“So far, the international response has been feeble,” wrote Jeremy Farrar, the director of the Wellcome Trust, the UK’s largest medical research charity, and Mark Woolhouse, University of Edinburgh professor of infectious disease epidemiology, in a tubthumping commentary published in the scientific journal Nature in May and presented at a press conference at the Royal Society (giving the proposal the imprimatur of the august scientific body).

The commentary took aim at the World Health Organization in particular, which in April issued its first ever report tracking antimicrobial resistance worldwide, finding “alarming levels” of bacterial resistance. “This serious threat is no longer a prediction for the future, it is happening right now in every region of the world and has the potential to affect anyone, of any age, in any country,” the authors warned.

Despite the acceleration of this universal risk, the UN body responded by simply calling for better surveillance. “The WHO missed the opportunity to provide leadership on what is urgently needed to really make a difference,” the authors wrote, acknowledging that surveillance is vital, but radically insufficient.

The growing threat from what are popularly termed “superbugs” is similar to that posed by climate change — they are “a natural process exacerbated by human activity and the actions of one country can have global ramifications,” according to a parallel statement put out by the two authors’ organizations.

They are not the only researchers or clinicians that have made the comparison between drug resistance and climate change. Last year, Davies described the situation as a more dangerous risk than terrorism, and a greater threat to humanity than global warming, telling the BBC,  “If we don’t take action, then we may all be back in an almost nineteenth century environment where infections kill us as a result of routine operations.”

So many medical techniques and interventions introduced since the 1940s depend on a foundation of antimicrobial protection. The gains in life expectancy that humanity has experienced over this time depended on many things, but they would have been impossible without antibiotics. Prior to the development of antibiotics, bacterial infections were one of the most common causes of death.

We need to keep discovering new classes of antibiotics because over time, the bugs that are susceptible to the drugs are eradicated. Those with random mutations that make them resistant survive, reproduce, and eventually dominate. This is just evolution.

And yet for almost three decades, there has been a “discovery void.” No new class of antibiotics has been developed since the use of lipopeptides in 1987. The reason for this is straightforward: big pharmaceutical companies have refused to engage in research into new families of antibiotic because such drugs are not merely unprofitable, but are antithetical to capitalism’s operating principles. The less they are used, the more effective they are.

As these firms readily admit, it makes no sense for them to invest an estimated $870 million per drug approved by regulators on a product that people only use a handful of times in their life, compared to investing the same amount on the development of highly profitable drugs that patients have to take every day for the rest of their lives.

Some governments have begun to partially recognize this market failure. The European Commission has set aside €600 million for an “innovative medicines” program endearingly named “New Drugs 4 Bad Bugs.” But the scale of investment allotted by governments to this solution remains inadequate.

Hence Farrar and Woolhouse’s demand for the establishment of a global, scientific body that’s up to the challenge. The new intergovernmental organization would exist to marshal evidence on drug resistance and to encourage policy implementation. Working with national governments and international agencies tasked with implementing its recommendations, it would set strict targets to stem the loss of drug potency and speed up the development of new therapies.

An Intergovernmental Panel on Antimicrobial Resistance would be welcome if it allowed for greater coordination of information sharing, surveillance, and analysis.

But to whom would this scientific policy recommendation body report? What overarching structure would decide what is to be done and then implement those recommendations?

While distinct problems, one has to presume that like climate policy, it would require a copy of the IPCC’s twin, the conference of parties to the UN Framework Convention on Climate Change (UNFCCC). The IPCC was established in 1988 by the UN Environment Program and the World Meteorological Organization. Four years later, the IPCC played a key role in the creation of its diplomatic corollary, the UNFCCC, a quadrennial space for horse-trading between governments that all but collapsed in 2009 in Copenhagen and which has moved hardly at all since.

We as a species are once again confronted by a difficult issue, with worldwide political and economic implications, and without a global democratic body to address it. And the only option imaginable is a process of technocratic and diplomatic decision-making.

Drug resistance and climate change are hardly the only topics like this. As the IPCC itself proudly declares, the relationship between it and the UNFCCC has become a model for interaction between science and decision makers, and a range of efforts have been mounted in the years since their founding to construct similar assessment and policy processes for other global issues.

In 2012, under the aegis of the UN Environmental Program (UNEP), the Intergovernmental Platform on Biodiversity and Ecosystem Services (IPBES) was established, but in partnership with parties signatory to multiple UN conventions, including those covering biological diversity, endangered species, migratory species, plant genetic resources, and wetlands: an “IPCC for biodiversity.” And a similar structure is currently being set up to bring together experts and officials into a subsidiary body of the conference of parties to the UN Convention on Combating Drought and Desertification: an “IPCC for deserts and dustbowls.”

For some, even the IPCC/UNFCCC is excessively politicized (read: democratic). Johan Rockstrom, the head of the Stockholm Resilience Centre, and Will Steffen, director of the Australian National University Climate Change Institute are two of the world’s leading climate strategists, and are best known for their development with twenty-six other researchers of the Earth-system concept of “planetary boundaries,” a framework for understanding “a safe operating space for humanity” — not just as it relates to climate change, but ocean acidification, pollution, ozone depletion, and others.

Rockstrom and Steffen call for a “global referee” independent of elected governments to ensure humanity does not exceed these boundaries: “Ultimately, there will need to be an institution (or institutions) operating, with authority, above the level of individual countries to ensure that the planetary boundaries are respected. In effect, such an institution, acting on behalf of humanity as a whole.”

They suggest the creation of an Earth Atmospheric Trust, “which would treat the atmosphere as a global common property asset managed as a trust for the benefit of current and future generations.” But how would the governors of such a trust be picked? Elected by the people of the Earth, or appointed by technocrats?

To be clear: the concern is not over the international aggregation of expertise in a particular topic. Who could oppose such a necessary pooling of knowledge and intellectual resources? Rather, the worry is that we have not properly interrogated this particular IPCC/UNFCCC model nor adequately wrestled with how expertise is imbricated with anti-democratic global governance and its retreat from norms of public accountability, participation, and popular decision-making.

Not all those asking questions about the IPCC and UNFCCC’s democratic deficit are climate denialists. Indeed, it is precisely those concerned about the ramifications of anthropogenic global warming who should be most worried about the galloping tendency of elites to remove decision-making from direct democratic control and the realm of political contest.

For Harvard science and technology studies researcher Sheila Jasanoff, there are a number of pertinent questions: what is the demarcation line between scientific and political institutions? How do governments construct what she calls “public reason” — those forms of evidence and argument used in making state decisions accountable to citizens? Are these new structures apolitical in service of the general interest, or do they provide unacknowledged protections to particular groups whose interests are at odds with the rest of humanity?

Riffing on this idea, German sociologist Silke Beck and her colleagues ask in a recent paper on the structures of the IPCC and the IPBES that we at least explore “the full range of alternative institutional design options as opposed to implementing a one-size-fits-all model of expertise.”

“So far,” says Beck, whose research focuses on new forms of environmental and science governance, “no debate has ever taken place about the IPCC’s relationship to public policy and to its various global ‘publics’ or about its normative commitments in terms of accountability, political representation, and legitimacy.”

In the last two years, there have been talks among stakeholders on the future of the IPCC, but participants in these closed-door meetings are bound by strict confidentiality agreements, and journalists and researchers have been shut out.

In a parallel fashion, great swathes of legislative topic areas such as monetary policy, trade, intellectual property, fisheries, and agricultural subsidies that used to be debated openly in democratic chambers are now drafted, amended, and approved in backroom arenas.

It’s what sociologist Colin Crouch calls “post democracy”: while the pageantry of general elections proceeds, decision-making takes place not in legislative bodies, but in closed-door, treaty-based negotiations between government leaders or diplomats, advised by experts.

In the case of the European Union, the most advanced technocratic governance space in the world, we can add to the list of topics outside democratic debate: fiscal policy (that is, all spending decisions) and labour market regulation, those core policy areas that, apart from defense and policing, perhaps define most what it is to be a state.

Since the advent of the Eurozone crisis, the European institutions have successfully insulated economic decision-making from electorates and shifted it to the junta of experts of the European Commission, the Council of Ministers, the European Central Bank, the European Court of Justice, or even ad hoc self-selecting groups of key players in the European institutional mosaic.

The Eurozone catastrophe was so grave that the EU no longer had time for “political games” or “politicization,” as outgoing commission president José Manuel Barroso and council president Herman Van Rompuy repeatedly stressed. In other words, they no longer had time for democracy.

It’s a common sentiment among elites. The incoming commission chief and ex-head of the Eurogroup of nations using the single currency, Luxembourger Jean-Claude Juncker, notoriously said a few year ago: “Monetary policy is a serious issue. We should discuss this in secret, in the Eurogroup,” he told a meeting on economic governance organized by the European Movement, not realizing the meeting was open to journalists. “I’m ready to be insulted as being insufficiently democratic, but I want to be serious. I am for secret, dark debates.”

The IPCC/UNFCCC model, the EU, and similar post-democratic structures also operate on the basis of consensus among “stakeholders,” rather than majority rule through democratic popular mandate. In other words, policy-making has been globalized, but democracy has not.

Consensus delimits the range of policy options available to those that are amenable to all stakeholders, potentially excluding policy options that may actually solve the given problem if it threatens the interests of a particular stakeholder. The possibility of overruling or even eliminating a stakeholder is precluded by this form of decision-making. The policy window is thus highly circumscribed, and incremental change is favored over dynamism and innovation. Such policy lethargy is not desirable when it comes to existential threats.

The argument for democracy, then, is not just one of principle. The UNFCCC’s post-democratic, consensus-based structure is one of the reasons why climate negotiations are perennially stalled.

And so it would be with a comparable governance model for drug resistance. Farrar and Woolhouse explain that such a strategy is necessary because “the scientific and business worlds need incen­tives and a better regulatory environment to develop new drugs and approaches.”

The pharmaceutical companies are thus considered stakeholders to be welcomed at the table, operators that need to be incentivized to change their ways rather than the key structural obstacle to be overcome. Such incentives include tax credits or grants for priority antibiotic development, “transferable priority review vouchers” that expedite regulatory review for another product of the company’s choosing, advance-purchase commitments, and patent-life extensions.

The concept of advance market commitments mdash; in essence, when a government guarantees a market for a successfully developed medicine — is promoted by the World Bank and free-market think-tanks like the Brookings Institution as a solution fills the gap left by market failures while leaving capital’s profits unchallenged.

The most elementary and cheapest solution would be the socialization of the pharmaceutical sector, permitting the democratic redirection of revenues from profitable therapies to subsidize R&D in unprofitable areas. Prior to privatization across the West, this cross-subsidization model permitted postal, rail, bus, and telecommunications services to be provided to remote regions, as revenues from the urban centers balanced things out in the interest of universal service.

But such a simple model is not merely off the table because it is politically unrealistic. It is off the table because the very structure of consensus-based intergovernmental and stakeholder decision-making does not allow such solutions to even be raised.

In a clarifying recent paper on the growing preference in some quarters for what he terms environmental authoritarianism, science and technology policy researcher Andy Stirling writes that “democracy is increasingly seen as a ‘failure,’ a ‘luxury,’ or even ‘an enemy of nature.’. . . So, knowledge itself is increasingly imprinted by the age-old preoccupations of incumbent power with rhetorics of control. It seems there is no alternative but compliance — or irrational denial and existential doom.”

On the contrary, Stirling argues, democratic struggle is the principal means by which sustainability is shaped in the first place — and we should view antibiotics as a precious resource to be carefully shepherded and sustained. “[C]oncentrated power and fallacies of control are more problems than solutions . . . among the greatest obstacles to [progressive social transformation], are ideologies of technocratic transition.”

A couple of thought experiments to underscore the point: first, French economist Thomas Piketty recently proposed a confiscatory global wealth tax as a solution to capitalism’s inherent tendency toward ever-greater inequality. It has to be global, he rightly says, in order to avoid inter-state competition to deliver the lowest tax rates.

But imagine if this policy were taken seriously for implementation. How could such a tax be imposed by any agency other than an elected, global government with a strong mandate to do so? A model based on the UNFCCC or EU structures would end up mired in years or decades of fruitless discussion, at best resulting in a highly watered down version that all stakeholders could agree to — much like the dismal, foundering effort to introduce a Tobin Tax across Europe.

A second thought experiment: If we discovered tomorrow that a large near-Earth asteroid were on a course for the planet and was due to obliterate human civilization in five year’s time, which would be your favored mechanism of developing a planetary defense system and mounting a mission to divert it?

A global, democratically elected government that could within weeks pick the best plan after receiving advice from experts and then rapidly direct resources to where efforts would be most efficient and likely to succeed?

Or a series of multilateral stakeholder talks debating for most of those five years who would bear the bulk of the cost (If you’re familiar with the “climate finance” debate, try “asteroid finance”); which country would get the most jobs from the project; which companies would win the contracts; how to share data, technology, and best practices; and which city would get to host the project secretariat?

About fifteen years ago, the global justice movement mounted a critique of this kind of extra-democratic decision-making, focusing on its incarnation in international institutions like the WTO, the World Bank, the IMF, and the G8, and in “investor rights” chapters and investor-to-state dispute settlement clauses in trade agreements that permit democratically approved legislation and regulations to be overturned by closed-door, unelected trade tribunals.

Similarly, the struggle today against EU-imposed austerity across southern Europe — often led by veterans of those millennial street battles — also involves a critique of the steady removal of ever larger sections of fiscal policy from the realm of democratic control.

But for the most part, this critique of post-democracy has amounted to little more than a demand for a return of national sovereignty. Globalization is neoliberal and undemocratic; therefore, we propose the small and local. European integration is austerian and technocratic; therefore, we propose a break-up of the EU.

Conversely, the recognition that existential threats such as drug resistance and climate change must be confronted at the global level often causes well-meaning, pragmatic people to embrace the creation of international, but post-democratic structures.

Yet there is a third option that is both better suited to the task and intrinsically preferable to the status quo: genuine transnational democracy, both at the continental and global level. This means an abandonment of polite but undemocratic stakeholder negotiation between bureaucrats, diplomats, and their experts, and the welcome return of robust ideological antagonism, of majority rule, and messy clashes of radically different ideas and programs, of what Stirling calls “open, unruly political struggle” — of democracy.

Existential threats are not just scientific, medical, or environmental problems. They are also social, political, and economic problems, and that is why democratic struggle is the solution that suits them best.

What precisely this could look like is beyond the scope of this essay. Perhaps a UN Parliament from which a global prime minister and cabinet were drawn, with similar models in Europe (meaning a dissolution of the unelected commission and indirectly elected council) and on other continents. The exact contours are not for me to describe anyway: if global governance is to be democratic, then by definition it has to be fought for and built by grassroots democratic movements. It cannot be an elite inspiration or construction.

But it is long past time that we set aside the idea that global government is a utopian — or dystopian — fantasy. It’s already happening, and we do need it desperately to deal with the global scale of problems we now face. Global government is here. We need to make it democratic.

Democracy is the Enlightenment sibling of science. It is no barrier to solving problems like antibiotic resistance and climate change. Rather, it is, as it has always been, humanity’s best hope.