Beyond resistance: alternative innovation models for global access and stewardship of new antibiotics

The development of new antibiotics—together with ensuring equitable access and responsible stewardship—is essential to combating AMR. To assess how today’s antibiotic innovation ecosystem supports this goal, researchers reviewed the literature, built a database of 211 antibiotic developers, and interviewed 10 stakeholders. They found that while some companies still follow the traditional market-driven model, most now work within two alternative innovation models.

The most common is the Publicly-Supported Private Initiative (PSPI) model, in which small and medium-sized enterprises receive public or philanthropic funding. This model supports R&D but does not adequately ensure global access and stewardship. The second and more promising model is the Collaborative Network (CN) model, in which public, private, philanthropic, and not-for-profit actors (e.g., Wellcome, CARB-X, GARDP) share resources and coordinate efforts to achieve innovation, access, and stewardship simultaneously.

Although the CN model holds the greatest potential, it is still emerging and must prove it can deliver results. As the norms and rules governing the antibiotics field evolve, policies such as pull incentives will determine which models thrive. Policymakers should therefore design incentives and frameworks that support innovation models capable of jointly delivering new antibiotics with equitable access and responsible stewardship.