How can the EU support sustainable innovation and access to effective antibiotics? Policy options for existing and new medicines

Michael Anderson, Dimitra Panteli, Elias Mossialos

Research output: Contribution to journalSpecial issuepeer-review


The key messages of this policy brief published by the European Observatory on Health Systems and Policies are as follows:

Antimicrobial and particularly antibiotic resistance is one of the biggest public health challenges the world faces. Over 1 million years of life are lost each year in the European Union (EU)/European Economic Area (EEA) alone due to antibiotic resistance, and it costs healthcare systems about €1.1 billion annually. These health and economic impacts are expected to worsen. Urgent steps are needed and this policy brief focuses on one area where the EU and its Member States can take effective action, fostering sustainable innovation and improving access to effective antibiotics.

1. Scientific, economic, structural and regulatory ‘barriers’ continue to limit the development of novel antibiotics with innovative characteristics despite intensified international efforts.

Only a handful of new antibiotics have been developed and launched over the last few decades, and almost none have any innovative characteristics. This means that they are vulnerable to cross-resistance with existing antibiotics.

Most large pharmaceutical companies have withdrawn from antibiotic research and development (R&D) because of the high risk of failure and because antibiotics are less profitable than other areas.

Small and medium-sized enterprises (SMEs), which now drive antibiotic R&D, face difficulty securing funding for preclinical and early clinical trials, and risk significant economic losses when launching new antibiotics.

2. Reinvigorating the antibiotic pipeline requires a holistic package of incentives.

Push incentives, such as direct funding and grants, can reduce the cost of R&D and have already improved the quality of the preclinical pipeline to some extent.
Pull incentives, such as financial rewards linked to R&D results, reimbursement reforms and regulatory changes, could increase potential revenue and create viable markets for antibiotics.

Aligning incentives is important and can be achieved by addressing:
public health factors targeting high-priority medical need, supporting antibiotic sustainability, promoting access, and protecting environmental health
market factors improving return on investment and supporting SMEs
implementation and operational feasibility considering potential political, regulatory, legislative, industry and financial hurdles.

3. Ensuring timely access to new and existing antibiotics is critical.

Limited access to effective antibiotics poses a risk to patients and drives the development of resistance.

Access to new antibiotics is often restricted because they are only launched in larger markets.

Access to many existing antibiotics is undermined by supply-chain problems or by their withdrawal due to low profitability.

4. Improving access to effective antibiotics requires both short- and longer-term measures.

Reducing regulatory administrative hurdles, engaging in good procurement practice, increasing joint purchasing efforts, and considering subscription payment models for these medicines can keep older (but effective) antibiotics on the market by ensuring their economic viability.

Strengthening the mapping of production capacities and product availability will improve the transparency of the antibiotic supply chain.

Stockpiling and strengthening manufacturing capacities within and outside of the EU can boost the supply chain itself.

5. The EU has a major role to play both in combatting antimicrobial resistance (AMR) and in contributing to global solutions.

The EU has a major role to play by supporting antibiotic R&D – increased and coordinated funding at the EU level can support both push and pull incentives.
EU engagement with other international efforts promotes optimal deployment of incentives.

EU commitment can help ensure that the lack of access to appropriate and effective antibiotics is recognized as a threat to global health security and a priority.

The EU is uniquely placed to build on its relationships with international institutions and act as a facilitator in the global space, to ensure synergies among existing structures, communicate the cost of inaction, and support national and regional initiatives.
Original languageEnglish
Pages (from-to)1-71
Number of pages71
JournalWorld Health Organization. Regional Office for Europe. Policy Brief
Publication statusPublished - 21 Jun 2023


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