The social dilemmas of climate change and antibiotic resistance: an analytic comparison and discussion of policy implications

Climate change (CC) and antimicrobial resistance (AMR) are two of humanity's most imminent existential problems (IPCC, 2018; O'Neill, 2016). A global temperature rise above 2 degrees Celsius is expected to lead to, for example, an increased frequency of droughts and flooding, generating immense human suffering (IPCC, 2018). Similarly, by 2050, about 10 million people are expected to die every year from the consequences of AMR (O'Neill, 2016). Scholars have acknowledged that the commonalities of CC and AMR are not limited to their urgency, severity and global dimension. They may also be interconnected, with climate change being a contributor to AMR, for example through the spread of disease vectors (Helwig, 2019). Additionally, the two problems share a similar underlying structure: They can both be understood as social dilemmas, in the sense that individual rationality is at odds with collective interests (Anomaly, 2010; Roope et al., 2019). People's consumption of fossil fuels and antibiotics is rational at the individual level, because it serves short-term, personal benefits: Fossil fuels provide comparatively cheap and easy access to energy needed for everyday conveniences (e.g., driving cars); and antibiotics provide efficient treatment for bacterial infections. Even though antibiotic medication often comes at a cost of immunocompromise or other side effects, these disadvantages are not well-known among the general public (Davies et al., 2013), or frequently dismissed by healthcare practitioners in the face of larger medical threats such as potential sepsis and death (Krockow et al., 2018). It is important to acknowledge the lack of viable alternatives to fully replace fossil fuels and antibiotic medication while maintaining the current standard of living. Instant cessation of all use of fossil fuels, for example, would likely lead to a collapse of the global economy and infrastructure, and antibiotics save lives and reduce suffering worldwide. However, current consumption of fossil fuels and unnecessary use of antibiotics are costly for collective goals, which include preventing rampant CC and decelerating the spread of AMR. The social dilemmas of CC and AMR require behavioural strategies (e.g., Colman et al., 2019; Milinski et al., 2008; Roope et al., 2018) and coordinated action to manage (Jagers et al., 2020). However, the existing literature falls short of a systematic conceptualisation and direct comparison of CC and AMR to form the theoretical basis for comprehensive policy suggestions. In this article, we propose to provide this urgently needed systematic analysis of CC and AMR, using game theory as a conceptual basis. We aim to provide an analytical comparison between the theoretical literature and the reality of CC and AMR. Additionally, we will present a conceptual comparison between the two social dilemmas. Both of these objectives will feed into the overall aim of discussing policy strategies to tackle CC and AMR. Specifically, we aim to address three main research questions: (1) How do core assumptions of game theory correspond to the real-world cases of CC and AMR? (2) How do CC and AMR compare in their social, political and behavioural challenges? and (3) What are the policy implications of this theoretical analysis, and what considerations need to be made when designing policy approaches to target CC and AMR? The remainder of this article will be structured as follows. First, we provide a theoretical overview of social dilemmas in the context of game theory. Next, we will present a step-by-step analysis of CC and AMR against the typical features of social dilemmas. Then, we will compare collective action approaches targeting AMR and CC, and contrast both with recommendations from game theory. Finally, we will discuss the implications of our analysis and make theory-based recommendations about the types of collective action that may prove most successful in different types of social dilemmas including CC and AMR.

The paper conducts a conceptual, theory-driven comparison of climate change (CC) and antimicrobial resistance (AMR) through the lens of game theory and social dilemmas, especially Hardin’s Tragedy of the Commons. The authors first outline defining features of social dilemmas and then analytically map real-world characteristics of CC and AMR against core game-theoretic assumptions. They structure the analysis around: - Decision makers: autonomy vs. principal–agent dynamics (e.g., prescribers as gatekeepers in AMR), asymmetries among actors (e.g., superusers, heterogeneous utilities), and information conditions (imperfect/misinformation, trust, and lack of perfect information on others’ choices). - The commons: renewability and reversibility (absorptive capacity for CC vs. evolution-driven, hard-to-reverse AMR; potential for scientific breakthroughs), tangibility/visibility, and perceived necessity. - Strategies: non-binary/continuous choice structures; ethical labelling complexities (e.g., prescribers’ pro-social motives in AMR); probabilistic, indirect links between actions and outcomes; and temporal/spatial distance that weakens reciprocity and accountability. Building on this mapping, the authors discuss policy implications using insights from experimental economics and collective action theory. They examine three policy dimensions—scale (global treaties vs. polycentric/local actions), target groups (superusers and gatekeepers), and policy design (reward/punish via economic, legal, informative instruments)—and illustrate with real-world examples. The approach is conceptual and integrative rather than empirical; no original data are collected.

- Both climate change (CC) and antimicrobial resistance (AMR) fit the structure of large-scale social dilemmas: individual incentives favor short-term overuse of a common resource (stable climate; antibiotic effectiveness), while collective welfare requires restraint and cooperation. - Significant discrepancies exist between classical game-theoretic assumptions and real-world contexts: complex actor networks with asymmetric power/impact (e.g., superusers in industry; gatekeepers in healthcare), imperfect/misinformation and low transparency, non-binary/continuous choices, weakly traceable action–outcome links, and substantial temporal and spatial distances that erode reciprocity and accountability. - Ethical framing diverges: punitive economic instruments (e.g., Pigouvian carbon pricing) are widely argued as efficient and fair for CC, whereas punitive measures for antibiotic prescribing are ethically fraught due to access concerns (especially in LMICs) and prescribers’ pro-social, risk-averse motives; exceptions may include taxing non-therapeutic agricultural antibiotic use. - Governance implications: third-party intervention is often necessary. Global agreements (e.g., akin to UNFCCC/Paris for CC) are needed for AMR but currently face a commitment–compliance gap; binding international legal mechanisms remain limited. Polycentric governance can complement treaties by enabling diverse local/national actions that aggregate to global benefits and foster learning. - Targeting key actors: transparency and reputation mechanisms for superusers (industry, hospital chains, agriculture) and tracking/publishing prescriber antibiotic rates can strengthen cooperative norms and accountability, though greenwashing risks require verification. - Policy design: combinations of economic, legal, and informational tools can be tailored as rewards or punishments. Information campaigns alone seldom change incentives but can shape social norms (e.g., “flight shame” for CC) and prepare public acceptance for more coercive policies. - Contextual data points: exceeding +2°C implies severe impacts (IPCC, 2018); AMR could cause ~10 million deaths annually by 2050 (O’Neill, 2016); evidence from experimental economics supports roles for transparency, reciprocity, and sanctions/rewards in fostering cooperation.

The analysis demonstrates that while CC and AMR share a Commons dilemma structure, real-world complexities weaken key cooperation facilitators assumed in game-theoretic models. The presence of superusers and gatekeepers, diffuse and delayed consequences, and limited transparency reduce the effectiveness of reciprocity and reputation. Consequently, third-party interventions become pivotal. The authors argue for a multi-level policy approach. International agreements are crucial to coordinate national and local actions, but mistrust among states and enforcement deficits limit effectiveness without domestic implementation and polycentric initiatives. For CC, economic penalties (e.g., carbon taxes) align with the polluter-pays principle and are broadly justifiable. For AMR, punitive instruments targeting clinical prescribing raise equity and ethical concerns; instead, focusing on agricultural non-therapeutic use, enhancing stewardship, and leveraging transparency and reputation among superusers and gatekeepers are more viable. Information strategies, properly framed to link individual actions to collective harms, can cultivate norms that support stricter future policies. Overall, aligning policy targets (superusers/gatekeepers) and instruments (economic, legal, informative) to each dilemma’s ethical and structural realities is essential to translate game-theoretic insights into practice.

The paper contributes a structured, game-theoretic comparison of climate change and antimicrobial resistance, showing both as social dilemmas with critical departures from classical assumptions. It underscores the need for binding international coordination coupled with polycentric local/national actions, emphasizes targeting influential actors (superusers and gatekeepers) with transparency to support reputation-based cooperation, and differentiates policy feasibility across dilemmas: carbon pricing is often efficient and acceptable for CC, while punitive approaches to antibiotic prescribing are ethically constrained, with more promise in curbing non-therapeutic agricultural use. Information policies, although non-coercive, can reshape norms and prepare societies for more stringent measures. Future work should develop and test enforceable international legal mechanisms for AMR, evaluate verification systems to prevent greenwashing, assess the effectiveness and equity of transparency and norm-based interventions, and explore context-sensitive combinations of economic, legal, and informative tools across diverse health and environmental systems.

- Conceptual analysis without original empirical data; findings are not empirically tested within this study. - Generalizability is bounded by the focus on CC and AMR; other Commons dilemmas may differ in structure and feasible policy mixes. - Policy typologies and examples are illustrative rather than prescriptive; effectiveness and equity impacts require context-specific evaluation. - International governance recommendations face real-world political constraints (e.g., mistrust, enforcement deficits) not resolved by the analysis.