The core market failure in antibiotic development is that revenue is tied to sales volume — but responsible antibiotic stewardship requires minimal deployment. The solution is to fully decouple revenue from volume via a subscription-based pull incentive.

A consortium of high-income countries (G7 + Australia) pre-commits to paying a fixed annual fee — like a Netflix subscription — for the right to access a newly approved antibiotic, regardless of how many units are used. The developer receives guaranteed revenue ($1-2B/year per priority antibiotic) for a fixed period (10-20 years) as long as the drug remains effective.

This transforms the business case: responsible stewardship now protects revenue rather than destroying it. The model has been piloted: the UK paid £10M/year each for cefiderocol and ceftazidime-avibactam in 2022 regardless of NHS use; Sweden ran a parallel pilot. Both developers reported the model changed their internal investment calculus.

Scaling to a G7-wide mechanism with standardized contracts, a shared secretariat, and an LMIC access tier could fund 10-15 new antibiotic classes over 20 years — enough to address the WHO critical priority pathogen list.

The agricultural reform linkage is the key innovation: subscription eligibility is conditioned on national compliance with WHO agricultural antibiotic restrictions, directly attacking the resistance reservoir that destroys new drug effectiveness.