Antimicrobial resistance (AMR) has emerged as a critical threat to global health security, with Europe currently failing to meet four of the five targets established by the EU Council for 2030. According to recent analysis inspired by discussions at the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Conference, the region must implement robust support mechanisms and innovative incentive models to complement existing stewardship policies if it hopes to lead the worldwide response.
AMR occurs when bacteria, viruses, fungi, and parasites evolve to resist the medicines designed to treat them. The consequences are severe: globally, resistant infections directly cause over one million deaths annually and generate approximately €61 billion in direct healthcare costs. In Europe alone, the annual death toll exceeds 35,000, with healthcare systems bearing a burden of around €11.7 billion. Without significant intervention, these figures are projected to worsen, undermining the United Nations’ goal of reducing global AMR-related deaths by 10% by 2030.
“For a patient, AMR becomes real when an antimicrobial does not work as expected,” explained Florian Wagenlehner, Director of the Clinic of Urology, Paediatric Urology and Andrology at Justus Liebig University in Giessen, Germany. He noted that limited treatment options can lead to complex care, extended uncertainty, and potentially life-threatening outcomes.
While the misuse and overuse of antimicrobials remain primary drivers of resistance, experts stress that stewardship alone is insufficient. Effective stewardship policies are essential to preserve the efficacy of current drugs, but new treatments are equally necessary to stay ahead of evolving resistance. However, innovation is lagging; since 2017, only 17 new antimicrobials have been authorized globally, just two of which belong to new classes.
Matteo Bassetti, Director of the Infectious Diseases Unit at AOM – IRCCS San Martino Polyclinic Hospital and the University of Genoa, Italy, highlighted the urgency of diversification. “When an infection becomes resistant to an antimicrobial, we need new medicines with diverse ways of overcoming that resistance,” he said.
The stagnation in new drug development is largely attributed to flawed economic models. Traditional pharmaceutical business practices rely on high sales volumes to recoup research and development costs. However, novel antimicrobials are designed to be used sparingly as last-resort treatments to combat resistance, creating a fundamental mismatch. Jorge Mestre-Ferrandiz, Associate Professor at Charles III University of Madrid, Spain, pointed out that many developers have exited the field because these reserve drugs often never generate sufficient revenue.
Furthermore, Health Technology Assessments (HTA) frequently undervalue antimicrobials by failing to account for their broader societal benefits, such as health system resilience. This has led to a surge in interest for “pull incentives”—mechanisms that delink financial returns from sales volume. The UK’s subscription model, which pays a fixed fee based on NHS value rather than usage, is cited as a global precedent. Similar initiatives are being piloted in Sweden, while Italy has established a €100 million fund and Germany has introduced a streamlined pathway for reserve antimicrobials.
Despite these national efforts, experts argue that isolated measures are inadequate. Bassetti cautioned that current examples do not yet constitute a stable system, emphasizing the need for scaling. The proposed solution is a “fair share” approach, where countries contribute to funding proportional to their economic capacity. Analysts estimate that $310 million USD annually per priority antibiotic over a decade is required to sustain R&D. While this approach would distribute costs across G7 and EU27 nations, only a handful of countries currently meet these targets.
Mestre-Ferrandiz described fair share funding as a way to solve the collective action problem, ensuring broad participation commensurate with economic strength. With 2030 targets approaching, European finance and health ministers are being urged to collaborate on coordinated action that rewards availability and clinical value, thereby strengthening health security and reversing the decline in antimicrobial innovation.
Only two new classes since 2017? That is terrifying. We are running out of options faster than companies will invent new ones.
I still doubt a ‘fair share’ EU fund will actually happen. Political will rarely matches the scale of this crisis.
The UK subscription model is exactly what other nations should copy. Delinking profit from usage volume is the only way forward.