OPEN-ABIOTICS: A Global Public R&D Commons for Antibiotic Discovery, Funded by a Pharma Patent Extension Levy
The antibiotic pipeline cannot be rebuilt by market incentives alone — the science base for novel antibiotic discovery has also atrophied as public research funding shifted elsewhere. OPEN-ABIOTICS creates a permanent, self-funding public R&D infrastructure by redirecting a small share of pharmaceutical industry profits into antibiotic discovery. The mechanism: a 0.5% levy on all pharmaceutical patent extension revenues globally (TRIPS-compliant; estimated to yield ~$1.2B/year) funds a network of 20 Global Antibiotic Research Nodes (GARNs) — public university labs with standardised equipment, shared compound screening libraries (5M+ compounds), and AI-driven target identification engines. All GARN discoveries are published open-access with mandatory open licensing for any antibiotic compound that reaches preclinical proof-of-concept, ensuring generic manufacturers can produce at scale from Day 1 of approval. A Commercialisation Bridge Fund ($400M) pays for Phase I–II trials of promising GARN candidates, handing off to subscription/prize mechanisms at Phase III. This addresses the 'underfunded public R&D' root cause — the one part of the pipeline that market incentives structurally cannot fix.
StewardshipFirst: Value-Based Hospital Reimbursement Tied to Antibiotic Stewardship Performance
Hospitals are currently penalised for using last-resort antibiotics (high cost, low margin) and rewarded for throughput over outcomes. StewardshipFirst flips this incentive structure through a national value-based reimbursement framework for antibiotic stewardship. Hospitals receive a Stewardship Performance Score (SPS) calculated quarterly from: (a) appropriate antibiotic prescribing rates vs. diagnostic-specific guidelines, (b) days-of-therapy per 1,000 patient-days for broad-spectrum agents, (c) resistance rates for sentinel organisms (E.coli, K.pneumoniae, S.aureus). Top-quartile SPS hospitals receive a 2.5% reimbursement premium on all DRG payments — worth $3–8M/year for a mid-size hospital. Bottom-quartile hospitals face mandatory stewardship programme accreditation. A $500M national Stewardship Investment Fund subsidises the upfront cost of hiring antibiotic stewardship pharmacists ($120K/yr) and clinical decision support software in hospitals that cannot self-fund. This creates a self-sustaining market: hospitals invest in stewardship because it improves their SPS score, which improves reimbursement, which funds more stewardship.
ADAPT-RX: Adaptive Trial Designs + Shared Control Arms to Cut Antibiotic Development Timelines by 60%
The 10–14 year, $1.2–2B cost to bring a new antibiotic to market is the single biggest deterrent to entry — and most of that cost is regulatory risk, not science. ADAPT-RX is a multi-stakeholder regulatory innovation programme that tackles this root cause directly. Three interlocking mechanisms: (1) Master Protocol Framework — a pre-approved adaptive trial architecture shared across antibiotic developers, with shared placebo/comparator arms across multiple compounds. This eliminates duplicate Phase II placebo cohorts, cutting per-compound Phase II costs by ~45%. (2) Rolling Regulatory Review — FDA/EMA pre-submission meetings from Phase I, with real-time review of data packages so that approval decisions come within 90 days of Phase III completion rather than 12–18 months. (3) Surrogate Endpoint Validation Fund — a $300M consortium investment in validating bacterial biomarkers as regulatory-grade surrogate endpoints for clinical cure, enabling 18-month Phase III trials instead of 36-month. Together, ADAPT-RX cuts average development time from 12 years to under 5, making the risk/reward calculus viable for mid-size biotechs and academic spin-outs — the most likely entrants to fill the pipeline gap.
AntibioticCommons: A Multilateral Subscription + Milestone Prize Model to Rebuild the Global Antibiotic Pipeline
AntibioticCommons decouples antibiotic revenue from volume sold — the core market failure — through two interlocking mechanisms. First, a G20-funded subscription pool: participating governments pay an annual flat fee (~$1B total/year across 20 nations) for guaranteed access to a shared formulary of priority antibiotics, regardless of units consumed. Revenue is distributed to manufacturers based on clinical value, not sales volume. Second, a tiered milestone prize fund ($500M per first-in-class novel antibiotic reaching Phase III, $2B upon WHO approval) funded by a 0.1% levy on hospital procurement budgets globally. A joint scientific committee (WHO + national agencies) maintains the priority pathogen list and evaluates milestone claims. Open-license clauses in prize agreements ensure generic production rights for LMICs within 3 years of approval. Together these mechanisms restore R&D incentives, steward responsible use, and ensure equitable access.