Dr Najy Alsayed MD, M.Sc., MBA
Global Therapeutic Area Head – Infectious Diseases, Menarini
Addressing AMR-restrained patients’ access and market failure requires a fundamental shift away from volume-based toward value-contribution valuation healthcare policies.
Why is antimicrobial resistance (AMR) becoming one of the greatest threats to patients’ lives and to our modern medicine?
Worldwide, there are 4.95 million AMR-associated deaths annually. They’re projected to exceed 10 million deaths yearly by 2050.
This was confirmed by a WHO report, which showed the rise in bacterial resistance across approximately 40% of pathogens between 2018 and 2023. 1 AMR is also associated with an estimated $66.4 billion yearly related to in-patient infections attributable to antibiotic resistance, and a projected 1.7 trillion annual reduction in global economic output and 28 million people living in poverty by 2050.2
Patients with cancer, organ transplants, haematological malignancies, autoimmune diseases and other immunocompromising conditions depend on reserve antibiotics availability. When antibiotics fail, even routine infections can become life-threatening.
Why should AMR be viewed as a direct threat to cancer care and transplantation?
Many cancer therapies can have a suppressive or compromising impact on the immune system. Additionally, frequent and prolonged hospital stays make patients vulnerable to AMR-related infections.
Without antibiotics, these patients will be exposed to an unfavourable risk-benefit balance when treated with advanced cancer therapies. Consequently, clinicians may be unable to deliver these treatments because the risk of an untreatable infection could become unacceptable.
Menarini Group recently supported the publication of a robust literature review, which indicated that, since 1990, there’s been a fourfold increase in MDR-GNB infections among onco-haematology-treated patients. Approximately half of transplant recipients could also experience AMR-related infections, with mortality rates reaching 30–40%.3
Similarly, an AMR-related infection increased risks by 3x in the cancer outpatient group compared to non-cancer patient groups.3
Investors direct capital toward therapeutic
areas offering more predictable returns.
Why is the reserve antibiotics market often described as “broken?”
Traditional pharmaceutical business models reward sales volume as a return on investments made. While it works for many therapeutic areas, it fails for reserve antibiotics because their societal value is disconnected from commercial revenues.
Investors direct capital toward therapeutic areas offering more predictable returns. The result is a vicious cycle where poor commercial sustainability leads to reduced innovation, while limited availability prevents vulnerable patients from accessing therapeutic advances.
We must learn from orphan medicine legislation, which demonstrated how targeted incentives can simultaneously improve innovation, investment attractiveness, industrial sustainability and patient access.
What’s your message for policymakers?
Without reserved antibiotics availability, many of the advances achieved in oncology, transplantation, surgery and intensive care will become increasingly difficult to sustain.
Unless policymakers support the implementation of sustainable reimbursement and innovation incentives, reflecting the true value contribution of reserve antibiotics, we risk a future where medical science continues to advance while patients’ protection from life-threatening infections, particularly vulnerable ones, is in jeopardy.
Finally, we need to enhance the encouraging progress made in the fight against AMR. This includes the landmark pull incentive schemes for reserve antibiotics successfully introduced in the UK and Italy, and additional initiatives under development, like in Switzerland and Canada.
[1] WHO. (2025). WHO warns of widespread resistance to common antibiotics worldwide. https://tinyurl.com/ywjw7smz.
[2] WOAH. (2024). Final Report of the 91st General Session – Paris
[3] Gupta, V. et al. (2025). Incidence and prevalence of antimicrobial resistance in outpatients with cancer: a multicentre, retrospective, cohort study. https://tinyurl.com/2k7yy3ns.
[4] Alsayed, N. (2025). Why is addressing the bacterial AMR threat so crucial to cancer care patient outcomes? https://tinyurl.com/4zaxx2ew.
[5] Naghavi et al. (2024). Global burden of bacterial antimicrobial resistance 1990–2021: a systematic analysis with forecasts to 2050. https://tinyurl.com/4ctz98sv.
