Bacterial resistance to existing antibiotics keeps increasing. Development of new ones has nearly stopped, and the reason is not that the science is impossible.
Why it is a bad business
A newly approved antibiotic effective against resistant bacteria will be deliberately held in reserve, used as rarely as possible to delay resistance developing to it.
So the company that spent a decade and enormous sums developing it is rewarded with minimal sales, on purpose, for good public health reasons.
Compare that to a drug for a chronic condition, taken daily for decades by millions. The incentive comparison is not close, and several companies that did develop antibiotics went bankrupt afterwards.
The consequence
Most large pharmaceutical companies have exited antibiotic research entirely. What remains is small companies and academic groups, chronically underfunded.
The proposed fixes
Subscription models, where a health system pays an annual fee for access to a drug regardless of how much is used. That decouples revenue from volume, which is the whole problem. Several countries have pilots.
Market entry rewards – a large payment on approval, independent of sales.
Extended exclusivity on other products for companies that develop antibiotics.
All of these have been proposed for years. Implementation is partial and slow.
What else helps
Reducing unnecessary use, particularly in agriculture, where a large share of antibiotic consumption happens. Better diagnostics that identify the specific pathogen quickly, so treatment is targeted rather than broad.
Why this is urgent and neglected
Because the harm arrives gradually and the failure is only obvious in retrospect. Routine surgery depends on effective antibiotics, and that dependency is invisible until it fails.