Document Type
Article
Publication Date
10-2025
ISSN
2589-5370
Publisher
Elsevier
Language
en-US
Abstract
Background
Antimicrobial resistance (AMR) poses an important global health challenge, including insufficient investment in research and development. This study quantifies the required “fair share” contributions from the G7+EU27 countries for an effective set of pull incentives for antibacterial research and development.Methods
Fair share targets within the G7+EU27 were calculated from GDP data and revenue targets from the literature, adjusted for inflation. Cefiderocol and ceftazidime-avibactam were selected as representative of key antibacterials. Revenues and volumes from IQVIA MIDAS data on these drugs were used to assess alignment with fair share targets. The study period was January 2015–December 2024.Findings
The G7+EU27 low-end, mid-range, and high-end annual revenue targets are US$258, US$363, and US$562 million in global revenues (USD 2024), respectively, consistently over ten years. An antibiotic meeting the mid-range target would be 230th in a global rank of drugs by revenues. While the UK and Italy are on track to meet annual mid-range targets going forward, other G7 countries are not, and only Italy has met cumulative mid-range targets for both drugs.Interpretation
Collectively, the G7+EU27 has not met cumulative mid-range targets. The UK meets mid-range annual targets going forward due to its antimicrobial subscription program. Italy meets mid-range targets due to higher use and may continue to meet them due to an “orphan” reimbursement fund for antibiotics. German, French, and Japanese antibacterial pull incentives have not met the mid-range targets. No G7 member meets high-end targets at current unit prices or volumes. A revenue guarantee pull incentive designed to top-up market revenues could support innovation and accelerate access without relying on higher prices or volumes. Progress in the UK and Italy demonstrates that meeting fair share targets are achievable within different national contexts.Funding
MG was supported by a post-doctoral fellowship at Boston University. ASK's work was funded by Arnold Ventures and International Collaborative Bioscience Innovation & Law Programme (Novo Nordisk Foundation grant number NNF23SA0087056). While KO is Executive Director of CARB-X, this work was not funded under any CARB-X grant.Recommended Citation
Maple Goh, Matt McEnany, Rachel Freeman, Max Newton, Aaron S. Kesselheim & Kevin Outterson,
Bridging the fair share gap for antibacterial innovation: an observational analysis of antibacterial revenues in the G7 and EU27
,
88
eClinicalMedicine
(2025).
Available at:
https://doi.org/https://doi.org/10.1016/j.eclinm.2025.103485
Link to Publisher Site
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