral thesis.
Background
Governments around the world face a number of severe shared challenges, ranging from climate change, and overexploitation of various resources to global health-related quandaries. These challenges typically take the form of collective action dilemmas, i.e. they require the active and concerted involvement of essentially all actors which, at the same time, all have incentives to defect or defer their part of the execution of joint policies. This dilemma occurs when actors’ self-interest is at odds with collective interests and where promoting the common interest calls for investment or self-restraint.
Antibiotic (or antimicrobial) resistance is one of the most acute global challenges to public health, causing substantial morbidity and mortality and threatening society’s ability to attain benefits from modern medicine. Antimicrobial resistance is already estimated to cause 700,000 deaths per year worldwide, and if resistance is left unchecked, it is, by 2050, expected to cause 10 million of deaths every year. As the World Health Organization (2014) cautions, “a post-antibiotic era — in which common infections and minor injuries can kill — far from being an apocalyptic fantasy, is instead a very real possibility for the 21st century”.
The key driver of antimicrobial resistance is the overuse of antibiotics in terms of treatment of humans or in farming animals for human food consumption. Yet consumption of antibiotics in the EU member states differs greatly between countries, which is unrelated to the prevalence of bacterial infections in each country. Thus, there is a growing consensus that overconsumption of antibiotics is caused by cultural, social and institutional factors and that widespread inappropriate use of antibiotics in health care and in the agricultural sector in the EU must come to an end.
However, curbing the use of antibiotics in the EU is a quintessential collective action governance challenge. The institutional system of the EU provides good opportunities for coordinated measures across the Union to curb the use of antibiotics and, by extension, to limit the growth of antibiotic resistance. However, despite the urgency of reducing the global use of antibiotics, since each EU member state’s contribution to the overall levels of antibiotic resistance is limited, there is little incentive for each member state to limit their antibiotic use. Implementing programs to limit antibiotic consumption puts pressure on health care systems and may lead to lower profits and competitiveness in the agricultural sector. While all countries have a long-term interest in curbing mortality and health sector expenditure, no countries have economic incentives to be a forerunner in that process.
Moreover, while the adversary effects of excessive antibiotic use have been detected at the point of the invention of antibiotics, regulation of antibiotic use has been lagging. The EU has requested all member states to implement the new EU One Health Action Plan against Antimicrobial Resistance. One part of this recommendation is that antibiotics for human use must be prescribed and administered by a physician. However, this is only a guideline and there are cross-country variations in the degree of implementation. Furthermore, in 2006 the EU installed a ban on antibiotics in livestock use for growth purposes. This is dependable by law, but there are still large variations in how well this law is implemented in the member states.
To be successful in promoting prudent use of antibiotics, all member states must submit to and implement the EU’s laws, directives, and recommendations; yet all member states have economic incentives to delay or obstruct implementation, as already mentioned. Submitting to an EU regime furthermore challenges notions of national autonomy and domestic regulatory practices among the member states’ public service. Coordination problems across the EU are furthermore exacerbated by the limited formal jurisdiction of EU institutions in the antibiotics policy area. In addition, each member-state institution charged with the implementation of the antibiotics policy must rely on the positive involvement of regional and sometimes also local institutions as well as organized interests in the agricultural markets.
An intriguing feature of political and institutional behavior is that collective action is frequently successful in achieving sustainable policy outcomes even when conventional rational choice-based collective action theory would predict otherwise. Action is not invariably driven by expected utility but is often guided by behavioral factors like formal or informal rules or social norms, such as trust and reciprocity, prescribing collaboration to address common problems. Some argue that collective action requires coercion to get actors to submit to a collective action regime while others maintain that collective action can be achieved in the absence of formal authority. In the case of antibiotic use, coercion alone is not a very efficient option. This is partly because the EU does not have full coercive authority on all the issues related to this set of policy problems and partly because even when the EU does have such authority we can see that member states differ extensively with respect to their willingness to transpose EU legislation and directives into their domestic regulatory frameworks. This opens up for the use of non-coercive instruments to promote collective action.
Indeed, given recent advances in behavioral research in economics, political science and public administration, contemporary collective action research displays two contending theories of collective action; one theory based on rational choice and another theory departing from rules and social norms prescribing collective behavior.
Research question
Against this backdrop, the overarching research question in this project is to what degree governance towards collective action in this complex policy area is primarily explained by rational, goal-oriented behavior among key actors in the European antibiotics policy space, or whether such behavior is shaped by social norms, formal and informal rules and reciprocity among those actors. The project thus speaks to collective action theory and governance theory. Instead of, as is common in collective action research, excluding contextual factors such as agency or institutional path dependencies the project embraces social complexity and administrative behavior, as we stipulate that the success or failure of collective action is often explained by such contextual factors.
By approaching the topic of human and animal antibiotic consumption from a collective-action and governance theory perspective, the overall aims of this project are to
- uncover institutional and actor-related obstacles to concerted and collective EU action towards prudent antibiotic use; and
- to use this empirical case to test the analytical and explanatory capacity of contending theories of collective action. Test the analytical and explanatory capacity of contending theories of CA.
Publications
Baekkeskov, E. and J. Pierre. 2024. Introduction to Special Issue: More than medicine: Antimicrobial resistance (AMR) as a social and political challenge that can be overcome. Journal of European Public Policy 31:3941-57.
Carelli, D. 2024. Bugs and Bureaucrats: Institutions, Administrative Autonomy, and the Governance of Antibiotic Resistance. PhD dissertation, University of Gothenburg.
Carelli, D. 2024. Drivers of transnational administrative coordination on super-wicked policy issues: The role of institutional homophily. Governance (included in PhD dissertation).
Carelli, D. 2024. From Ignorance to Awareness: Quality of Collaborative Governance Enhances Public Awareness of AMR. Social Science and Medicine (included in PhD dissertation).
Carelli, D., E. T. Mitsouli, J. B. Ogne and J. Pierre. 2023. The Best Laid Plans? International Governance Perspectives in AMR National Action Plans in Europe. European Journal of Public Health 33, 682-6.
Carelli, D., J. Ogne and J. Pierre. 2024. Coming of age: governance challenges in updated AMR national action plans in the EU. European Journal of Public Health, 34, 885-9.
Carelli, D. and J. Pierre. 2024. When the cat is away: How institutional autonomy, low salience, and issue complexity shape administrative action. Public Administration 102, 207-21 (included in PhD dissertation).
Carelli, D., J. Pierre and B. Rönnerstrand. 2023. Contested governance of collective action against AMR in the EU. In Steering Against Superbugs: The Global Governance of Antimicrobial Resistance, edited by O. Rubin, E. Baekkeskov and L. Munkholm (Oxford: Oxford University Press), 71-82.
Lampi. E. D. Carelli, J. Pierre and B. Rönnerstrand. 2023. Two Pandemics: The COVID-19 Pandemic´s Impact on Future AMR Collaboration in Europe. Humanities and Social Sciences Communications – Nature 10, Article Number 44.
Lampi, E. and B. Rönnerstrand. 2024. What makes a leader? Antimicrobial resistance leadership among 29 European countries. Journal of European Public Policy 31,4008-34.
Pierre, J. 2025. Bad bureaucrat: Administrative autonomy and bureaucracy bashing. In Handbook of Administrative Autonomy, edited by B. G. Peters (Cheltenham: Edward Elgar).
Pierre, J., D. Carelli, E. Lampi and B. Rönnerstrand. 2022. The governance challenge of antimicrobial resistance in Europe: results from an international expert survey. Mimeo. University of Gothenburg.
Pierre, J., D. Carelli and B. G. Peters. 2024. The Four Worlds of Politics and Administration: How Institutional Arrangements Shape the Struggle Against Antimicrobial Resistance. Journal of European Public Policy 31:4088-4115.
Pierre, J., D. Carelli and B. Rönnerstrand. 2024. Free riding is not the problem: How agency, heterogeneity and authority challenge collective action against antimicrobial resistance in the European Union. Journal of European Public Policy 31:4035-62.
Rönnerstrand, B., D. Carelli, J. Pierre and E. Lampi. 2022. Leviathan versus the super bugs: free riding drives support for EU power over antimicrobial resistance. Journal of European Integration 44, 1041-57.
Research group
- Daniel Carelli, Doctor, Department of Political Science.
- Elina Lampi, Senior Lecturer, Department of Economics.
- Jon Pierre, Professor and PI, Department of Political Science.
- Björn Rönnerstrand, Researcher, The SOM Institute, University of Gothenburg.
Interns
Elisavet Mitsouli and Josefin Ogne.
