Response to O’Neill AMR Review report 14th May 2015 Laura JV Piddock Professor of Microbiology and Deputy Director of the Institute of Microbiology and Infection, University of Birmingham Director, Antibiotic Action (antibiotic-action.com) Since 2011, numerous reports have been published by the World Health Organization, the European Union, and the US Centers for Disease Control and Prevention, to name a few, that have been followed by action plans discussing how to tackle the antimicrobial resistance problem. Most recently, the Review on Antimicrobial Resistance, established by the UK Prime Minister David Cameron and led by the esteemed economist Jim O’Neill, has also reported on this issue. All of these reports and action plans call for more funding for research programmes, but in particular to increase discovery, research and development of effective new treatments. The latest report issued today ‘Securing new drugs for future generations: the antibiotics pipeline ‘ calls for the establishment of a Global Innovation Fund to stimulate antibiotic drug discovery efforts. It has been widely recognised that the paradigm for antibacterial discovery has changed over the last decade; increasingly, antibacterial drug discovery has been made by university, research institutes and/or small companies. These have then been either co-developed with, or licenced to, large Pharmaceutical companies for development. However, even that paradigm has recently shifted with many discoveries being developed with public money supporting Phase 1 and Phase 2 clinical trials. Meanwhile the world watches to see whether the four large Pharmaceutical companies remain or others re-enter this field. However, it is notable that many companies that once were very active in antibacterial discovery, and were very successful, have been acquired by larger companies and subsequently had the Discovery department reduced or closed. Cubist, who had a very successful antibiotic discovery department, exemplifies this: within months of being acquired by a larger company, the entire discovery department was made redundant. Therefore, how and where are the new, future antibacterial drugs to be discovered and developed? While many have been investigating how to encourage large pharmaceutical companies to re-enter or stay in this field, the paradigm shift of discovery and research taking place within academia, research institutes and small and medium enterprises has been largely over-looked. This has resulted in a woefully small amount of funding for this activity. For instance, within the United Kingdom, there has been a cross-funding agency AMR call. The entire budget is approximately £20 million, sub-divided across various categories including discovery and research. This is despite it being widely reported that the level of funding needs to be hundreds of millions and not tens of millions of pounds/dollars/Euros. As a consequence the funding provided in the UK and in other countries remains woefully inadequate. With such a paucity of research funding, what inevitably happens is that research teams compete against each other rather than collaborate. Nonetheless, the Medical Research Council (MRC)-led cross funder theme 1 AMR call has recently funded two consortia. Unfortunately, the complicated and lengthy process of applying for funding and the limited funding available so far has led to fierce competition rather than collaboration. Furthermore, many believe that grant committees are now faced with so many fundable high quality applications, that decisions end up being very difficult to make. As a consequence the field suffers. With this background, I welcome the establishment of a Global Innovation Fund (GIF) and eagerly await details as to how the fund will operate and in particular the mechanism by which funds will be disbursed. It is particularly encouraging that this fund will support research from all sectors, including universities and small companies. A new GIF should be able to address these issues by funding more projects and encourage the establishment of a network of researchers within this discipline to both share discoveries and enhance each other’s work rather than waste valuable resources developing applications of which the majority will not be funded. The University of Birmingham has already responded to the global challenge of antibacterial resistance when it established the Institute of Microbiology and Infection in 2012 with multi-million pound investments. This investment is to be increased so that University of Birmingham researchers can exploit their exciting discoveries and help to replenish the antibacterial drug discovery and development pipeline. I am hopeful that we will be able to apply to this new global fund for the resources to take our research to the next level!