A New Grand Bargain to Improve the Antimicrobial Market for Human Health

June 27, 2022

AMR is already associated with an estimated 5 million deaths per year, and some projections warn it could lead to 10 million deaths a year by 2050 if left unchecked. This is almost five times the number of recorded deaths during the first year of the COVID-19 pandemic. This burden falls heaviest on the world’s poor, with a child born in Africa being 58 times more likely to die from resistance in the first five years of life than one born in a high-income country (HIC).

While there have been high-level commitments from the World Health Assembly, the United Nations General Assembly (UNGA), the G20, and the G7 to tackle AMR, there has yet to be a fundamental change in how we purchase antimicrobials, or an international approach to improving access, fostering innovation, or reducing unnecessary use. Moreover, research and policy recommendations have mainly focused on HIC solutions to increase investment in and secure access to new antimicrobials.

Therefore, CGD has recently launched a new working group to explore possible purchasing systems that will improve access, stewardship, and innovation for antimicrobials in LMICs. CGD has an established track record on AMR, including publications on The Race Against Drug Resistance, Meeting the Challenge of Drug Resistant Diseases in Developing Countries, and A Global Treaty to Reduce Antimicrobial Use in Livestock, as well as considerable work in areas where markets are failing to deliver adequate innovation. The latter includes CGD’s work on Advance Market Commitments, which played an important role in encouraging innovation for  pneumococcal vaccines.

This working group will seek out and amplify the voices of LMIC actors to ensure the fair representation of their needs in a new grand bargain governing action on AMR to ensure adequate access to antimicrobials, stewardship of the drugs, and innovation to replace drugs rendered ineffective by the spread of resistance. The process will culminate in a final report, launched at the time of the UNGA in September 2023, providing actionable policy recommendations about the design and implementation of purchasing systems for LMICs. Recommendations will be informed by a portfolio of extensive country case studies and CGD-commissioned research projects in participating LMIC countries.


Working group members:

  • Javier Guzman, Center for Global Development (Chair)
  • Anthony McDonnell, Center for Global Development (Technical lead)
  • Austen Davis, Norwegian Agency for Development Cooperation
  • Badri Narayanan, National Institution for Transforming India
  • Brenda Waning, Stop TB Partnership at UNOPS
  • Faisal Sultan, Former Special Assistant to the Prime Minister of Pakistan
  • Jayasree Iyer, Access to Medicine Foundation
  • Jeremy Knox, Wellcome Trust
  • Kevin Outterson, CARB-X
  • Mahlet Kifle Habtemariam, Africa Centres for Disease Control and Prevention
  • Manica Balasegaram, GARDP
  • Milton Ozorio Moraes, Fiocruz
  • Mirfin Mpundu
  • Naomi Rupasinghe, World Bank
  • Prashant Yadav, Center for Global Development
  • Rachel Silverman, Center for Global Development
  • Siddhartha Bhattacharya, NATHEALTH
  • Steve Isaacs, Aduro BioTech
  • Thomas Cueni, International Federation of Pharmaceutical Manufacturers and Associations
  • Tochi Okwor, Nigeria Centre for Disease Control
  • Yot Teerawattananon, HITAP

CGD research staff:

  • Katherine Klemperer
  • Morgan Pincombe