Introducing ARMoR's Access Program

We have lifesaving antibiotics that are cheap, effective, and have existed for decades. They still fail to reach the patients who most need them.

The antibiotic that would have saved a child's life might be:

1. Not registered in their country.

2. Registered, but caught in a supply chain disruption somewhere

3. Manufactured and supplied, but missing from the national formulary or excluded by the procurement system.

4. Procured, but unaffordable to a family paying out of pocket.

5. Stocked, but degraded in storage, falsified upstream, or unreachable on roads impassable in the rainy season.

Each of these is a regulatory, market, or system failure, and together they describe a problem that gets less attention than it deserves: not the absence of effective drugs, but access to them. Bacterial infections are associated with 7.7 million deaths each year, the vast majority of which fall on patients in low and middle income countries (IHME GBD). From initial conversations with experts, we estimate that 10 to 15 percent of these deaths would be avertable through better access to antibiotics that already exist, before any new drug is developed.

For the past two years, ARMoR has focused primarily on the policy, financial, and regulatory architecture that drives antimicrobial research and development, including our contributions to the EU's General Pharmaceutical Legislation reform adopted in December 2025. Although this work remains essential, it has become increasingly clear that even when new antimicrobials are successfully developed, they rarely become widely accessible (Cecchini et al.). An effective response to AMR globally requires action on both the development pipeline and the systems that deliver existing antibiotics to the patients who need them. Given this, with funding from Founders Pledge, we are now launching an 18-month program focused on identifying the highest-impact interventions for improving global access to antibiotics. This post introduces that work.

Who is working on this problem

There is a growing recognition that highly cost-effective interventions targeting these access failures are possible. However, despite this consensus around the significance of the issue, the volume of effective work being done on access remains small relative to the scale of the problem.

To our knowledge, only a handful of initiatives are currently working specifically on antibiotic access in LMICs, and most are at relatively early or preparatory stages:

• SECURE has been developing analytical and country-engagement groundwork; substantial preparatory work is in place

• Aranda has begun pilot work on a subscription-style model that bundles antimicrobials, diagnostics, and consumables for LMICs. 

• MedAccess has expressed interest in financing instruments such as volume guarantees

• The Clinton Health Access Initiative's AMR programme, which had planned to pilot in one to two countries, was wound down following USAID cuts. 

• Advance-ID has produced academic analysis of access barriers within Asia.

These represent real efforts by serious people, and we expect to work alongside several of them. But taken together, they represent a small fraction of what a problem of this scale warrants. Most are early-stage, narrow in geography, or thinly funded. Meanwhile, funder interest in supporting access-related interventions has been growing, amd there is a lack of clarity on which interventions and initiatives are most worth supporting.

Why ARMoR?

This field requires rigorous analysis of which interventions actually work, the relationships to test them with governments, regulators, and delivery partners, and the independence to take a clear public position on where money should go. Large multilateral collaborations move slowly by design. Academic groups can analyse but rarely implement. Implementing organisations are often locked into specific countries or models. Furthermore, much of the field is held back by the same funding constraints that limit how fast any single initiative can move.

ARMoR has spent two years building exactly the position this problem requires. We are small enough to move on tight timelines, and our analytical work in the antimicrobial R&D ecosystem has placed us in working relationships with the funders, regulators, developers, and country-level actors whose decisions shape antibiotic access globally. The organisations already working in this area are doing essential delivery and pilot work and we don't want to duplicate these efforts. Our aim is to help the field develop a sharper view of which interventions deserve serious investment, and to support those organisations in pursuing them.

What we're going to do

Our goal is to identify and analyze interventions that could meaningfully increase the rate at which patients in LMICs get the antibiotics they need, and to do this rigorously enough that funders and implementers can act on our conclusions.

We are modelling our research process on Ambitious Impact's iterative methodology, structured across three phases:

• Phase I: Mapping. A long list of candidate interventions, each documented with its evidence base, implementation pathway, key uncertainties, and the stakeholders involved. Built from a literature review of access barriers, a landscape of who's already working on what, and geographical data on where the burden of preventable bacterial deaths falls.

• Phase II: Shortlisting. A methodology for comparing interventions against each other, applied to the most promising candidates. Cost-effectiveness estimates, needs assessments, and analysis of financing tools like revenue guarantees and advance market commitments. Access needs are country-specific, so we'll engage directly with health ministries, regulators, and clinical leaders to ground the shortlist in local priorities.

• Phase III: Implementation. For the most promising candidates, we'll write implementation reports, run small pilots where appropriate, and co-develop concrete proposals with national governments, delivery partners, and funders. The goal is to end the program in a position to take direct action on the best interventions and to hand off well-specified plans to organisations well placed to run them.

By the end of this program, we want more than a set of recommendations. We want a clear view of where the highest-impact interventions sit and the relationships and credibility to act on them. If the field turns out to be less tractable than we currently expect, or no candidate clears a reasonable cost-effectiveness bar, we will publish those findings clearly as well.

To lead this program, we hired Ann Squire. Ann was previously Director at Med4All and part of the PharmAccess Foundation, where she worked on medicines access in Ghana. She injects direct country experience of the systems this program will engage with.

What we're looking for

We are still at an early stage of this program and would benefit considerably from input, especially from:

• People who've seen antibiotic access up close: clinicians, pharmacists, regulators, procurement specialists, and anyone with direct experience of how access succeeds or fails.

• Funders considering this space. We'd like to understand what would make a recommendation actionable for you.

• Anyone who thinks our approach could be improved.

You can reach us at aanika.dalal@armoramr.org.

We'll be writing publicly throughout this program. The next post will be a deeper look at the barriers preventing antibiotic access in LMICs, alongside a framework for organising them!

Sources

Global Burden of Disease Collaborative Network. "Global Burden of Disease Study 2023 (GBD 2023)." Institute for Health Metrics and Evaluation, 2025, https://vizhub.healthdata.org/gbd-results/.

Cecchini, Michele, et al. “Patient Access in 14 High-Income Countries to New Antibacterials Approved by the FDA and EMA from 2010 to 2020.” Clinical Infectious Diseases, vol. 74, no. 7, 1 Apr. 2022, pp. 1183–1190. Oxford Academic, https://doi.org/10.1093/cid/ciab612.