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.

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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.

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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.

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The Antibiotic Reserve System is a framework for how such an institution could be designed. The underlying paper is available on SSRN.