Melissa Gong Mitchell, the Secretariat Lead at the AMR Industry Alliance, discusses the challenges hindering the development of urgently needed new antibiotics and the sustainable solutions needed to address these issues
Antimicrobial resistance (AMR) is one of the most pressing health threats of our time. It is already linked to nearly five million deaths annually, and without action, that number could rise to ten million by 2050. Despite this looming crisis, policymakers are failing to deliver the innovation needed to respond. The reason is a slow-motion collapse of the scientific workforce and the broken market meant to support it.
The challenges facing antimicrobial development
Last year, the AMR Industry Alliance, one of the largest private sector coalitions created to provide sustainable solutions to curb AMR, published Leaving the Lab, a report that reveals the field of antimicrobial research is rapidly losing its talent base. There are now just 3,000 active AMR researchers globally, compared to nearly 46,000 in oncology and 5,000 in HIV/AIDS. Over the past 20 years, the number of AMR publications, patents, and active scientists has declined dramatically. The AMR R&D pipeline is not just broken, it’s losing its most essential resource: people.
This isn’t due to a lack of passion or commitment. The scientists we spoke to remain deeply engaged with the mission of developing new treatments. What’s driving them away is their economic reality. The market for antimicrobials is structurally broken. These drugs must be used sparingly to preserve their effectiveness, which limits sales volumes. At the same time, they are typically priced low and often rapidly replaced by generics. The result is an untenable business model where even success can lead to bankruptcy.
Take Achaogen, for example. The company secured approval for a new antibiotic, plazomicin, after more than a decade of research and close to a billion dollars in investment. Less than a year later, it declared bankruptcy. This is not an isolated case. As larger pharmaceutical companies have scaled back or exited the field altogether, smaller biotech firms have tried to pick up the slack, but many are barely staying afloat. According to a survey by the BEAM Alliance, over half of SMEs in this space can’t fund operations for more than a year.
The consequences of inaction are measured in lost innovation and lives.
Push and pull incentives
Governments and policymakers have started to acknowledge the urgency of the problem, and there has been meaningful progress on both push and pull incentives. Push incentives, such as research grants and programs like CARB-X, provide critical early-stage support for small companies. Pull incentives – including market entry rewards or subscription models like the UK’s pilot program – are designed to reward successful development and ensure commercial viability.
However, these incentives remain limited in scope and scale. Without consistent and predictable support, they are not yet reversing the outflow of talent. Our research found that when companies shut down AMR programs, 90% of the researchers affected leave the field entirely by their second job change. The pipeline of innovation is only as strong as the people behind it. Right now, we are losing them.
This crisis is especially acute for infectious disease specialists, whose clinical expertise is critical to late-stage drug development. In the US, nearly half of infectious disease fellowship positions went unfilled in 2022. Many doctors are deterred by lower compensation and high training costs. It’s a huge ask – and without better incentives, fewer will answer the call.
A sustainable approach to AMR
We urgently need a more strategic and long-term approach. That means expanding pull incentives and ensuring that governments treat antibiotics as essential infrastructure, just like vaccines or emergency response systems. It also means investing in the workforce itself. The private sector cannot fix this alone, nor should it be expected to. Governments, academic institutions, non-profits, and industry must work together to restore a thriving R&D ecosystem. Organizations like ICARe and Future Leaders Against AMR are helping to train the next generation of researchers. These efforts must be scaled and sustained.
The world has no shortage of scientific talent, but talent needs opportunity, stability, and support. Without it, we will continue to lose the people best equipped to solve the AMR crisis. The consequences of inaction are measured in lost innovation and lives.
It’s time to reinvest in the people behind the pills. If we are to bring new antibiotics to market – the ones that are effective, equitable, and available when needed – then we must fix the system that supports their development. That starts with valuing the researchers who make that future possible.
