Laura J. V. Piddock, Jean-Pierre Paccaud, Seamus O’Brien, Michelle Childs, Rohit Malpani, and Manica Balasegaram

https://doi.org/10.1093/cid/ciab887

Antibiotics underpin modern medicine and are critical for pandemic preparedness. Push funding has revitalized the preclinical anti-microbial resistance (AMR) pipeline and government funding via CARB-X and BARDA, as well as private sector–led investment via the AMR Action Fund, will help several new antibiotics obtain regulatory approval. Nevertheless, revenues generated by new antibiotics are not considered sufficiently profitable by commercial developers to address unmet need. The question remains: Who could viably fund development and secure global equitable access for new antibiotics? Public health need should be the primary driver for antibiotic development. Improved prioritization and government oversight by funders who allocate public resources are a needed first step. In this framework, nonprofit research and development organizations, with support from public funders, and unconstrained by commercial profitability requirements are well positioned to work with public and private actors to viably provide new antibiotics to all in need.