Equitable access to innovative antibiotics—global challenges and policy options
On January 13, 2026, the Parliamentary Group on Antimicrobial Resistance (PKAMR) convened for its second working session of this legislative period in the German Bundestag.
The second working session of the Parliamentary Group on Antimicrobial Resistance (PKAMR) focused on the question of how equitable access to antibiotics – especially new reserve antibiotics – can be ensured in low- and middle-income countries (LMICs). At the same time, the group discussed how new incentive models (“pull mechanisms”) can strengthen the development of urgently needed antibiotics without creating false incentives for higher consumption.
The Parliamentary Group on Antimicrobial Resistance (PKAMR) convened on January 13, 2026, for its second working session of this legislative period in the German Bundestag. The focus was on how to ensure equitable access to antibiotics—especially new reserve antibiotics—in low- and middle-income countries (LMICs). At the same time, the group discussed how new incentive models ("pull mechanisms") can strengthen the development of urgently needed antibiotics without creating false incentives for higher consumption.
The meeting was opened by chairwoman Dr. Franziska Kersten, Member of the German Bundestag. Ralf Sudbrak (DNAMR) from the Global AMR R&D Hub, representing the DNAMR, introduced the topic of pull mechanisms and highlighted the connection between research incentives and global access.
The first presentation was given by Jasmin Behrends, Policy Advisor for Global Health at Médecins Sans Frontières (MSF). She made it clear that LMICs bear the greatest burden of antimicrobial resistance—while often having limited resources, weak health systems, and inadequate diagnostics. In crisis and conflict regions in particular, destroyed infrastructure, cramped living conditions, malnutrition, and poor water and hygiene conditions exacerbate the spread of resistant infections. MSF takes a broad approach to this issue, encompassing infection prevention and control, antibiotic stewardship, diagnostics, and access to established and new antibiotics.
Behrends also emphasized that patients in LMICs often do not have reliable access to life-saving antibiotics—neither to long-established essential drugs nor to reserve antibiotics. Structural barriers mean that in many countries, new products only arrive years after initial approval—if at all. Against this backdrop, Behrends emphasized the need for new pull incentives. With regard to the reform of EU pharmaceutical legislation, she referred to the instruments currently under discussion—in particular the Transferable Exclusivity Voucher (TEV) and a (voluntary) subscription model for joint procurement. From MSF's perspective, pull mechanisms must be linked to a global access strategy. This includes timely registration in LMICs, affordable prices, transparency on studies and costs, diversified production, and collaboration with non-profit and multilateral initiatives.
Peter Beyer, Deputy Executive Director of the Global Antibiotic Research and Development Partnership (GARDP), then presented the perspective of a non-profit product development partnership. He emphasized that development and access must be considered together—especially in the case of reserve antibiotics, which are deliberately used sparingly to avoid resistance and are therefore often not commercially viable. Beyer also pointed to regulatory hurdles. In many African countries, approvals have so far been granted primarily at the national rather than regional level. This slows down procedures and increases costs. However, initial approaches for joint regional approvals are currently being developed.
As a concrete example, Beyer explained the project involving the reserve antibiotic Cefiderocol developed by Shionogi. This shows how a non-profit access model can work in partnership with industry. Shionogi is collaborating with GARDP and the Clinton Health Access Initiative (CHAI). Since June 2022, a licensing and cooperation agreement has enabled access to cefiderocol in up to 135 countries. GARDP can further develop, register, manufacture, and distribute the drug in these countries. CHAI supports technology transfer, market design, and access in Africa and Asia, among other things. Sublicenses ensure production and distribution, while requirements for quality (including WHO prequalification), stability, environmental standards, and stewardship are intended to support responsible use. At the same time, cefiderocol illustrates that market-based incentives alone are often not enough—especially in the case of reserve antibiotics, economic viability remains uncertain without additional pull mechanisms. The TEV model, as adopted in the EU's GPL, is therefore to be welcomed, especially since new antibiotics must first be available before issues of access to them can be addressed.
Finally, Pol Vandenbroucke, Vice President, Global Government Affairs at Shionogi, reported from the perspective of a research-based pharmaceutical company. He explained that Shionogi had examined various access options for cefiderocol and had deliberately chosen to partner with GARDP and CHAI, as a purely commercial approach would make it difficult to ensure equitable access in many LMICs. From a corporate perspective, global access requires a multi-pronged approach that brings together registration, manufacturing and supply chain, diagnostics, stewardship, and lifecycle management. He also pointed to the importance of international cooperation and discussion of access and financing models in order to combine access, quality, and responsible use.
Call to action for the Bundestag:
The federal government should actively advocate for access conditions such as timely registration, affordable prices, transparency, and stewardship to become a binding component of new, effective incentive models. At the same time, voluntary partnerships between industry and non-profit organizations as well as regional approval procedures should be specifically supported in order to make urgently needed new antibiotics available worldwide.
Source: News of the German Network against Antimicrobial Resistance (Deutsches Netzwerk gegen Antimikrobielle Resistenzen, DNAMR), in German
