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Working Group Report on Antibiotic Delinkage

By Kevin Outterson
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Antibiotics are powerful drugs that prevent many deaths each year. Modern medicine relies on them as a safety net. They are a precious global resource that must be managed on a sustainable ecological basis. Many stakeholders believe that an antibiotic crisis is fast approaching or may already be upon us. Owing to the long lead times for antibiotic research and development (R&D), society must act a decade before the need becomes immediately urgent.

A central proposition in this report is that it is desirable to develop new business models where the return for investment in R&D on antibiotics is not dependent on the volume of sales, an approach generally known as “delinkage”. There is a need to incentivize investment in R&D without also incentivizing sales volumes, which may lead to the over-marketing of antibiotics, the acceleration of the development of resistance and the undermining of stewardship and conservation measures necessary to limit the growth of resistance. The report therefore considers the ways in which delinked models could be implemented and the myriad challenges involved in moving towards new business models, which require global reach to address what is a global problem.

Charles Clift is a Senior Consulting Fellow in the Centre on Global Health Security at Chatham House. He is also chair of the board of the Medicines Patent Pool Foundation.

Unni Gopinathan is a medical intern at Akershus University Hospital and a PhD candidate at Oslo University Hospital/University of Oslo.

Chantal Morel is a Research Officer at the London School of Economics and Scientific Adjunct at the University of Geneva Medical School.

Kevin Outterson is a Professor of Law and the N. Neal Pike Scholar in Health and Disability Law at Boston University, where he co-directs the Health Law Program. He is an Associate Fellow at the Centre on Global Health Security at Chatham House.

John-Arne Røttingen is the Director of the Division of Infectious Disease Control at the Norwegian Institute of Public Health; Professor of Health Policy at the Institute of Health and Society, University of Oslo; and Adjunct Professor of Global Health at the Harvard School of Public Health. He is an Associate Fellow of the Centre on Global Health Security, Chatham House.

Anthony So is Professor of the Practice of Public Policy and Global Health and Director of the Program on Global Health and Technology Access at Duke University’s Sanford School of Public Policy and the Duke Global Health Institute.


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