Investing in a Sustainable Future for Antibiotics: A Conversation with Dr. Henry Skinner, CEO of AMR Action Fund

As antimicrobial resistance (AMR) increasingly threatens global health, the AMR Action Fund, led by CEO Dr. Henry Skinner, is driving a monumental $1 billion initiative to tackle this crisis. Under Dr. Skinner’s leadership, the fund supports biotech companies developing urgently needed treatments for drug-resistant infections—a mission critical, as AMR now contributes to 4.9 million deaths each year. In this conversation, Dr. Skinner shares his insights into the challenges facing antimicrobial drug development and his call to action in building a sustainable future for antibiotics.

Henry, thank you for joining us. The AMR Action Fund represents a major international effort to combat antimicrobial resistance. Could you tell us about what inspired its creation and how it’s addressing the AMR crisis?

Henry Skinner: The AMR Action Fund came about from a shared recognition across the private sector, pharmaceutical companies, IFPMA, Wellcome, and the WHO that investment in new antimicrobials was rapidly dwindling, while the need for these drugs was skyrocketing. With the antibiotic pipeline shrinking, the fund was established as a short-term solution to support innovative biotech companies developing new antimicrobials and diagnostics. Beyond funding, we also provide guidance on antimicrobial development and advocate for market-based solutions that will incentivize private sector investment to make AMR drug development financially sustainable.

How does the fund decide which projects to invest in?

Henry Skinner: We prioritize investments that promise the greatest global impact, focusing on treatments for pathogens that cause the most harm and mortality worldwide. Our primary lens is where the patient need is most pressing, which we gauge through references like the WHO, US CDC, and ICMR lists of priority pathogens. We particularly target treatments for the most dangerous pathogens, like Acinetobacter, Pseudomonas, and E. coli.

After that, we look at a drug’s spectrum of activity, safety profile, and whether it introduces a novel mechanism of action. Novel mechanisms are especially valuable because they provide new ways to combat resistance. We focus on late-stage clinical activities where funding needs are greatest and where treatments are close to reaching patients. Our ultimate goal is to ensure that these therapies are backed by well-designed development plans, ensuring access while giving physicians clear guidance on their use.

What would you say are the biggest challenges in antimicrobial drug development today?

Henry Skinner: There are several, but I’d highlight four main challenges. First, discovering safe and effective antimicrobials is inherently risky. Antimicrobial compounds need unique properties to kill microbes, which adds complexity to drug discovery compared to, say, cholesterol or diabetes treatments.

Second, clinical trials for antimicrobials often face hurdles because it’s ethically necessary to compare new treatments with effective existing ones, making it difficult to demonstrate superiority. Trials are generally designed to show “non-inferiority” rather than direct superiority, even if the new treatment might be more effective against drug-resistant pathogens.

Third, the high costs of clinical development are a major hurdle. Trials often cost hundreds of millions of dollars and ideally should be global to reflect AMR’s worldwide impact. Running trials across multiple countries, especially in low- and middle-income areas, adds complexity and cost, though efforts to build global clinical networks are helping.

Finally, financing remains an enormous obstacle. Securing enough capital for these trials is tough, as most investors shy away. Like in cancer treatment, antibiotics must be tested across multiple indications—respiratory, urinary, and intra-abdominal infections, for instance—each requiring separate studies. In the current funding climate, developers are fortunate if they can finance even one indication.

Are there solutions underway to address the funding challenges?

Henry Skinner: Yes, and there are two main points to consider. First, we have to acknowledge that investors need a viable financial model to keep investing. Right now, the economics of antimicrobial development make it unappealing for investors, so we have to fix that.

One way to do this is through “pull incentives,” a system that guarantees returns for companies that successfully develop new and effective antimicrobials. These incentives need to be significant and globally coordinated to attract rational investment back into the space. They should also align with patient needs, focusing on specific drug-resistant pathogens while ensuring global access. Importantly, incentives should be delinked from sales volume to avoid misuse—these drugs should be used only when absolutely necessary.

To make this field more attractive to investors, we need to ensure that if they support the right antimicrobials, they’ll see a clear return. We encourage investors to work with policymakers to push for the changes needed to make AMR investment viable. In the meantime, there’s opportunity in unmet needs, like treating non-tuberculous mycobacteria (NTM) and other resistant infections, as well as developing broad-spectrum, safe antifungals. However, broader engagement requires policy changes and secure financial returns.

Are there policy changes you believe could help reduce AMR and accelerate new drug development?

Henry Skinner: Absolutely. Microbes will always evolve to resist antimicrobials—the key is controlling the speed and spread. That means using antibiotics wisely and creating policies that support this. We need stronger diagnostics, evidence-based guidelines, and solid epidemiology to track resistance patterns. This way, we can create targeted policies that address AMR in hospitals, communities, and beyond.

Prevention is also essential. Vaccination plays a huge role here; vaccines reduce infection rates and prevent secondary bacterial infections, which often require antibiotics. Expanding the use of vaccines and developing new ones for bacterial, fungal, and viral infections would have a massive impact.

Finally, we need to ensure clean water, sanitation, and basic hygiene in healthcare settings to prevent infection. Improving manufacturing practices so antibiotics are produced without harmful environmental effects is also essential. These are foundational policies that, when strengthened, will reduce infections and limit the spread of resistance.

Given the long timelines for developing new drugs and the current lack of options, can we make better use of existing antibiotics to address AMR?

Henry Skinner: Definitely. The pipeline is thin, but it’s not empty. For instance, we supported Utility Therapeutics in bringing Pivmecillinam, an older antibiotic, to the U.S. for approval earlier this year, which helps broaden the tools doctors have to treat infections effectively.

Globally, AMR is about both innovation and access. There are places where people lack access to essential antibiotics and diagnostics and are forced to rely on outdated options with high resistance rates. We need new antibiotics that work against multidrug-resistant pathogens, but we also need to ensure worldwide access to effective treatments.

Are there any recent or upcoming developments in AMR that you find particularly promising?

Henry Skinner: I’m particularly excited about vaccines. Advances in vaccine technology, especially following COVID-19, offer great promise for AMR. Vaccines could play a transformative role in reducing infections and reliance on antibiotics.

Diagnostics are another area of hope. Right now, diagnosing bacterial and fungal infections can take days, which makes it hard for doctors to prescribe the right antibiotic immediately. Rapid, affordable diagnostics that deliver real-time results would be a game-changer, especially in resource-limited settings. I believe progress in this area is close and could have a tremendous impact on AMR.

There are also promising developments with in vitro technologies that accelerate the discovery of new antimicrobials and alternative approaches that enhance the body’s natural immune response. While some of these may take years to reach patients, they hold immense potential for reshaping how we tackle AMR in the future.

Thank you, Henry. As we wrap up, do you have any final thoughts you’d like to share?

Henry Skinner: I do. As scientists and leaders in healthcare, we have a moral responsibility not only to advance our work but also to raise public awareness about AMR and its impacts. We can’t afford to operate in isolation; we need the public to understand that AMR is a major threat to high-quality healthcare globally. Without effective antibiotics, we risk compromising cancer treatments, organ transplants, diabetes care, and even routine surgeries. Everyday procedures, from dental work to childbirth, carry infection risks, and AMR threatens the safety of these interventions.

Antibiotics are a public good, essential for both current and future generations. Safeguarding them is as vital as protecting our environment and addressing climate change. The R&D community, scientists, physicians, and investors all share the responsibility of ensuring the public understands this urgency.

For the investment community, I urge you to work with policymakers and make clear what’s needed to incentivize investment in AMR solutions. Together, we can shape a future where innovation flourishes and effective treatments remain available for generations to come.