Public health Policy, research + analysis

Fighting superbugs: The Path Forward

July 2025

Fighting superbugs: The Path Forward

Antimicrobial resistance (AMR) is a growing public health crisis—and one of the most serious threats to human life. It occurs when microbes such as bacteria, viruses, fungi or parasites evolve to resist medicines that once killed them, rendering once-treatable infections increasingly difficult—or impossible—to cure. AMR poses a significant risk not only to human health, but also to animal and environmental health, threatening to undermine decades of medical progress.

If current trends continue, an estimated 10 million people globally could die each year from drug-resistant infections by 2050—many of them from conditions that are still treatable today. These deaths are preventable, but only if new antimicrobials are developed to replace those that are losing effectiveness. And yet, the commercial market for antimicrobial development remains fundamentally broken.

Unlike other therapeutic areas, antimicrobials are generally used infrequently, reserved for last-line treatment, and subject to stringent stewardship. As a result, even highly effective new products tend to see low clinical use and limited sales revenue. This dynamic creates an enduring market failure: while society urgently needs new antimicrobials to address drug-resistant infections, the financial incentives for companies to develop and commercialise them are vanishingly small.

Recognising this challenge, Evohealth partnered with the Australian Antimicrobial Resistance Network (AAMRNet) and MTPConnect to publish Fighting Superbugs: Ensuring Australia is ready to combat the rise of drug resistant infections back in 2023. This foundational report outlined the scale of Australia’s AMR challenge and presented a series of targeted policy and funding reforms, including the need to pilot a subscription-style reimbursement model that delinks payment from sales volume. The model, successfully trialled in the United Kingdom, offers a sustainable way to reward innovation while ensuring responsible use.

In parallel, the Australian Government undertook a comprehensive Health Technology Assessment (HTA) Policy and Methods Review between 2022 and 2024, examining how Australia assesses and funds new health technologies. This review was significant in scope, generating 50 final recommendations to modernise the system, improve access, and better reflect emerging health technologies and clinical contexts. Among them, Recommendation 21 specifically addressed the need to develop and evaluate a flexible, value-based reimbursement policy for antimicrobials. The recommendation mirrored many of the findings and proposals outlined in Fighting Superbugs, marking a major step forward in aligning national policy with AMR funding needs.

To build on this momentum and ensure Recommendation 21 could be implemented in a practical and timely way, Evohealth facilitated a high-level national roundtable in November 2024, in collaboration with AAMRNet and MTPConnect. The roundtable brought together more than 30 stakeholders, including clinical experts, policy leaders, industry representatives, and researchers, to develop a detailed blueprint for piloting a subscription model in Australia.

The roundtable drew heavily on the UK’s pioneering approach, adapting key elements to fit the Australian context. It produced a set of 10 key principles to guide implementation, covering areas such as product eligibility, assessment criteria, procurement processes, stewardship safeguards, and pricing considerations. The design was intended to be modular and implementation-ready—a “plug-and-play” model that could be launched within existing infrastructure and governance frameworks.

However, despite broad support and policy alignment, the proposed pilot was not included in the first tranche of HTA Review recommendations selected for implementation by the HTA Review Implementation Advisory Group in its May 2025 communique. While several important reforms were prioritised, including improvements to transparency, consumer involvement and assessment of high-value therapies, Recommendation 21 was notably absent.

The case for delinked reimbursement remains strong. The UK model has demonstrated that such an approach can work—not only in sustaining commercial interest, but also in supporting access and stewardship. In Australia, AAMRNet’s modelling shows that piloting even two novel antimicrobials through a subscription scheme could have meaningful health system impact, while helping to stabilise a fragile development pipeline.

Australia has the expertise, infrastructure, and cross-sector support to take this step forward. The groundwork has been laid—through our 2023 report, the 2024 HTA review, and the roundtable’s implementation roadmap. What remains is a decision to act.

As policymakers continue to assess the sequencing of HTA reforms, we encourage renewed consideration of Recommendation 21. The urgency of AMR is not diminished by process. And while not every HTA reform can be implemented at once, this is one with a clear case for early action.

Addressing the market failure in antimicrobial development is not just a health system issue—it’s a matter of national preparedness. The longer we wait to address it, the fewer options we will have when resistance threatens the effectiveness of our existing arsenal.