Big corporations have mostly left the field already, and SMEs are struggling to survive, as raising money is highly difficult in the AMR space. If nothing is done quickly, most companies will have gone out of business within the next two years. Who will be left to bring new antimicrobials all the way to the market?

The sooner we come up with practical solutions, the more SMEs (and currently developed products) we can save from vanishing. We won’t find one global solution. The complexity of the task upon us calls for a diversity of solutions, whose coordination may take some time. But, we need a first move to give the signal that changes are coming.

Significant progress has recently been made in implementing different PUSH financial incentives (CARB-X, etc.), and we are encouraging further extensions, possibly through the upcoming EU Horizon Europe framework programme. But, the recent failure of Achaogen reminds us that R&D financial de-risking is only one part of the solution. More should be done to attract private investors back to the field and ensure sustainable business.

The salvation may come from a range of PULL incentives. To be effective, the proposed mechanisms should provide a renewed investment profile and allow companies to present a viable business case.

As a first fix, reforms must be engaged to enforce the fair pricing assessment of antimicrobials’ societal value. Reimbursement protocols should also be modified to unleash the budgetary constraints that are currently preventing hospitals from delivering the most appropriate treatment to their patients. Finally, some buying commitment mechanisms should help to secure a minimal market uptake during the first commercialization years of the newly approved drugs. Otherwise, the Achaogen story will repeat over and over again.

More is needed to reshape a sustainable AMR market. But, without a quick start, there will soon be no companies left to support.

First published in European Biotechnology Magazine, Summer Edition 2019.