(Inter)nationalising the antibiotic research and development pipeline

This paper critically examines the wider context of international efforts to stimulate commercial antibiotic research and development (R&D) via public-private initiatives. Despite these efforts, antibiotics remain a global common without an international support structure that is commensurate to the risks from antibiotic-resistant infections and the long-term nature of required solutions. To protect this common, we propose a two-pronged antibiotic R&D strategy based on: (1) a short-term strengthening of incentives, such as market entry rewards, to maximise the delivery of existing opportunities in the pipeline; and (2) a concurrent medium- to long-term establishment of a global, publicly-funded antibiotic R&D Institute. Designed to sustainably deliver novel and first-in-class antibiotics targeting key human health gaps, the Institute and its staff would become a global resource that, unlike the private pharmaceutical sector, would be managed as an open science platform. Our model of internationalised public R&D would maximise scientific synergy and cross-fertilisation, minimise replication of effort, acquire and preserve existing know-how, and ensure equitable and sustainable access to novel and efficacious antibiotics. Its genuinely global focus would also help counteract tendencies to equate donor with global health priorities. Our proposal is not radical. Historical precedent and developments in other research areas show that sustained international funding of publicly owned research can hasten the delivery of critically-needed drugs and lower access barriers.