Antibiotic drug development is fraught with scientific risk and business challenges (Nat. Rev. Drug Discov. 14, 529–542; 2015 and Nat. Rev. Drug Discov. 13, 711–713; 2014). Two recent reports have laid out plans to tackle both these hurdles.

A scientific roadmap by the Pew Charitable Trusts lists four sets of scientific priorities. These include the need for new chemical matter that might lead to more success with antibacterial discovery. “One key challenge is that commercially available chemical matter is not well suited for antibiotic discovery given that the physicochemical properties of antibiotics are unique,” they write, before suggesting a multi-step plan to selectively generate and modify chemical matter for the discovery of new antibiotics. They also argue that proof-of-concept studies are needed to enable the development of 'nontraditional' therapies, like antivirulence strategies, monoclonal antibodies against bacterial targets and combination approaches.

A second 18-month review of the antimicrobial resistance (AMR) landscape, commissioned by the prime minister of the United Kingdom and chaired by economist Jim O'Neill, took a broader perspective. The final report from this review suggests nine interventions, ranging from improved sanitation to increased R&D funding. On the funding front, they write that “there is insufficient private and public investment in R&D in support of new drugs and other areas relevant to the global AMR challenge. The funding that does exist is not always as focused and coordinated (particularly across national borders) as it could be to maximize its impact.” They therefore called for the creation of a Global Innovation fund for AMR, endowed with US$2 billion over 5 years. They also call for 'market entry rewards' — of around $800 million to $1.3 billion — for sponsors who successfully develop new antibiotics for prospectively defined unmet needs.

O'Neill and his colleagues estimate that the total cost of global action on AMR is about $40 billion over a decade. They note that “the investment needed to take action is dwarfed by the human and financial cost of inaction which is mounting already.” They propose a few possible ways to pay for the necessary initiatives, including the reallocation of a fraction of global funding from international institutions to AMR, and the application of an antibiotic investment charge to pharmaceutical companies who do not invest in AMR research.