The world's last-resort antibiotics have no custodian.
The global response to antibiotic resistance contains a structural flaw: novel antibiotics function as strategic reserves but are managed as commercial products. No institution exists to govern them as such.
I have spent two decades working at the intersection of pharmaceutical development, public health policy, and antimicrobial resistance governance. I contributed to the DRIVE-AB global antibiotic valuation consortium, served as inaugural Chair of the Royal Pharmaceutical Society's Expert Antimicrobial Group, and advise the Global Antibiotic Research and Development Partnership on access and translation.
Over time, one gap became increasingly difficult to ignore. Market reform, pull incentives, and stewardship programmes address real problems. None of them were designed to govern a strategic reserve.
The institution that would do so, holding authority comparable to a central bank in finance or the International Atomic Energy Agency in nuclear governance, does not yet exist.
The Antibiotic Reserve System is a framework for how such an institution could be designed. The underlying paper is available on SSRN.