Invisible Threat: How Airborne Pollution Fuels Antimicrobial Resistance in the EU
TSE Working Paper N. 25-1610. Job Market Paper. (Click here to see the latest version)

Abstract: Recent scientific research suggests that the environment represents an important pathway for the spread of antimicrobial resistance (AMR). This paper is the first to provide causal estimates of the impact of fine particulate matter (PM2.5) on AMR diffusion. I focus on EU countries and the period 2002 to 2019. To pin down causal effects, I use an instrumental variable approach that exploits temperature inversions as a source of exogenous shocks to air pollution. I find that a 1% increase in PM2.5 leads to about a 0.7% increase in average antibiotic resistance, but there is significant heterogeneity across pathogen-antibiotic combinations in their responsiveness to changes in pollution. I then separately estimate the direct impact of pollution on resistance, as well as the impact of an indirect channel via antibiotic consumption. When antibiotic use is accounted for, the direct influence of air pollution on AMR remains sizable and significant. Finally, I provide a counterfactual analysis assessing the impact of alternative air pollution control policies on resistance and compare their effectiveness vis- à-vis interventions aimed at reducing antibiotic use in humans. Findings imply that pollution reduction policies can be fruitfully leveraged in the fight against AMR propagation.

Outreach: Economics of antibiotics & antibioresistance journal (TSE Health Center).

COVID-19 and the role of inequality in French regional departments
with Victor Ginsburgh and Glenn Magerman. European Journal of Health Economics, 22: 311-327 (2021).
DOI: https://doi.org/10.1007/s10198-020-01254-0. 

Prescription Opioids and Economic Hardship in France
with Mathias Dewatripont, Victor Ginburgh, Michel Goldman, and Patrick Legros. European Journal of Health Economics (2023).
DOI: https://doi.org/10.1007/s10198-022-01557-4.
Media coverage: LeMonde, Médor (1/2), Médor (2/2), lepharmacien.be, Alternatives Economiques, ARTE tv.

Economic Opportunity and Opioid Regulation: the Case of Codeine in France
TSE Working Paper N. 24-1563. Previous Job Market Paper. (Click here to see the latest version)

Abstract: Policies restricting access to opioid medications are often powerful tools to reduce misuse, but their effectiveness may vary depending on local socioeconomic conditions. This paper shows how economic disadvantage shapes the magnitude of responses to such policies, focusing on a 2017 French regulation that banned over-the-counter (OTC) sales of Codeine-containing drugs. I first estimate the causal impact of this regulation, using a difference in differences (DiD) approach and monthly sales data for the 94 departments of Metropolitan France. I then exploit cross-department variation in the prevalence of poverty to examine heterogeneous policy responses. I find that the policy led to a significant reduction in overall Codeine consumption, but departments in economic disadvantage experienced smaller decreases in consumption. This shows that demand-side factors can amplify or hinder the effect of supply-side interventions. I further investigate substitution patterns by using data on non-opioid analgesic use, emergency department (ED) visits, and drug-related crimes. Finally, I consider potential dynamic effects and quantify the long-term policy impact. Results imply that increased barriers to access should move in parallel with additional measures addressing the most deprived local communities to ensure that regulatory efforts do not exacerbate existing health disparities.