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Antimicrobial resistance (AMR) will cause more deaths in Africa than tuberculosis, HIV and malaria combined by 2050, according to research. Yet large pharmaceutical companies are retreating from antibiotic development, a move that severely undermines the response to drug-resistant infections across the continent.
Fackswell Mateyo, a pharmacist and antimicrobial manufacturing expert, explains the reasons why big pharma companies are no longer investing in antibiotics and how this compounds the threat of AMR in Africa
“Nearly 1.3 million people die of drug-resistant bacterial infections every year. Yet for more than a decade, there was not a single genuinely new antibiotic approved. The ones that do make it to market are mostly variations of existing drugs, effective, yes, but not built for the next generation of resistance.” Mateyo says.
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By Fackswell Mateyo
Imagine spending over $1 billion developing a medicine that doctors are encouraged not to use. That’s a paradox existing today in antibiotic discovery and innovation. But why does it exist?
The Numbers Tell a Brutal Story
18 global pharma companies developed antibiotics in 1990, 5 remain today in 2026. The antibiotic discovery pipeline is collapsing. The last entirely new class of antibiotic was discovered in the late 1980s.
Nearly 1.3 million people die of drug-resistant bacterial infections every year. Yet for more than a decade, there was not a single genuinely new antibiotic approved. The ones that do make it to market are mostly variations of existing drugs, effective, yes, but not built for the next generation of resistance.
This is not about neglect by researchers or pharmaceutical companies; it’s more to do with the economics and business model of developing new antibiotics. The antibiotic market is designed in a way that makes it less attractive to investment. How so?
The Economics Are Simply Broken
Developing a new antibiotic costs an estimated $1.5 billion. The average annual revenue it generates is far less than that.
Seven of the 12 companies that successfully brought a new antibiotic to market in the past decade went bankrupt or exited the business.
Take the case of Achaogen. After 15 years of research and significant government backing, they brought Plazomicin to market, a genuinely novel antibiotic effective against some of the most resistant bacteria known to medicine. In its first year on the market, it generated less than $1 million in sales. The company filed for bankruptcy in 2019.
Compare that to Humira, AstraZeneca's rheumatoid arthritis drug, which generated over $19 billion in a single year. The return-on-investment comparison is not even close. Pharma companies are concerned about their bottom line as well and invest where financial returns are certain and high. Antibiotics, right now, are not that place.
Why This Matters
If companies that successfully develop life-saving antibiotics cannot survive financially, fewer investors will fund similar research in the future.
The withdrawal of large pharmaceutical companies from antibiotic research creates a dangerous gap. Without sustained investment, innovation slows while resistance continues to rise.
If antibiotic innovation stalls while resistance accelerates, even routine medical procedures could become significantly more dangerous.
Is There a Way Out?
A few promising models are emerging — though none are yet at scale.
Subscription-based payment model: instead of paying per prescription, the government commits to fixed annual payments to pharma companies in return for access to developed antibiotics. This decouples financial reward from volume sold, which is the root of the problem. It is early, but it is the right structural idea. The UK government has started piloting this model.
AI-assisted drug discovery is also changing the economics of early-stage research. Using deep learning to screen candidate molecules is dramatically cutting the time and cost of identifying new antibiotic compounds — potentially making the early phase of development viable again, even if the commercialisation problem remains unsolved.
International coalitions like CARB-X, WHO's global action plan, and the proposed PASTEUR Act in the US are all attempting to rebuild the pipeline through public funding and coordinated incentives. But progress is slow, and the urgency is not reflected in the pace.
The system that funds drug development financially rewards drugs that are used continuously and discourages medicines that should be used sparingly.
This system should be revised to include antibiotic drug discovery and innovation as well. This requires deliberate policy and global coordination to make it a success.