[LONDON, SciDev.Net] Antibiotic production from big pharmaceutical companies has slowed significantly in the last five years, leaving children in low- and middle-income countries particularly exposed to hard-to-treat infections, according to new analysis.

The report by the Access to Medicine Foundation comes amid a growing global crisis of antimicrobial resistance (AMR), where the drugs used to treat deadly infections are no longer effective. Previous research shows that AMR contributes to more than four million deaths each year and this number is expected to rise to more than eight million by 2050.

Despite this growing threat, the number of candidate antimicrobial drugs in the pipeline of large research-based pharmaceutical companies has shrunk by 35 per cent since 2021, according to the 2026 Antimicrobial Resistance Benchmark report released Tuesday (10 March).

The report particularly highlights a stark lack of antibiotics formulated for children. Only 14 per cent of medicines under development by the companies assessed are for those aged under five. In Sub-Saharan Africa, 17 countries have no children’s antibiotics available from these companies.

“Chronic underinvestment, weak development pipelines and declining interest from the private sector mean communities affected by drug-resistant infections suffer,” said John-Arne Røttingen, chief executive officer of the charitable foundation Wellcome, which co-funds the Access to Medicine Foundation’s AMR programme.

While big pharma companies such as GSK are slated to put a few new drugs on the market in the coming years, their accessibility and affordability in lower-income regions might not be far-reaching, the report suggests.

Seven drugs in late-stage development promise to treat infections that have demonstrated resistance to other existing antibiotics—from gonorrhea to urinary tract infections (UTIs) to drug-resistance tuberculosis, according to the Benchmark report, which looked at 25 companies.

UK-based pharma giant GSK is involved in three of them, including the already-approved UTI antibiotic gepotidacin, while other drugs will come from smaller companies like Venatorx and Innoviva.

All companies involved in the development of new antimicrobials have plans to get their drugs registered, to implement early-access programmes, and to ensure that patients involved in clinical trials can access the medicines after the studies end, the report says.

But of these seven upcoming antimicrobials, only two, from Innoviva and Otsuka, are expected to be available at an affordable price in low- and middle-income countries, according to the Access to Medicine Foundation’s analysis. The Foundation looked at how companies tackled availability, affordability and continuous supply of medicines in low- and middle-income countries.

“With these treatments so close to reaching the market, the current gaps in access planning could leave millions in LMICs with delayed treatment—or no access at all,” the report says.

Martijn Van Gerven, research programme manager for the Access to Medicine Foundation’s AMR programme, told SciDev.Net that companies need to have external incentives to make their medicines widely available, such as governments promoting research and development or revenue guarantee schemes, such as those implemented in the UK. Antibiotics are expensive to make and are not used continuously, making them an unattractive investment for many companies, Van Gerven explained.

The subscription model works when governments pay a subscription to drugs, to ensure that they remain available regardless of market dynamics. But this needs to be done on a global scale for it to be successful, Røttingen, of Wellcome, told a press briefing in London on Tuesday.

Although most companies analysed in the report do have plans to make their products accessible, the problem is the lack of specificity of those plans, Claudia Martinez, director of research at the Access to Medicine Foundation, told the briefing.

“What we want to see is not a huge lag between registration and availability,” she said.

Most antibiotics sold around the world come from generics manufacturers—companies that make off-patent, cheaper medicines. These are the ones that are mostly sold in low- and middle-income countries.

The Benchmark report analysed ten generics manufacturers, including Abbott, Hikma and Sandoz, and found that six of them tracked how many patients their products reach in low- and middle-income countries. Sandoz and Viatris were the only companies that did this kind of tracking for all their medicines. Fresenius Kabi and Alkem do not disclose details on their patient tracking methodologies, according to the report.

For Ayodele Majekodunmi, a Nigeria-based One Health epidemiologist and executive director of the data company Ajisefini Consulting, the real game-changer when it comes to reaching low- and middle-income countries is ensuring that at least part of the manufacturing takes place in those countries, allowing prices to drop.

This can be done when big pharma companies partner with and transfer knowledge to other companies in the global South, or when those big players set up factories in lower-income regions, explained Majekodunmi, who is also project lead for the World Organisation for Animal Health’s Health Security Programme, West and Central Africa. But the former leaves those countries less vulnerable to big pharma companies that may decide to leave a particular market, she added.

“Where you have local companies that are owned by people in that country, there’s nowhere for you to pack up and go. So local ownership and local investment is needed, definitely,” Majekodunmi told SciDev.Net.

Anand Anandkumar, founder of the India-based biopharmaceutical company Bugworks, told SciDev.Net that he is implementing a strategy to ensure that his company’s novel antibiotics—which haven’t yet gone through human trials—reach as many people as possible around the globe once they are ready to be sold.

Bugworks is working with the Global Antibiotic Research and Development Partnership (known as GARDP) to make its products affordable, according to Anandkumar.

Subject to regulatory approvals, Anandkumar expects his antibiotics to be manufactured in India and for GARDP to help stockpile them for distribution in Latin America and Africa.

“I think if you give enough volume guarantees, manufacturers in India can manufacture a tonne of products for most of the developing world,” he said.

GSK’s chief scientific officer Tony Wood said in a press statement that GSK is using cutting-edge technology to bring much-needed innovation to patients, including a new first-in-class antibiotic last year. “While this is welcome progress, it is not enough and today’s report underlines the need for governments and industry to work together to improve economic incentivisation of R&D and implement better access and stewardship models,” the statement read.

This piece was produced by SciDev.Net’s Global desk.