Abstract
The escalating threat of antimicrobial resistance (AMR) necessitates novel strategies to stimulate the research and development (R&D) of new antimicrobial agents. This paper provides a global policy analysis of the effectiveness and interplay of 'push' and 'pull' incentives in addressing the market failures inherent in antimicrobial R&D. Push incentives aim to reduce the costs and risks of R&D, while pull incentives aim to increase the potential returns on successful innovation. We review the theoretical underpinnings and empirical evidence for various push mechanisms (e.g., grants, tax credits, research collaborations) and pull mechanisms (e.g., market entry rewards, subscription models, priority review vouchers). Employing a mixed-methods approach, this study analyzes policy documents, expert interviews, and market data from key global health organizations and pharmaceutical companies active in antimicrobial R&D. Our findings indicate that while both push and pull incentives play crucial roles, their efficacy is highly context-dependent and often synergistic. Push mechanisms appear more effective in supporting early-stage, high-risk research, whereas pull mechanisms are critical for incentivizing late-stage development and market entry, particularly for antibiotics addressing urgent public health needs. Challenges remain in optimizing the design and coordination of these incentives to ensure a sustainable pipeline of essential antimicrobials. The analysis highlights the need for robust, predictable, and globally coordinated policy frameworks to adequately address the AMR crisis through enhanced R&D investment.