Investments into AMR solutions

Current approaches to investments in AMR solutions are generally evidence-based, driven by the agendas and priorities of various funding organisations and strategically focused on technical innovations. Key funders in the AMR landscape include Wellcome, World Bank, Novo Nordisk, the Gates Foundation, and global health government-driven initiatives like the Fleming Fund in the United Kingdom, along with other government programs from countries like Canada, the US, Japan, Denmark, and Germany. They either provide direct funding to projects or larger global health initiatives such as CARBX, GARDP and The AMR Action Fund.

Foundations and organisations investing in AMR typically follow a structured process to decide which initiatives to back, prioritising investments based on a combination of scientific, public health, and financial considerations. This includes:

1. Evidence-Based Prioritisation

Investment priorities in AMR are primarily driven by global and regional disease burden data, with foundations focusing on pathogens designated as critical threats by organisations like WHO and CDC. The WHO Priority Pathogen List, initially developed in 2017 and recently expanded to include fungi alongside bacteria, is a key tool guiding R&D investments. While these lists draw on epidemiological data about resistant infections and treatment failures, they are constrained by limited data availability from low-resource settings, potentially underrepresenting the needs of regions with the highest AMR burden. The evidence base guiding AMR investments, though extensive, is predominantly sourced from developed nations. This unintended data imbalance may lead to a partial representation of global AMR challenges, particularly those faced in Low and Middle-Income Countries (LMICs).

1. Alignment with Strategic Objectives

Funding organisations in the AMR space align their investments with their established strategic priorities, ranging from research and innovation to health systems strengthening and policy reform. This strategic alignment is exemplified by the Gates Foundation's AMR initiatives, which prioritise reducing neonatal sepsis in line with their broader organisational objectives.

1. Return on Investment (Impact)

Funding organisations prioritise investments that promise significant impact, measured through public health outcomes such as lives saved and infections reduced, as well as program sustainability. While traditional financial returns are not the primary driver, funders employ impact assessments to evaluate potential success and favour projects demonstrating potential for co-funding and global scalability. Unlike commercial R&D investments, the focus remains on reducing AMR-related morbidity and mortality. However, the concentration of funding organisations in high-income countries introduces inherent biases in project selection, raising questions about the equitable accessibility of resulting treatments, particularly in low- and middle-income countries.

1. Collaborative Ventures:

The AMR funding landscape favours collaborative initiatives that bring together foundations, governments, academic institutions, and industry partners, as these partnerships help distribute risk while increasing chances of success. This collaborative approach is exemplified by organisations like GARDP, which pools resources from multiple stakeholders to develop new treatments. This collaborative model while reducing risk, may favour established institutions.

The current frameworks, while well-intentioned may inadvertently contribute to disparities in resource allocation and solution development. There's potential to further tailor approaches to local contexts, especially in LMICs, where unique challenges may require specially adapted solutions. This localisation of efforts could significantly enhance the effectiveness of AMR interventions in these regions. Funding mechanisms in the AMR space, like many areas of global health, often operate within established bureaucratic processes. While these processes ensure due diligence, they may sometimes impact the speed of response to rapidly evolving AMR threats. Exploring ways to streamline these processes, while maintaining necessary oversight, could improve responsiveness to emerging needs.

Additionally, the complex, long-term nature of the AMR crisis suggests a need for sustained, flexible funding models. Current funding streams, often constrained by shorter-term cycles, may benefit from evolution towards more adaptable, long-term approaches. This shift could better support enduring initiatives such as capacity building, infrastructure development, and complex research projects that require extended timelines to demonstrate impact.