
As an update to my
all-expense-paid trip to DC (including swine flu) post from yesterday, I'm going to get a little political science-y on you. Ever heard of the
tragedy of the commons? The tragedy of the commons (similar to a collective action problem or a prisoner's dilemma) results when what's best for a
group of people conflicts with what's best for an
individual. In particular, this tragedy results when individual people, acting in their own best interests (selfishly but rationally) exploit a common resource that leads to the depletion/destruction of that resource, so that no one (including the individual) can benefit from it. The tragedy is that, unless laws are in place -- and enforced -- to prevent this type of behavior, it is bound to happen because each individual person will add to the tragedy by acting in a rational manner, trying to secure their own interests (safety, profit, livelihood, etc.). Wouldn't a rational person
realize the consequences of their actions, and thus moderate their behavior? No, because a rational person would realize that all the other rational-but-selfish individuals in society -- their "competitors," so to speak -- are going to exploit the resource for their own benefits, and so it's only smart (at least in the short-term!) to get a piece of the pie before it's all been eaten.

We see the tragedy of the commons in many areas of our lives, particularly in the environment; the over-fishing of our oceans so that some marine life is in danger of becoming extinct is a good example. We also see it in the pharmaceutical/medicinal supply chain when disease -- or the mere threat of it -- sweeps the world. In 2005, when fears of the avian flu were reaching all corners of the world, the only two anti-viral drugs that were
proven effective, Tamiflu and Relenza, were scooped up off the pharmacy shelves by people who were not (yet) affected. This created shortages of the drug all around the world that prevented people with valid prescriptions from being able to get their medicine. An individually rational decision --
I should get myself a dose of this medicine so that I will survive if I get sick -- turns into a socially irrational outcome, wherein infected people cannot get the medicine they need, thus infecting more people; and unaffected people preemptively take the medicine as protection, which allows the flu virus to become more resilient to these medicines in the future. The cold hard fact that there is a limited supply of these drugs in the world -- in other words,
there is not enough medicine for each person in the world, and if you need the medicine, you might not be able to get it -- leads to an individually selfish but completely rational decision that it's best to stockpile the medicine for yourself first, since there is a chance that the medicine could run out and not be available if you needed it -- which then leads to a self-fulfilling prophecy of the medicine, in fact, running out and hurting everyone in the process.
Which leads me back to my upcoming trip to the States. Here in Qatar, it's incredible the types of things you can get without a prescription. Birth control pills are available over the counter -- sometimes just on a shelf -- and for around 36 riyals for Yasmin, that's $9 a pack, much less than even a co-pay with insurance in the US. So I figured that Tamiflu, a prescription-only medicine in the US, was probably available here without a prescription. Considering that Qatar Airways is now
issuing masks for all crew and passengers originating from the US, as well as all employees at the Doha airport, and amid rumors of the investigation of passengers with flu-like symptoms, with the possibility of being turned away from entering their destination country, I felt it was in my best interests to see about getting a pack of Tamiflu to bring with me on my trip to the US. I won't be taking it proactively, but if I do come down with the flu while visiting DC, I want to be able to quickly self-medicate myself, both for my own health and so I won't be denied entry back to Doha. I also don't trust the pharmacies in the US to have Tamiflu in stock (again, the tragedy of the commons; see
South Florida, where not a single case has yet been reported!), so I figured I'd try my luck in Doha.
This is when I ran into the tragedy of the commons. Yes, I was contributing to the problem, but at least I had a legitimate reason for wanting to get a pack of Tamiflu: I'll be arriving in the US in two weeks, when swine flu is probably reaching its peak (in terms of infection and panic), and I need to be prepared. Do you think that this type of situation affects so many people in Doha that all the Tamiflu would be off the shelves? Keep in mind that the swine flu hasn't come to any country in the Middle East except Israel, and you would think that a Muslim country that bans pigs would be particularly shielded from an outbreak. Yet the first two pharmacies I went to both had been completely bought out of Tamiflu. Luckily (for me, not sure about the world), the second pharmacy directed me to a third, which happened to have five packs left of Tamiflu. And suddenly my mentality shifted.
As a political scientist, it's fun to step outside of yourself and study your own behavior once in a while. I know all about the tragedy of the commons. I know that individually selfish behavior will wreak havoc on the general good. And yet, the fact that it was difficult to get Tamiflu -- when I realized that other individually rational people were protecting themselves (and hurting me) by stockpiling this drug -- made me seriously consider buying all five packs that were left in this pharmacy. I started thinking, "Well, I need one. And Nick needs one. And then our closest friends will need them. I should make sure the people I love have access to this medicine first!" The speed at which I jumped from
hoping that there would be just one left for me to feel safe on my trip to
strategizing about how many packs I would need to stockpile to save the VIPs in my life was frightening. A minute before I entered that pharmacy, I would have been eternally grateful if someone had said, "Oh, I have an extra pack, here you go"; a minute after, I was perfectly willing to take away another person's chance at peace of mind (or survival).
A couple things stopped me. Yes, the price -- at $50 a pack, it really lets you come back down to reality and say, "Okay, it's not like I know people who are dying of this yet..." And yes, also, a bit of conscience. I know that I'm being part of the problem. I know that I shouldn't have bought Tamiflu before I got sick. If no one did this, then it would definitely be available for anyone who did get sick (including myself). But after seeing the government response (or lack of one) to disasters like Hurricane Katrina, I know that there is a real possibility that help would not be there for me if I needed it, and that I need to be prepared to help myself. How libertarian of me! Even anarchist! And yet, how true; how sad but how true. (For example, disease control experts recommend that governments stockpile enough medicine to treat 25-40% of their population; the highest estimates of the US stockpile are 10%, with some as low as 1%.) So I couldn't stop myself from buying two packs (one for me and one for my husband), but I left the other three sitting on the shelf, hoping that they go to individuals who need them for specific purposes, but knowing that most probably the next overreacting person who came into the pharmacy looking for Tamiflu would buy them all and take them home to place next to the nuke pills, plastic wrap, and duct tape.
So now I feel "safer" about my trip to the US, but also feel guilty, knowing that I am contributing to the
problems associated with drug hoarding. And for all of you out there who like to carp on politics and say that you see no use for politics, politicians, institutions, regulations, and the like, here's your rebuttal. The only human mechanism that has been shown to mitigate collective action problems like the tragedy of the commons is that of politics, which is the non-violent way of dividing up limited resources to a needy society. A more perfect political system (which does a better job of regulating resources like Tamiflu) would help prevent tragedies of the commons from happening, and it's something worth striving for.
By the way, does anyone in the US need me to bring them some Tamiflu? ;-)

Photo credits:
Tamiflu, Astrit Lulushi's blog (original?)Tragedy of the commons cartoon, Dave CoverlyDilbert comic, Scott Adams