Five years after the release of its previous Antimicrobial Resistance (AMR) Benchmark, the Access to Medicine Foundation finds bright spots in pharma’s efforts to tackle superbugs. However, drug resistance is outpacing industry-wide efforts. The challenge now is to urgently develop and apply approaches across more products and across more countries to mimimise this global threat and save lives.
More than one million people die each year as a direct result of drug-resistant infections, while antimicrobial resistance (AMR) contributes to over four million deaths in total. By 2050, direct and indirect deaths are projected to rise to nearly two million and more than eight million, respectively. While the outlook is dire, AMR is not an insurmountable challenge. As part of the global consensus on what needs to be done to address one of the biggest threats to global health, there are vital areas where pharmaceutical companies must play their part – making the findings of the 2026 AMR Benchmark timely.
Five years since the release of the 2021 AMR Benchmark, this new iteration evaluates the efforts of 25 pharmaceutical companies, comprised of seven large research-based companies, ten generic medicine manufacturers and eight small- and medium-sized enterprises (SMEs). Findings highlight numerous strong examples – spanning strategies, products, and geographies that demonstrate real-world actions companies are taking to curb drug resistance. However, more comprehensive action is needed across the board.
“We can tilt the battle against superbugs in humanity’s favour. Our findings show practical approaches that can ramp up progress on all fronts,” Jayasree K. Iyer, CEO, Access to Medicine Foundation
Thin pipeline, high stakes
The current lack of antimicrobial research and development (R&D) is one of the biggest challenges in the battle against AMR. The inclusion of eight SMEs in the 2026 iteration reflects these players’ immense importance in holding the line while large research-based companies (LRBs) continue to forego infectious disease R&D. This makes the efforts of companies still engaged in this space that much more vital. While the Benchmark does find a 35% decline in the antimicrobial pipelines of LRBs, it also identifies seven late-stage projects that exhibit genuine innovation with potential to overcome resistance. These products originate from both LRBs GSK, Otsuka, Shionogi and SMEs BioVersys, F2G, Innoviva, Venatorx – and have the potential to tip the scales for millions.
Annually, approximately 150 million people develop a urinary tract infection (UTI), and 50-60% of women globally will experience a UTI in their lifetime. GSK’s gepotidacin targets uncomplicated UTIs and marks the first new oral antibiotic class for uncomplicated UTIs in nearly 30 years. During the Benchmark’s analysis period, gepotidacin was approved for uncomplicated UTIs as well as uncomplicated gonorrhoea, alongside Innoviva’s zoliflodacin, marking the first introduction of new oral treatment options for gonorrhoea in decades. Gonorrhoea affects around 82 million people every year and it is resistant to nearly every antibiotic class.
These advances show it is possible to turn the tide against superbugs, but the pipeline must start catching up with growing resistance. Given the high cost of bringing new products to market, addressing the rate of innovation requires a more holistic approach. Governments and policymakers play a crucial role in shaping sustainable markets to support continued industry innovation and investment – without which global efforts to curb resistance cannot succeed.
“Chronic underinvestment, weak development pipelines and declining interest from the private sector mean communities affected by drug-resistant infections suffer. The solution lies in diverse partnerships, bringing together private companies, pharma and biotech, researchers, public and philanthropic funders, and new payment models to drive urgently needed advancements in antimicrobials.” – John-Arne Røttingen, CEO of Wellcome
Better access to existing drugs – especially child-friendly versions – is vital
For children, who are more vulnerable to infections, the thin pipeline is compounded by the fact that child-friendly formulations of any new drugs can take years to be approved. At the same time, the availability of existing antibiotics in LMICs is often woefully inadequate, especially when it comes to products for children. As a result, patients too often receive suboptimal treatments that are not up to the job, allowing resistance to develop.
Among companies with paediatric formulations on the market, five – Aurobindo, GSK, Hikma, Sandoz and Teva – stand out by registering their paediatric formulations, on average, in around 50-70% of the LMICs where they register their other off-patent antimicrobials. Despite this, gaps in access are prominent in 17 sub-Saharan African countries, where no child-friendly versions of any of these products have been registered by any of the companies assessed by the Benchmark.
Where we go from here
The bright spots from individual companies in the Benchmark are grounds for hope. Notably, we have seen companies take more ownership, for example, in mitigating the risk of AMR from manufacturing across their supply chains. For the first time, the AMR Benchmark assessed the approaches used by generic medicine manufacturers to track and monitor patient reach – with six of the ten generic companies assessed doing this across almost all their antibiotic and antifungal products analysed.
Overall, however, the industry-wide performance across LRBs and generic medicine manufacturers has declined since 2021. And antimicrobial development remains worryingly sparse, with GSK, Otsuka and Shionogi among the only big players still investing in innovative R&D. Collectively, the eight SMEs assessed account for almost a quarter of all pipeline projects, but they are constrained by limited access to capital and a lack of global reach.
AMR demands coordinated action across sectors; no single stakeholder, including pharmaceutical companies, can tackle it alone. Nevertheless, pharmaceutical companies have a responsibility to contribute to addressing AMR within their sphere of influence, with opportunities to already take stronger, more targeted action at various stages of the pharmaceutical value chain.
“From R&D through manufacturing, to access and stewardship and measuring real-world patient reach, the Benchmark illustrates the potential for companies to develop more comprehensive approaches. But we need intensified, industry-wide action.”– Claudia Martínez, Director of Research, Access to Medicine Foundation
By revealing where companies perform strongly and where progress needs to be accelerated, the Benchmark helps clarify the path to ensuring the sustainable development, supply and appropriate use of antibiotics for the benefit of the entire world.