| Superbugs are set to kill more than 39 million people over the next 25 years. That equates to 30,000 people every. single. week. And the superbugs that will be killing thousands won't be some rare, novel diseases you've never heard of, but common bacterial infections that are increasingly resistant to treatment by antibiotics. So we're talking horrible afflictions like Clostridium difficile, or C.diff as it's known, which looks an awful lot like diarrhea only much worse and potentially life-threatening. And don't even get me started on the true horror of flesh-eating MRSA-induced necrotizing fasciitis. It's a stark, miserable picture and yet the world is still grappling to find a solution to the problem, which the World Health Organization has dubbed a "silent pandemic." Eight years ago, global health leaders met at a United Nations conference and pledged to support "incentives and funding initiatives" for new antibiotics to treat this new breed of germ. Fast forward to 2024, and health leaders are again assembled in the US — a country where more than 35,000 people die each year from superbugs — and are pledging the same thing again. Just with slightly tweaked language. This time round the declaration is to "explore, encourage and promote a range of innovative incentives and financing mechanisms" for R&D to address superbugs. If we are to avoid talking about this again in another eight years (when roughly about 12.5 million people could be dead, according to the doom-laden projections) then something has to change, starting with new antibiotic drug development. The rate of innovation during the last two decades has halved, GSK's Chief Executive Officer Emma Walmsley told a team of Bloomberg reporters in New York this week. The reason companies have been going bankrupt from working in this space is "you're trying to innovate for something that needs to be kept on the shelf so it can be used, not only for last resort, but for more sort of precision interventions," she says. Some initiatives have gained traction. Countries like the UK are using subscription-style models that there is "big demand" for, says Walmsley. That approach — the so-called Netflix model — sees the health service pay a fixed annual fee to a pharmaceutical company to access new antibiotics. That removes the need for the company to have high sales of its antibiotic, and hopefully prevents overuse. Walmsley also points to the approaches taken by other countries like Sweden and Japan. Sweden has taken a similar tack to the UK but instead of a fixed price for antibiotics, the Nordic country guarantees a minimum annual revenue in exchange for a set supply. Japan is also working on a minimum revenue model for certain antibiotics. However, some countries have found it harder to get these pilots off the ground. The US has had an Act sitting in Congress for several years that, if authorized, would see $6 billion for subscription contracts for antibiotics. And then there are other countries in poor, climate-challenged regions where the lack of the best drugs is further spurring the growth of superbugs. Since mid-2017, only 13 new antibiotics have been authorized, with only two representing a new chemical class and considered innovative. This highlights the scientific challenge of finding an effective antibacterial drug that is also safe for humans. There's work being done but what's in place now still "isn't enough," says Manica Balasegaram, executive director of the Global Antibiotic R&D Partnership. — Ashleigh Furlong | 
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