Large drugmakers are developing fewer antibiotics, analysis finds

STAT News – Tuesday, March 10, 2026
By Ed Silverman

The number of potential antimicrobial treatments being developed by the world’s largest pharmaceutical companies nosedived by 35% — from 92 to 60 — over the past five years, according to a new analysis, and the findings underscore increasing concerns about containing superbugs that threaten public health.

Meanwhile, only five, or 13%, of 39 antimicrobial pipeline projects targeting priority pathogens listed by the World Health Organization are being developed for children under five years old. All five are already approved for adults, but the process for winning approval for use in children has taken several years and, in two cases, is ongoing.

Inequities were also uncovered. In 17 sub-Saharan African countries, none of the companies whose pipelines were assessed had registered pediatric formulations of their antimicrobials. Although regulatory challenges exist, the analysis noted that companies did register other medicines in 10 of these countries.

“The situation is dismal,” said Jayasree Iyer, who heads the Access to Medicine Foundation, an independent nonprofit research organization that produced the analysis and regularly evaluates drugmakers and their access plans. “You’ve got such a small number of companies innovating in new antibiotics and the state of access is poor. If we see more pullbacks it will be quite bad.”

The findings arrive as public health officials continue to raise alarms about the dearth of new antibiotics available and uncertain measures taken to address the problem. Antimicrobial resistance remains one of the most urgent global health threats, causing more than one million deaths annually.

Without intensified action, it is estimated that 39 million deaths traced to antibiotic resistance will occur by 2050, according to an analysis published two years ago in The Lancet. In the U.S., more than 2.8 million antimicrobial-resistant infections occur each year, according to data from the Centers for Disease Control and Prevention.

Nonetheless, few new antibiotics have reached medicine cabinets or hospital storage facilities over the past two decades. The WHO last October released a report noting that the number of antibacterial medicines under development fell to 90 early last year from 97 in 2023. Of those, just 15 were deemed innovative.

A key reason is because antibiotics are usually used for short periods of time and often only when necessary to slow the development of resistance. As a result, antibiotics generate less revenue and profits than medicines to fight chronic diseases, which explains why many large drugmakers withdrew from antibiotic research over the years.

Antibiotic resistance occurs when microbes evolve in ways that make them impervious to existing drugs, which makes infections harder to treat and often results in deaths that would have been preventable in the past. Ara Darzi, the chair of surgery at Imperial College London and the executive chair of the Fleming Initiative, maintained antibiotic resistance is worsening.

“It’s not an abstract projection. I believe it’s a clinical emergency. It’s happening now,” he said. “It’s closing our wards, it’s delaying surgeries, and it’s killing patients. And it’s happening because we have treated antibiotics as an expendable, rather than as what they truly are — the invisible infrastructure on which all modern medicine depends.”

Nonetheless, the Access to Medicine Foundation did find some bright spots.

Of 78 pipeline projects assessed, seven were deemed notable because they target priority pathogens in need of new treatments, exhibit innovation with potential to overcome resistance, and are in late-stage development with access plans in place. Taken together, this suggests they could become available in low- and middle-income countries.

Two were approved by the Food and Drug Administration in recent months. One was developed by GSK to treat gonorrhea and urinary tract infections in women aged 12 years and older. The other is a new kind of oral antibiotic to treat gonorrhea jointly developed by Innoviva and the Global Antibiotic Research and Development Partnership, a nonprofit.

But planning for widespread access and availability varied. The report found that the companies behind all seven products mapped out regulatory registrations, early access programs, and access commitments after clinical trials were completed. But pricing ceilings and equitable pricing were only established for two of the antibiotics.

Separately, the report determined that five companies — Aurobindo, GSK, Hikma, Sandoz, and Teva Pharmaceutical — stood out by registering their pediatric formulations, on average, in 50% to 70% of the low- and middle-income countries where they registered their other “off-patent” antimicrobials. Off-patent refers to medicine that has lost patent protection.

“Against this dwindling pipeline, there are some promising projects that will make a difference to people, especially in low-income countries,” said Iyer. But she lamented that too many companies are waiting for different governments to develop financing models that would provide incentives for research and development.

Consequently, there has been a growing push to find ways to boost development of novel antibiotics.

In 2021, a pharmaceutical industry venture called the AMR Action Fund was launched to invest in small companies that can develop two to four novel antibiotics by 2030. The effort began with $1 billion in backing from several large drugmakers, the European Investment Bank, and Wellcome Trust. So far, nearly a dozen investments have been made.

Last fall, the European Union created the Partnership on One Health Antimicrobial Resistance, which will bring together 53 organizations from 30 countries to collaborate on research, advance policies, and support access to and better use of data. The 10-year effort will have $276 million in funding.

The U.K. created the Antimicrobial Products Subscription Model, which is designed to make it possible for the National Health Service to purchase newly developed antibiotics to treat infections caused by drug-resistant bacteria. The payment model aims to encourage drug companies to develop new antibiotic medicines and to prevent their overuse.

In the U.S., a bill called the Pasteur Act was re-introduced in Congress to create a similar model in which the federal government offers up-front payments to companies in exchange for unlimited access to their antibiotics. The idea is to enable companies to recover costs and make an appropriate profit without having to sell large volumes of antibiotics.

“But if companies wait for that to happen, there will be a supply problem” in the meantime, Iyer said. “Large companies have resources to make these products available and should make efforts way more than smaller companies … But small and medium-sized companies are [the ones that are] driving quite a bit of innovation.”

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