Antibiotic production by big pharmaceutical companies has slowed significantly over the past five years, leaving children in low- and middle-income countries particularly exposed to difficult-to-treat infections, according to a new analysis.
The report by the Access to Medicine Foundation comes amid a growing global crisis of antimicrobial resistance (AMR), where drugs used to treat deadly infections are no longer effective. Previous studies have shown that AMR contributes to more than 4 million deaths each year, and this number is expected to increase to more than 8 million by 2050.
Despite this growing threat, the number of antibiotic candidates in the pipelines of large research-based pharmaceutical companies has declined by 35 percent since 2021, according to the 2026 Antimicrobial Resistance Benchmark Report released on Tuesday (March 10).
In particular, the report highlights a severe shortage of antibiotics prescribed for children. Only 14% of the drugs being developed by the companies evaluated are for children under the age of five. In sub-Saharan Africa, pediatric antibiotics are not available from these companies in 17 countries.
“Chronic underinvestment, weak development pipelines and declining interest from the private sector are leaving communities affected by drug-resistant infections at a disadvantage,” said John Arne Rottingen, CEO of the philanthropic foundation Wellcome, which co-funds the Healthcare Access Foundation’s AMR program.
Big pharma companies such as GSK are planning to bring several new drugs to market in the coming years, but accessibility and affordability in low-income areas may not be far off, the report suggests.
Seven drugs in late-stage development hold promise to treat infections that have become resistant to other existing antibiotics, from gonorrhea to urinary tract infections (UTIs) to drug-resistant tuberculosis, according to a benchmark report that looked at 25 companies.
UK-based pharmaceutical giant GSK is involved in three drugs, including the already approved UTI antibiotic gepotidasin, while other drugs will be developed by smaller companies such as Venatorx and Innoviva.
All companies involved in developing new antibiotics have plans to register their medicines, implement early access programs, and ensure that patients participating in clinical trials have access to the medicines once the studies are completed, the report said.
However, an analysis by the Access to Medicine Foundation found that of these seven upcoming antibiotics, only two – Innoviva and Otsuka – are expected to be affordable and available in low- and middle-income countries. The foundation looked at how companies are addressing the availability, affordability and continuity of supply of medicines in low- and middle-income countries.
“These treatments are on the verge of market availability, and gaps in current access plans could result in millions of people in LMICs receiving delayed treatment or no access at all,” the report said.
Accelerating innovation
Martijn Van Gerven, research program manager for the AMR program at the Access to Medicine Foundation, said: SciDev.Net For companies to make their medicines widely available, they need external incentives, such as governments promoting research and development and profit guarantee schemes, such as those in place in the UK. Antibiotics are expensive to produce and are not used consistently, making them an unattractive investment for many companies, Van Gerven explained.
Subscription models work when the government pays for the subscription for medicines, ensuring that they are available regardless of market trends. But for this to be successful, it needs to be done on a global scale, Wellcome’s Rottingen told a press conference in London on Tuesday.
Most of the companies analyzed in the report have plans to make their products accessible, but the problem is a lack of specificity in those plans, Claudia Martinez, director of research at the Access to Medicine Foundation, said at a briefing.
“What we want to see is that there’s not a huge delay between registration and availability,” she says.
Most of the antibiotics sold around the world come from generic drug manufacturers, companies that make cheaper drugs that are off-patent. These are primarily sold in low- and middle-income countries.
The benchmark report analyzed 10 generic drug makers, including Abbott, Hikma and Sandoz, and found that six of them track how many patients their products reach in low- and middle-income countries. Sandoz and Viatris were the only companies to do this kind of tracking for all their medicines. According to the report, Fresenius Kabi and Alkem did not provide details on how they would track patients.
Local manufacturing
For Ayodele Majekodunmi, a Nigeria-based epidemiologist with One Health and executive director of data firm Azisefini Consulting, the real game-changer in expanding to low- and middle-income countries is ensuring that at least some of the manufacturing takes place in those countries, enabling lower prices.
This is possible when large pharmaceutical companies partner with other companies in the Global South to transfer knowledge, or when those large companies set up factories in low-income areas, explained Majekodunmi, who is also project leader of the World Organization for Animal Health’s West and Central Africa Health Security Program. However, in the case of the former, these countries are not vulnerable to large pharmaceutical companies that may decide to exit certain markets, she added.
“When you have local businesses owned by people in the country, there’s no place to pack up and go. So we definitely need local ownership and local investment,” Majekodunmi said. scientific development.net.
affordable access
said Anand Anandkumar, founder of India-based biopharmaceutical company Bugworks. SciDev.Net He said the company is implementing a strategy to ensure that once its new antibiotic (which has not yet been tested in humans) is ready for sale, it reaches as many people as possible around the world.
Anandkumar said Bugworks is working with the Global Antibiotic Research and Development Partnership (known as GARDP) to make its products affordable.
Anandkumar hopes that, subject to regulatory approval, his company’s antibiotics will be manufactured in India and that GARDP will help stockpile antibiotics for distribution in Latin America and Africa.
“I think Indian manufacturers can make large quantities of products for most of the developing countries if they guarantee enough quantities,” he said.
Tony Wood, GSK’s chief scientific officer, said in a press statement that GSK is leveraging cutting-edge technology to bring much-needed innovation to patients, including last year’s new first-in-class antibiotics. “While this is welcome progress, it is not enough and today’s report highlights the need for government and industry to work together to improve economic incentives for research and development and introduce better access and management models,” the statement said.
