The rising rates of multi resistant bacteria appear to create a market for new antibiotics. However, the absolute number of infections by  each type of multiresistant bacteria is relatively small and each new antibiotic developed for this finality competes in a splintered market. Recently, the manufacturer of plazomycin, a new antibiotic useful for multiresistant carbapenase resistant bacteria, Achaogen, went bankrupt.

There are incentives for Big Pharma companies to develop new antibiotics, but they need sales of 10 million dollars/year at least to justify the investment in new antibiotics to their shareholders and no antibiotic can ever get the sales volume such as statins. On the other hand, nonprofit organizations having no shareholders and less pressure to increase drug prices could develop and profit from drugs with a smaller sales volume. Traditionalists will argue that nonprofit companies will not be capable of innovate. . Perhaps they are right,  but profitable Big Pharma companies have not been able of translating innovation into antibiotic research to clinical use.  Asking for subsidies for Big Pharma to develop new antibiotics may conflict with the low public esteem of those companies and may increase the risks that they will ask for subsidies for other classes of drugs

I believe that an alternative model for sustaining discovery of antibiotics is overdue, and that nonprofit organizations for antibiotic development should be pursued.

The editor’s note: The authors of the study did not consider state owned pharmaceutical organizations as a possible alternative in any part of the paper. Our experience in Brazil with State directed and owned pharmaceutical entities suggests that they are right: these type of organizations are nonprofit, but they are pressured by political and other type of issues, in addition, to my knowledge, there is no register of any new antibiotic developed by these entities

Nielsen TB, Brass EP, Gilbert DN, Bartlett JG, Spellberg B. Sustainable discovery and development of antibiotics – is a nonprofit approach the future? N Engl J Med. 2019;381(6):503-5. https://doi.org/10.1056/NEJMp1905589.