Chapter 3.9 Explains how payment mechanisms should respond to the notion of antibiotics as global public goods. Global public goods are goods and services whose benefits are universal in scope. Antimicrobial resistance (AMR) poses a major health and economic threat world-wide, making novel antibiotics a global public good. Payment mechanisms have an important part to play in encouraging crucial research and development (R&D). Key learning includes that

• The antibiotics market is broken. Despite global concerns about the failure of current antibiotics, industry struggles to develop the innovative drugs needed.

• The pharmaceuticals market is patent-centric and does not incentivize innovation. The development pipeline is dominated by redeveloped versions of classic compounds than to developing novel antibiotics.

• National and global incentive programmes are crucial in making the antibiotics market attractive to industry and in prompting the development of innovative, high-priority antibacterial drugs.

• Incentives must address barriers at different stages of the value chain, including the:

• – Scientific stage, for example by splitting the roles of the public and private sector in R&D

• – Regulatory stage, by speeding up approval processes and harmonizing approaches across countries, and

• – Economic stage, countering low commercial rewards compared to other therapeutic areas

• Drug regulatory agencies must strike a balance between rapid approval and ensuring that licensed drugs meet quality, safety, and efficacy standards.

• International coordination is key to reviving the antibiotics market and development pipeline.