Worryingly, current treatments in development fail to address the biggest public health threats posed by increasingly drug-resistant gram-negative bacteria – a point reiterated by the G20 health ministers at their very first meeting in 2017. The declaration issued following this meeting welcomed initiatives, including GARDP, to ‘reinvigorate research and development (R&D) in science and industry for antimicrobials.’

 

Global collaborations on R&D

 

The challenge of antibiotic R&D is not an easy one and it is crucial to bring actors together that complement each other. Global collaborations that include industry, academia and governments, for instance, can help ensure resources are optimised and that the right actors are brought in to accelerate product development.

 

Prioritising global health needs

 

Astonishingly, more people currently die from lack of access than from resistance.

Taking a global perspective and developing treatments that reflect public health needs should be the starting point for all public investment. Real-world, clinical context needs to be considered when prioritising which treatments to focus on. This means developing antibiotics that target populations and indications of global significance, including those that will not be addressed by actors due to perceived risks, challenges and lack of commercial interest. Investment needs to focus on how to optimise use, access, and quality of both existing and new antibiotics. Astonishingly, more people currently die from lack of access than from resistance.

 

Addressing stewardship and access

 

Of course, any effort to tackle AMR must address the complex issues of stewardship, ensuring access but not excess while reflecting the realities of clinical practice. Commitments need to go beyond vague promises. Some of the steps can include limiting indications of new treatments, improving formulations and drug profiles, and providing an evidence base to develop stewardship guidelines.

 

Sustainable investment in R&D

 

What is clear is that a coordinated global effort is urgently needed as new and remaining actors in the antibiotic development landscape struggle to mobilise financial resources. Yes, we need sustainable investment in R&D, but this should be tied in closely to prioritising global public health needs, access and stewardship. We need a commitment from governments but also long-term funding from other sources to tackle AMR.