Advancing the Case for Antimicrobial Incentives

Link to research brief

Support for antimicrobial development through push and pull incentives is a necessary part of ensuring sustainable antimicrobial R&D and access. Despite calls for additional action, progress remains slow. In this brief, we aim to investigate and address key uncertainties around the adoption of these incentive mechanisms and add further urgency to deployment.

Key messages

• Antimicrobial development faces both scientific and economic barriers. Despite growing political attention, current action remains insufficient.

• Political and financing challenges continue to slow progress. Governments remain hesitant due to uncertainty over incentive size, public health value, and implementation design.

• Scale matters. Global incentives of around USD 3–4.5 billion are needed to make most development programmes commercially viable. 

• A balanced mix of push and pull funding is essential. Without major increases in public push funding, pull incentives would need to be prohibitively large.

• Delay is costly. A five-year failure to act could further weaken the research and development ecosystem and result in nearly three million avoidable deaths.

• The value for money is clear. A hypothetical new antibiotic for drug-resistant Enterobacterales lower respiratory infections could generate an estimated 5:1 return on investment in Denmark and 9:1 in Greece, underscoring the strong case for pull incentives.

• Access must be built in from the start. Access and stewardship conditionalities can achieve strong public health outcomes without undermining commercial appeal.

• We know what to do next. Lessons from existing and planned pull policies provide a roadmap for national and regional implementation.

We would like to thank the Novo Nordisk Foundation for the funding this work and Permaanalytics who performed the health and economic benefit analysis of new antimicrobials.