Incentives for R&D

This webpage summarizes key reports (just below) and newsletters about ways to fund the antibiotic ecosystem. For summaries of needed types of antibiotics and analyses of the state of the global pipeline, go to this webpage.

Key Reports on Ways to Fund the Antibiotic Ecosystem

  • 2014: Eastern Research Group for the US Department of Health and Human Services: link
  • 2015: Chatham House in London: link 
  • 2016: UK AMR Review led by Lord Jim O’Neill: link
  • 2017: Duke-Margolis Center for Health Policy (11): link
  • 2018: DRIVE-AB for the European Union: link 
  • 2020: United States Government Accountability Office: link
  • 2020: WHO-sponsored survey: Gotham et al. Reimbursement models to tackle market failures for antimicrobials: Approaches taken in France, Germany, Sweden, the UK, and the US. Health Policy, 2020 (
  • 2021: EU-JAMRAI-sponsored survey of interest in incentives by policymakers in 13 countries (10 from EU plus Canada, South Africa, and Japan)
  • 15 Feb 2021 position paper from IFPMA entitled “Global Principles on Incentivizing Antibiotic R&D
  • 24 Mar 2021: the AMR Alliance Japan and the Nikkei FT Communicable Diseases Conference Asia Africa Medical Innovation Consortium (AMIC) AMR Consortium released calls for pull incentives in Japan that suggest delinked rewards of 20-80 billion yen (~$200-800m) over ten years. Go here and here for documents in English, here and here for Japanese. Also of interest are an 11 Jan 202 newsletter giving some of the history of antibiotics in Japan, multiple prior documents from the Japanese Pharmaceutical Manufacturers Association (JPMA) on the need for Pull incentives (link), and the calls for Pull incentives in the report from the Nikkei FT 7th Communicable Diseases Conference (6 Nov 2020).

Newsletters about value, incentives, and funding

  • 1 Nov 2021 (link): “Appropriate Pull Incentive For New Antibacterials: $2.2-4.8b For Full Delinkage” – An open-source modeling exercise has amended oversights in prior models. The UK’s “Netflix” model and the US PASTEUR Act are right on target for each country’s fair share.
  • 14 Sep 2021 (link): “Outstanding Discussions Of Pull, The NHS Pilot, And Antibiotic Value” — A review of the 26-28 Aug 2021 annual BEAM Alliance meeting. Lots of good video discussions.
  • 20 Aug 2021 (link): “‘Astonishing Mismatch’: Market Potential Of AMR Tools Vs. Patient Needs” – A report from the Global AMR R&D Hub documents (again) the value of new antibiotics. There is also a fascinating discussion of the very different challenge for diagnostics.
  • 16 June 2021 (link): “PASTEUR Act Re-Introduced And Levels Up Antimicrobial Economics For Strong Innovation!” — The title of this one is the message! 
  • 11 Feb 2021 (link): “UK Antibiotic Subscription Pilot: Updates from a webinar” — the ground-breaking antibiotic subscription model being piloted by the UK’s NHS and NICE was discussed in a recent webinar. We need more countries to commit to this!
  • [GOOD QUICK INTRODUCTION] Feb 2021 (link): “Brilliant 5-minute video explainer of the AMR problem!” — Andrew Jack of the Financial Times has produced an excellent brief video on how Netflix-like models can address the difficult economics of antibiotics. Highly recommended.
  • [WHY IT COSTS WHAT IT COSTS] 11 Jan 2021 (link): “All-In Cost Of A New Antibiotic From Discovery To 10 Years On Market” — An integrated update on everything we know at present about the real cost ($ and time) bringing a new antibiotic to market and keeping it there.
  • 9 Dec 2020 (link): “Global Survey Of Novel Antibiotic Reimbursement Models / PASTEUR Act Introduced To US House.” — In parallel with PASTEUR moving from the Senate to the House, a WHO-based group has authored an excellent review of global efforts to find new ways to reimburse for the full value of antibiotics.
  • 28 Nov 2020 (link): “Global AMR Action: EU Pharmaceutical Strategy; One Health Global Leaders Group On AMR” — EU has announced a pharmaceutical strategy that includes a specific call for “… new incentives to develop antimicrobials as well as new pricing systems.” The strategy also includes a call to create an EU Health Emergency Response Authority (HERA) that sounds very much like BARDA!
  • 21 Oct 2020 (link): “Nature Outlook: Antimicrobial Resistance.” — As a supplement to Nature, this superb collection of brief outlook papers (2-4 pages each) provides a concise survey of pretty much everything relevant to the AMR problem: broken economics, new approaches to discovery, use of antibiotics in fish farming, and more. If you only have time for one paper, look at “No money for new drugs” by Plackett (link).
  • 30 Sep 2020 (link): “PASTEUR Act (re)introduced: A delinked Pull award advances in the US!” — This is huge deal: bipartisan legislation that would create predictable subscription-based market entry rewards for new antibiotics.
  • 9 July 2020 (link): “AMR Action Fund: A $1b Down Payment From Industry; A Call For Creation Of Strong Pull Incentives” — The announcement of the AMR Action Fund is the beginning of the next step towards a stable ecosystem for antibiotics!
  • 12 June 2020 (link): “Perspectives on restoring the antibiotic ecosystem: ACS ID, June 2020 issue” — This newsletter surveys the excellent series of papers on AMR R&D in the June 2020 issue of ACS Infectious Diseases. 
  • 7 June 2020 (link): “Assessing antibiotic value: DTR, fire extinguishers, and a view from Australia” — This newsletter begins with a very succinct summary of the problem with antibiotics.
  • [A KEY REVIEW OF THE DATA] 14 Apr 2020 (link): “Pull Incentives For Antibiotics: How Much And Why? — A literature survey” — A summary of papers approaching value from the diverse view points of scientific features at baseline, features that emerge, top-down value estimates, and bottom-up value estimates.
  • 29 Mar 2020 (link, plus link to follow-up FAQ): “UK Antibiotic Subscription Pilot Implies Pull Incentive Of Up To $4b”
  • 23 Mar 2020 (link): “Tetraphase Sold For $14m … And $600m Goes Up In Smoke!” 
  • 6 Mar 2020 (link): “What Does An Antibiotic Cost To Develop? What Is It Worth? How To Afford It?”
  • 11 Jan 2020 (link): “Japan’s Antibacterial R&D Landscape / Japan Calls For Pull Incentives” 
  • 5 Jan 2020 (link and link, a 2-part series): “Melinta Goes Bankrupt / Never Let A Good Crisis Go To Waste” — Note that part 2 of this series contains the best estimate to date of the post-approval costs incurred by an antibiotic developer.
  • 22 Apr 2019 (link and link, a 2-part series): “Scary, Scarier, Scariest: Achaogen bankruptcy”
  • 17 Feb 2019 (link): “Modeling The Value Of An Effective Antibiotic: Megiddo et al.”
  • 23 Jan 2018 (link): “Push! Pull! Push! Pull! / Highlights From Davos 2018”
  • 11 Sep 2017 (link): “Incentives For Antibiotics: Summary of the insights from DRIVE-AB”
  • 8 June 2017 (link): “Ardal et al. / Pull Incentives For Antibiotics – TATFAR Analysis Of 6 Models”the 

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