Small drugmakers and biotech firms that are developing the bulk of new antibiotics need far more financial support, according to a new report, which warned that without these life-saving medicines there could be a pandemic of drug-resistant infections, worse than Covid-19. The Access to Medicine Foundation, an Amsterdam-based non-profit group, said small and medium-sized firms, which account for three-quarters of all late-stage antibiotics in development, struggle to secure enough funding and are often at risk of bankruptcy, potentially leaving new medicines stranded on the lab bench. “If the loss of such promising products continues, the pandemic of drug-resistant infections will pose a bigger global health emergency than Covid-19,” the foundation’s report warned. Last year, 138 vaccines or drugs targeting 18 bacterial and fungal infections were in development worldwide, down from 175 projects two years earlier. Antimicrobial resistance (AMR) occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to medicines, making common infectious diseases such as pneumonia, tuberculosis and gonorrhoea harder to treat. Jayasree Iyer, executive director of the Access to Medicine Foundation, said: “Small and medium-sized companies are very critical for antimicrobial research. Big pharma has been leaving this space – only a small handful of companies are still developing drugs.” Big pharma is also involved in the $1bn AMR Action Fund, a collaboration with the WHO, European Investment Bank and Wellcome Trust, which was launched last July to support clinical-stage antibiotic research and aims to bring two to four new antibiotics to market by 2030. The foundation’s report highlighted four small US firms: Bugworks, Entasis, Qpex and Cidara, which are developing new drugs targeting the superbugs Candida auris, Neisseria gonorrhoeae, Acinetobacter baumannii and Staphylococcus aureus. To support such projects, Iyer called for subscription-based models, such as the UK’s – where governments make regular payments in return for on-demand supply of effective antibiotics – as well as international partnerships with bigger firms. Iyer said China’s role, as the world’s biggest producer and user of antibiotics, was key to the development of these life-saving medicines. Some small drugmakers work with partners in China and the report said: “There are compelling signs that China will become a global hub for the development, manufacturing and commercialisation of antibiotics and anti-fungals.” She dismissed concerns that China was becoming too powerful in controlling the supply of drugs globally. “We need China and the US to set up incentives and to work together.”