The shrinking pipeline of new antibiotics makes antimicrobial access a pressing concern for health systems worldwide. Patients in low- and middle-income countries face particular risks from drug-resistant infections. As reported by the Access to Medicines Foundation, companies now show varying levels of commitment in their strategies to bring these medicines to those who need them most.

Pipeline Contraction Creates Urgency

Research shows a 35 percent reduction in pipeline projects from major pharmaceutical firms over five years. The number fell from 92 to 60 candidates. This contraction heightens the importance of the seven innovative projects currently in late-stage development. These candidates target some of the deadliest drug-resistant pathogens, many of which disproportionately affect people in low- and middle-income countries.

The projects come from GSK, Otsuka, Shionogi, BioVersys, F2G, Innoviva and Venatorx. Three focus on multidrug-resistant tuberculosis, a condition that still leaves two in five patients without appropriate treatment in many regions. For these medicines to deliver public health benefit, developers must translate early plans into practical antimicrobial access strategies that address registration, pricing and supply.

Innoviva and Otsuka have produced the most detailed product-specific antimicrobial access plans. Their approaches explicitly cover availability, affordability and continuous supply in low-resource settings. Other developers mainly discuss availability but provide fewer concrete details on pricing models or long-term supply security. Partnerships with the Global Antibiotic Research and Development Partnership appear to support more comprehensive thinking on these issues.

Five of the seven projects include specific stewardship provisions. These range from diagnostic partnerships to data-sharing arrangements that help ensure appropriate use. Such measures matter greatly for last-resort medicines. Companies increasingly recognise that access and stewardship must develop together rather than in sequence.

Health Economics and Policy Implications

The thin pipeline creates both challenges and opportunities for market access. Without sustainable revenue models, investment in new antimicrobials may decline further. Governments and industry therefore need to design incentive structures that guarantee returns while enabling fair pricing across different markets. Equitable pricing strategies tailored to country income levels will prove essential for successful uptake in LMICs. Recommendations for decision makers include:

• Develop product-specific roadmaps with clear registration timelines and pricing commitments for low- and middle-income countries.
• Integrate stewardship provisions directly into access strategies from Phase II onwards.
• Work with governments to test novel incentive models that balance innovation with broad availability.
• Strengthen supply chain planning to prevent stockouts in high-burden settings.
• Prioritise the three multidrug-resistant tuberculosis candidates given the size of the unmet need.

These steps would help translate scientific progress into real-world impact. The current seven projects represent some of the last promising options for certain resistant infections. How companies design their antimicrobial access plans in the coming months will influence treatment outcomes for millions of patients.

Reference

https://accesstomedicinefoundation.org/resource/thin-pipeline-high-stakes-how-are-companies-planning-to-expand-access-to-vital-new-antimicrobials