• Ramanan Laxminarayan, Isabella Impalli, Radha Rangarajan, Jennifer Cohn, Kavi Ramjeet, Betsy Wonderly Trainor, Steffanie Strathdee, Nithima Sumpradit, Daniel Berman, Heiman Wertheim, Kevin Outterson, Padmini Srikantiah, and Ursula Theuretzbacher.
• One Health Trust, Bengaluru, India; High Meadows Environmental Institute, Princeton University, Princeton, NJ, USA. Electronic address: ramanan@onehealthtrust.org.
• Lancet. 2024 Jun 8; 403 (10443): 253425502534-2550.

AbstractThe increasing number of bacterial infections globally that do not respond to any available antibiotics indicates a need to invest in-and ensure access to-new antibiotics, vaccines, and diagnostics. The traditional model of drug development, which depends on substantial revenues to motivate investment, is no longer economically viable without push and pull incentives. Moreover, drugs developed through these mechanisms are unlikely to be affordable for all patients in need, particularly in low-income and middle-income countries. New, publicly funded models based on public-private partnerships could support investment in antibiotics and novel alternatives, and lower patients' out-of-pocket costs, making drugs more accessible. Cost reductions can be achieved with public goods, such as clinical trial networks and platform-based quality assurance, manufacturing, and product development support. Preserving antibiotic effectiveness relies on accurate and timely diagnosis; however scaling up diagnostics faces technological, economic, and behavioural challenges. New technologies appeared during the COVID-19 pandemic, but there is a need for a deeper understanding of market, physician, and consumer behaviour to improve the use of diagnostics in patient management. Ensuring sustainable access to antibiotics also requires infection prevention. Vaccines offer the potential to prevent infections from drug-resistant pathogens, but funding for vaccine development has been scarce in this context. The High-Level Meeting of the UN General Assembly in 2024 offers an opportunity to rethink how research and development can be reoriented to serve disease management, prevention, patient access, and antibiotic stewardship.Copyright © 2024 Elsevier Ltd. All rights reserved including those for text and data mining, AI training, and similar technologies.

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