Let s begin with some applause. Not too much, mind you, perhaps a polite golf clap. The US Food and Drug Administration recently approved two new antibiotics to combat drug resistant gonorrhoea, an increasingly problematic sexually transmitted infection currently infecting 82 million people annually. One of these drugs, zoliflodacin, emerged not from a gleaming Big Pharma research fortress, but through a non profit partnership between a global health organisation and a pharmaceutical company. Researchers called this a turning point. Investors called it niche. And herein lies our first contradiction.

The triumph over disease narrative makes for excellent press releases. The commercial realities, however, reveal something far less heroic. Drug resistant infections kill over a million people annually according to the Lancet, yet only 1 of the 43 antibiotics in clinical development target priority pathogens identified by the WHO. Gonorrhoea made that list years ago. Even now, with cases tripling across Europe and England seeing record infections, we must ask why this particular breakthrough required charity sector intervention rather than commercial urgency.

Antibiotics remain the pharmaceutical industry s ugly stepchild for reasons Wall Street understands perfectly. Unlike cholesterol medications taken daily for decades or cancer therapies commanding six figure price tags, antibiotics get used sparingly and briefly. Developing one still costs between $1 500 million according to MIT research, but with gross revenues averaging just $50 million annually. Compare this to blockbuster arthritis drugs generating billions while slowly losing patent protection. The maths determines the corporate priorities even before examining investor demands for quarterly returns.

This brings us to the second uncomfortable reality. The pharmaceutical industry s much vaunted innovation engine will happily reverse gears when commercial incentives vanish. Since 2000, over 30 major drug companies abandoned antibiotic development entirely according to the Pew Trust, with several publically traded firms collapsing despite promising pipelines. Remaining players focus predominantly on recasting existing molecules rather than genuine innovation. The market fundamentally broke, yet instead of system wide reform, we get corporate sob stories about supplier constraints while executive bonuses remain intact.

Regulatory attempts to fix this through programmes like the GAIN Act offering patent extensions have failed spectacularly. Approval of new antibacterial agents actually decreased post implementation according to Johns Hopkins Bloomberg School of Public Health. Meanwhile, resistant gonorrhoea rates doubled between 2022 and 2024 while treatment efficacy slipped below 90 in some regions. When markets and public health objectives collide, the invisible hand appears to be flipping society the bird.

Which brings us back to zoliflodacin. The Global Antibiotic Research Development Partnership model shows potential by separating profit motives from essential medicine development. Providing commercial rights in low and middle income countries ensures access where disease burden remains highest yet purchasing power lowest. It resembles modernised corporate social responsibility, except with actual products rather than vague sustainability pledges.

The third angle deserving scrutiny investor complicity. While environmental, social, and governance frameworks obsess over carbon emissions and board diversity, antibiotic resistance constitutes one of the most material health threats to workforce productivity and economic stability. Research from the World Bank suggests drug resistant infections could shave 3 8 off global GDP by 2050 while pushing 28 million into poverty. Yet how many institutional investors demand antibiotic pipeline disclosures from healthcare holdings How many shareholder resolutions address therapeutic development misalignment At present, zero.

The situation mirrors climate change denial with lab coats. Everyone acknowledges the problem, executives make appropriately concerned faces at Davos panels, then capital continues flowing toward metabolic syndrome treatments for wealthy ageing populations. Modern portfolio theory apparently cannot comprehend investing in preventing civilisational collapse.

Here s where the gonorrhoea story connects to broader business strategy failures. Corporate leadership remains plagued by a ‘distant crisis’ bias in decision making. Zenopa’s 2023 C Suite Health Survey found only 14 of pharmaceutical executives considered antibiotic resistance a top five strategic priority, despite overwhelming evidence it threatens modern medicine. Hospital acquired infections alone cost European healthcare systems €7 billion annually according to WHO Europe. But delayed consequences enable delayed investment.

The final irony this very tendency to neglect slow burn threats creates new commercial opportunities. Private equity firms now acquire abandoned antibiotic pipelines at distressed prices after public companies exit. The model simple. Obtain sole rights to a niche antibiotic, acquire orphan drug status through savvy lobbying, then charge healthcare systems astronomical sums for critical treatments. Pharmaceutical brokering with better marketing.

Where does this leave our gallant non profit success story Dangling like a Band Aid over a haemorrhaging wound. Commendable, necessary, yet fundamentally insufficient when 90 of antibiotic development globally still relies on traditional commercial models. We celebrate medical breakthroughs while perpetuating conditions ensuring more will be required.

The uncomfortable truth remains. Until governments impose serious consequences for therapeutic negligence, through taxation penalties or compulsory licensing threats, and until investors treat antibiotic pipelines with the urgency of oncology franchises, little will change. Public sector organisations will keep delivering what private capital cannot or will not.

Some may call this criticism harsh. To them I say watch the earnings calls. When pharmaceutical executives start discussing antibiotic development with the same enthusiasm as weight loss drugs, we ll know systemic change arrived. Until then, enjoy those polite rounds of applause.