ABSTRACT
Background
The aim is to showcase a detailed analysis of the contribution of public funding to two successful (gepotidacin and zoliflodacin) and two failed (epetraborole and ridnilazole) public sector investments in antibiotic development, using a previously developed and refined framework.
Methods
Detailed development histories of four products were constructed using information gathered from publicly available sources. Then searches were carried out on funding sources using press releases, investor reports, annual reports, patents and scientific publications. The framework for classifying public contributions was applied.
Results
The two successful antibiotics received a significant amount of public funding: $519 million for gepotidacin and $281 million for zoliflodacin. Whilst the two unsuccessful antibiotics received considerably smaller sums from public or philanthropic sources ($85 million for ridinilazole and $18 million for epetraborole). The development trajectories of the two successful antibiotics notably demonstrate that market forces alone were insufficient for their completion. Despite promising clinical results, these products faced potential abandonment and were only advanced through substantial public funding and robust public-private partnerships. National research funding agencies emerged as the predominant source of support. In terms of absolute levels of funding, public private partnerships were the largest single contributors to total R&D contributions in three of the four cases. Specific funding amounts were least likely to be traceable for charitable/philanthropic contributions.
Conclusion
Using our established methodology for source identification and funder classification, we uncovered compelling evidence of the essential role played by public and philanthropic funding in antibiotic development. However, there is a significant amount of missing funds-related information. The work we have done on identifying sources for funding can be referenced in support pharmaceutical price negotiations to better reflect the level of public contribution to product development.
KEYWORDS: Antibiotics, antibacterial agents, public return on public investments (PRoPI), transparency, research and development (R&D), pharmaceuticals
Introduction
Antimicrobial resistance poses one of the most significant threats to global public health, with the World Health Organization consistently highlighting antibiotic research and development as a critical priority. However, research and development (R&D) in this field is not pursued by big pharmaceutical companies. Two WHO reports, ‘Antibacterial agents in clinical development – an analysis of the antibacterial clinical development pipeline’ (World Health Organization (WHO), 2019b) and ‘Antibacterial agents in preclinical development’ (WHO, 2019a) have found that R&D for antibiotics principally occurs among small – or medium-sized enterprises (SMEs). The reports suggest that, as a result of relatively low prices for antibiotics and a lack of return on their investment, large pharmaceutical companies are less willing to develop antibacterials, and there is a weak antibiotic therapeutic pipeline as a result. The WHO report acknowledges that mechanisms such as the Biomedical Advanced Research and Development Authority (BARDA), Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator (CARB-X), the Replenishing and Enabling the Pipeline for Anti-Infective Resistance (REPAIR) Impact Fund, and the Global Antibiotic Research and Development Partnership (GARDP) have all led to an increase in public and philanthropic investment in developing antibacterial agents in recent years, which has partly offset the decline in private investment. The market context for antibiotic development is an example of a market failure, with SMEs and academic institutions now constituting the main drivers of development (Anderson et al., 2023).
The evidence for public contributions (push and pull incentives) to developing new antibacterial agents is strong, and in parts of the scientific community this observation is referred to as ‘the public pays twice’ and ‘risks are socialised and rewards are privatised’ (Vogler et al., 2023). Public contributions are not only financial in the form of funding grants but also include in-kind contributions such as research infrastructure, hospital facilities and expertise, as our framework makes explicit. Greater transparency around R&D costs is essential for analysts and policymakers; without it there is no reliable way to identify costs and transactions in the market. An example of policymakers requesting more transparency on actual costs and expenditures for R&D can be seen in the European Commission’s newly proposed revision of the pharmaceutical legislation (European Commission (EC), 2023) and the World Health Assembly's (WHA) resolution WHA72.8 on ‘Improving the transparency of markets for medicines, vaccines, and other health products’ (WHO, 2019c).
Within the context of increasing transparency on public contributions, a framework for reporting and analysing public contributions to R&D was developed as part of the EC Horizon Europe project HI-PRIX (Grant Agreement Nr. 101095593) and subsequently published (Wild et al., 2024). Previously conducted work from the authors (Schmidt et al., 2025) piloted this framework for analyzing public contributions to R&D of medical innovations (AdisInsight; Butler et al., 2022, 2023; Walesch et al., 2023; Wild et al., 2024; WHO, 2021) on a cohort of medicines. It is the intention of this analysis to investigate the public and philanthropic contributions in the development of antibiotics to showcase the size of the investments, the type of funders as well as the opportunity costs of public risk investments in failed developments.
Methodology
Antibiotic examples
Four examples of antibiotics were selected to provide a balanced portfolio for analysis – two were examples of successful antibiotic development, and two represented examples of unsuccessful developments. All four antibiotics had reached phase 3 of development and were at clinical trial stages involving tests of superiority. Two of the antibiotics were successful at this stage (zoliflodacin and gepotidacin) and are proceeding to market authorisation whilst the other two antibiotics were unsuccessful with failing to demonstrate superiority (epetrabole and ridinilazole), and further development was discontinued.
Search for information on funding
Following our well-established methodology for identifying funding sources, we conducted the following steps in order to determine the drug development history of the products. All sources were searched up to December 2024:
Search for product identifiers, including initial numbers and character combinations, generic or non-proprietary names of active ingredients, and trade or brand names. This search was performed in AdisInsight (https://adisinsight.springer.com/) and supplemented with additional alternative names as needed.
Search for clinical trials in clinicaltrials.gov and at the International Clinical Trials Registry Platform (ICTRP), using all identified product names. The relevant study data we collected included the title, trial ID, phase, status, sponsor, number of patients, and study duration.
Further online sources searched included the FDA’s Orange Book for patents, patent citation data, citation analyses on acknowledged funding and grants, employment information of authors and the NIH RePORTER for NIH funds per drug and per target. Additionally, we looked at pharmacological and historical information on chemicals, drugs and biologicals (Merck Index or Therapeutic Target Db (TTD)), clinical trials, safety, commercial deals and patents (AdisInsight) and on change of ownership (Technology Transfer Websites from universities on spin-out/offs, SEC-filings for royalty, mode of agreements such as licensing agreements or acquisitions and payments in FiercePharma, FierceBiotech, STAT Health).
PubMed searches on drug names identified in 1 and principal investigator names identified in 2 were carried out to identify publications associated with the development of the products. The financial disclosure or acknowledgement sections of these publications were assessed for any funding information.
Product development story information was searched for online via company websites, press releases, investors’ websites, and pharmaceutical news pages. These sources are also useful in identifying funding streams that are not official research funding or are funding grants at an early stage of product development, which would otherwise be difficult to identify.
The websites of any funders named in any of the sources 1–5 identified above were checked for funding amount information in any currency. We were unable to account for missing funding amounts in our analysis. Any funding amounts specified were then converted to a common U.S. dollar currency (using the US Federal Bank Nov 2022 exchange rates for £ and Euros: https://www.federalreserve.gov/releases/h10/current/default.htm).
Application of framework for public funding
Lastly, the framework of public contributions to R&D of medical innovations, recently published elsewhere (Schmidt et al., 2025; Wild & Fabian, 2024), and subsequently piloted and revised (Schmidt et al., 2025) was applied by classifying the identified public contributions for the development of antibiotics in terms of the funder category. The framework helps make sense of the range of information available on funding source, providing a means of structuring the information according to type and stage of funding. The framework consists of stages of development (discovery, preclinical development, clinical development and market authorisation) and category of public contributions associated with each stage: public agency funders (supranational and national), charities (supranational and national), public investment banks (supranational and national), public-private partnerships, and local public funding. Allocation of funder to a category is achieved through the information gathering described in ‘search for information on funding’ above.
Results
A short development summary of each of the antibiotics examined in this paper is given below.
Gepotidacin was developed through a public-private partnership between GlaxoSmithKline, the U.S. government’s Biomedical Advanced Research and Development Authority and the Defense Threat Reduction Agency. This collaboration was set up in 2013; GlaxoSmithKline had previously been working on the drug since 2007, one of the last few pharma companies that were still working on antibiotics (Adams, 2019). In the EAGLE-1 trial, GSK’s gepotidacin met its primary endpoint showing non-inferiority to a combination of ceftriaxone and azithromycin, a standard treatment for gonorrhoea (Patchen, 2024). The Food and Drug Administration (FDA) started a priority review of GSK's gepotidacin in October 2024; if successful, it could become the first in a new class of oral antibiotics for uncomplicated urinary tract infections in more than 20 years (Taylor, 2024).
Zoliflodacin, originally developed by AstraZeneca and its spin-off company Entasis Therapeutics, was not actively promoted by the company – despite a positive phase 2 trial – until the publicly financed Global Antibiotic Research & Development Partnership (GARDP) stepped in to provide funding for a phase 3 programme for gonorrhoea in 2019 (Taylor, 2023). GARDP reported that zoliflodacin was safe and effective for uncomplicated urogenital gonorrhoea in a phase 3 non-inferiority clinical trial (National Institute Allergy and Infectious Diseases (NIH), 2023). The FDA designated zoliflodacin as a ‘qualified infectious disease product’ and granted fast track status.
Epetraborole is a small-molecule inhibitor of bacterial leucyl-tRNA synthetase that Anacor and GlaxoSmithKline put through clinical trials more than a decade ago but ceased pursuing the drug after seeing microbiological resistance among some patients in a phase 2 trial. AN2 Therapeutics tested epetraborole in a phase 2/3 pivotal trial among patients with lung disease – an indication not previously targeted by GSK or Anavor (Taylor, 2022). However, AN2 voluntarily paused this study due to potentially lower than expected efficacy (Cameron, 2024).
Ridinilazole, an antibiotic for Clostridium difficile infection, was developed by a small British biotechnology company Summit Therapeutics and brought to trial thanks to public investment from U.S. BARDA (Al Idrus, 2020). However, it did not meet superiority for sustained clinical response (SCR) in a randomised clinical trial, although it did reduce recurrence (Dall, 2024).
Types of public contributors
Our analysis identified diverse funding sources across the four investigated antibiotics, with varying levels of financial transparency and geographical distribution of support, as detailed in Table 1. Table 1 shows the public (including charitable/philanthropic) funders we identified across the four antibiotics, classified according to their type (national, supranational, local/regional, public-private partnerships and charitable/philanthropic) and geographical region of the funder (U.S., Europe, other). The most numerous sponsors were of the national funders and were observed across all geographical regions. For research funding bodies, such as the NIH, it is much easier to trace exact $ funding amounts as they prepare user-friendly, searchable databases of grant information. Particularly for governmental department grants, both in Europe and outside Europe/U.S., it can be difficult to discern exact $ amounts. In terms of countries of funders, alongside the U.S., Germany and the UK, China and South Korea were notably active funders – particularly in the case of zoliflodacin and epetraborole. Another sizeable category of contributors is local or regional funding. This commonly takes the form of university support much of which is provided through in-kind resources, and as a result, it was not possible to document exact $ estimates for this.
Table 1.
Public and philanthropic sponsors across the four antibiotics.
| Classification of public contributions | Public and philanthropic sponsors documented across the four antibiotics |
|---|---|
| National funding |
United States: U.S. National Institutes of Health, U.S. Department of Veterans Affairs Office of Research & Development, U.S. Veterans Administration, U.S. Department of Health and Human Services, U.S. Centers of Disease Control and Prevention, National Institute of General Medical Sciences, U.S. National Science Foundation, National Institute of Allergy and Infectious Diseases, U.S. Department of Energy, U.S. National Science Foundation Europe: Deutsche Forschungsgemeinschaft, German Centre for Infection Research, Robert Koch Institute, German Federal Ministry of Education and Research, German Federal Ministry of Health, German Academic Exchange, Institut National de la Sante et de la Recherche Medicale, Agence Nationale de la Recherche, French Infrastructure for Integrated Structural Biology, Ministry of Science, Innovation and Universities Spain, Spanish Network for Research in Infectious Diseases, Hungarian Academy of Sciences, Hungarian Ministry of Human Capacities UK National Institute for Health Research (NIHR)/MRC Public Health England, UK Medical Research Council, UK Department for International Development, UK Department for Health and Social Care, GAMRIF UK aid programme, Royal Pharmaceutical Society, UKRI, Dutch Ministry of Health Welfare and Sport Conselleria d’Innovació, Universitats, Ciència i Societat Digital Valencia Spain, SwissTransMed, Swiss Initiative for Systems Biology, Flemish Government – Department of Economy, Science & Innovation, Netherlands Organization for Health Research and Development (ZonMW), Research of National Center for Diseases Prevention and Control (CCM), Italian Ministry of Health Other: Department of Biotechnology, Government of India, Department of Science and Technology, Government of India, Örebro, Sweden and the Brazilian Ministry of Health, National Natural Science Foundation of China, Chinese Academy of Sciences, Chinese Academy of Medical Sciences, National Science and Technology Major Project China, Nanjing Incubation Program for National Clinical Research Center, National Key Research and Development Program of China, National Research Foundation of South Korea Centers for Disease Control and Prevention Korea, Ministry of Health and Welfare Republic of Korea, Korea Disease Control and Prevention Agency, Korea Health Industry Development Institute, Ministry of Education and Human Resources Korea, National Research Foundation of Korea, Ministry of Health and Welfare of Taiwan, Ministry of Science and Technology of Taiwan, NHMRC Australia, Australia research Council, Higher Colleges of Technology UAE, Fund for Improvement of Science and Technology Infrastructure India, South African Medical Research Council, South African National Research Foundation, national research facility of the University of Saskatchewan |
| Supranational funding | Instruct-ERIC, European Centre for Disease Prevention and Control, Centre for Genomic Pathogen Surveillance, CORDIS, WHO Collaborating Centre for Gonorrhoea and Other Sexually Transmitted Infections |
| Public-private partnership | BARDA, Defense Threat Reduction Agency, Global Antibiotic Research & Development Partnership (GARDP) |
| Local/regional funding |
United States: Boston University, University of Washington, Colorado State University, University of Nebraska, McGill University Health Centre, Baylor College of Medicine, Tufts University, University of Houston, University of Alabama Europe: Universite de Lille, Institut Pasteur de Lille, Region Hauts-de-France, the Li Ka Shing Foundation (Big Data Institute, University of Oxford), Mésocentre de Calcul (University of Strasbourg), Örebro County Council, Foundation for Medical Research at Örebro University Hospital, University of Southampton Other: School of Pharmacy, Faculty of Health and Medical Sciences, Taylor’s University, Malaysia, Rhodes University South Africa, Foundation of Hunan Province, Key Project of Hunan Provincial Science and Technology Innovation, Central South University China, Natural Science Foundation of Jiangsu Province, Shandong Province, National Science Foundation of Sichuan province |
| Charitable/philanthropic | Wellcome, Smith Family Foundation, Bill and Melinda Gates Foundation, Kongelig Hofbundtmager Aage Bangs Fond, Generalitat Valenciana, Cystic Fibrosis Canada, The Watson Foundation, Vaincre la Mucoviscidose, Association Gregory Lemarchal, Cancer Research Campaign/Cancer research UK |
Figure 1(A)–(D) shows the frequency with which categories of funders were acknowledged in the sources we searched. The results are shown for each of the four antibiotics in turn. As can be seen, national funders were the most frequently cited sources of funding across all four products. It is notable that charitable contributions constituted a much higher proportion of declared total funding acknowledgements for the two failed antibiotics than the two successful ones. Unlike our previous analyses of products, we were unable to document any instances of public bank investment (e.g. European Investment Bank or Bfi France) among the four antibiotic developments we analysed, nor small business or seed funding. Table 2 complements Figure 1 by detailing the specific funders and the amount of their contribution, if known, again grouped into funder categories.
Figure 1.
(A) Frequency (number of references to funding sources) by type of funder for gepotidacin. (B) Frequency (number of references to funding sources) by type of funder for zoliflodacin. (C) Frequency (number of references to funding sources) by type of funder for epetraborole. (D) Frequency (number of references to funding sources) by type of funder for ridinilazole.
Table 2.
Detailed public funding amounts, by antibiotic.
| (A) Detailed public funding amounts for gepotidacin | |
|---|---|
| Funder name | Funding amount (in $) |
| Wellcome | – |
| Smith Family Foundation | – |
| Boston University | 3,518,241 |
| Universite de Lille | – |
| Institut Pasteur de Lille | – |
| Region Hauts-de-France | – |
| Li Ka Shing Foundation (Big Data Institute, University of Oxford) | – |
| Foundation for Medical Research at Örebro University Hospital | – |
| Mésocentre de Calcul (University of Strasbourg) | – |
| School of Pharmacy, Faculty of Health and Medical Sciences, Taylor’s University, Malaysia | – |
| Örebro County Council Research Committee and the Foundation for Medical Research at Örebro University Hospital | – |
| National Institutes of Health | 46,220,814 |
| U.S. Department of Veterans Affairs Office of Research & Development | 3,969,864 |
| Deutsche Forschungsgemeinschaft | – |
| German Centre for Infection Research | – |
| Robert Kock Institute | – |
| Department of Biotechnology, Government of India | – |
| Institut National de la Sante et de la Recherche Medicale | – |
| Agence Nationale de la Recherche | 78,678,517 |
| Ministry of Science, Innovation and Universities, Spain | – |
| Spanish Network for Research in Infectious Diseases | – |
| Hungarian Academy of Sciences | – |
| Hungarian Ministry of Human Capacities | – |
| UK Research and Innovation/Biotechnology and Biological Sciences Research Council | 428,625 |
| French Infrastructure for Integrated Structural Biology | – |
| Instruct-ERIC | – |
| U.K. National Institute for Health Research (NIHR)/MRC | – |
| Public Health England | – |
| UK Medical Research Council | – |
| Örebro, Sweden and the Brazilian Ministry of Health | – |
| Conselleria d’Innovació, Universitats, Ciència i Societat Digital, Valencia, Spain | 249,576 |
| Ministry of Science, Innovation and Universities, Spain | – |
| U.S. Veterans Administration Merit Review Award | 1,984,932 |
| National Natural Science Foundation of China | – |
| European Union | 26,204,711 |
| Defense Threat Reduction Agency | 114,300,000 |
| Biomedical Advanced Research and Development Authority (BARDA) | 243,664,288 |
| TOTAL | 519,219,568 |
| (B) Detailed public funding amounts for zoliflodacin | |
|---|---|
| Funder name | Funding amount (in $) |
| Gates Foundation | – |
| Kongelig Hofbundtmager Aage Bangs Fond, Denmark | – |
| Generalitat Valenciana | 245,104 |
| Smith Family Foundation | – |
| Wellcome Trust | – |
| Higher Education US funding | 5,781,426 |
| SwissTransMed | – |
| Örebro County Council | – |
| Örebro University Hospital | – |
| Li Ka Shing Foundation (Big Data Institute, University of Oxford) | – |
| Rhodes University, South Africa | – |
| University of Washington | – |
| Foundation of Hunan Province | – |
| Hunan Provincial Science and Technology Innovation | – |
| Third Xiangya Hospital of Central South University | – |
| Central South University (Open Sharing Fund for the Large-scale Instruments and Equipment) | – |
| Natural Science Foundation of Jiangsu Province | – |
| National Institutes for Health | 51,767,971 |
| U.S. Veterans Administration | – |
| South African Medical Research Council | – |
| South African National Research Foundation | – |
| Swiss Initiative for Systems Biology | – |
| Ministry of Science, Innovation and Universities Spain | 176,159 |
| U.K. Department for International Development | – |
| Dutch Ministry of Health Welfare and Sport | – |
| German Federal Ministry of Education and Research | – |
| German Academic Exchange Service scholarship | – |
| German Federal Ministry of Health | – |
| German Center for Infection Research | – |
| Chinese Academy of Medical Sciences Initiative for Innovative Medicine | – |
| Korea Centers for Disease Control and Prevention, | – |
| Ministry of Health and Welfare, Republic of Korea | – |
| The National Health and Medical Research Council (NHMRC) Australia | – |
| U.K. Department of Health and Social Care | – |
| Flemish Government – Department of Economy, Science & Innovation | 549,018 |
| Australia Research Council | – |
| Global AMR Innovation Fund (GAMRIF) UK Aid Programme | 12,516,000 |
| Department of Health and Human Services | 4,088,695 |
| U.S. Centers for Disease Control and Prevention | – |
| National Institute of General Medical Sciences | – |
| World Health Organisation Collaborating Centre for Gonorrhoea and Other Sexually Transmitted Infections | – |
| European Centre for Disease Prevention and Control | – |
| Centre for Genomic Pathogen Surveillance | – |
| European Union | 20,718,752 |
| Global Antibiotic Research & Development Partnership (GARDP) | 185,102,200 |
| TOTAL | 280,945,325 |
| (C) Detailed public funding amounts for epetraborole | |
|---|---|
| Funder name | Funding amount (in $) |
| Cystic Fibrosis Canada | – |
| Watson Foundation | – |
| Gates Foundation | – |
| Vaincre la Mucoviscidose | – |
| Association Gregory Lemarchal | – |
| Colorado State University, U.S. | – |
| University of Nebraska, U.S. | – |
| McGill University Health Centre, U.S. | – |
| University of Houston, U.S. | – |
| Shandong Province | – |
| National Institutes of Health, U.S. | 8,032,577 |
| U.S. National Science Foundation | 1,019,937 |
| National Institute of Allergy and infectious Diseases, U.S. | 4,957,446 |
| National Research Foundation of Korea | – |
| Ministry of Education and Human Resources Korea | – |
| National Research Foundation of South Korea | – |
| Korea Disease Control and Prevention Agency | – |
| Korea Health Industry Development Institute | – |
| U.S. Department of Energy Office of Science User Facility | – |
| University of Saskatchewan, Canada (national research facility) | – |
| National Natural Science Foundation of China | – |
| European Union | 4,265,834 |
| Biomedical Advanced Research and Development Authority (BARDA) | – |
| TOTAL | 18,275,794 |
| (D) Detailed public funding amounts for ridinilazole | |
|---|---|
| Funder name | Funding amount (in $) |
| Wellcome | 7,870,337 |
| Cancer Research Campaign/Cancer Research U.K. | – |
| Baylor College of Medicine, U.S. | 5,177,994 |
| Tufts University, U.S. | 338,652 |
| University of Southampton, U.K. | – |
| University of Houston, U.S. | – |
| National Science Foundation of Sichuan Province | – |
| National Institutes of Health, U.S. | 1,038,922 |
| National Institute of Health and Social Care Research (NIHR) U.K. | – |
| Ministry of Health and Welfare of Taiwan | – |
| Ministry of Science and Technology of Taiwan | – |
| National Health & Medical Research Council | – |
| Medical Research Council | – |
| Royal Pharmaceutical Society, U.K. | – |
| Deutsche Forschungsgemeinschaft, Germany | – |
| German Center for Infection Research | – |
| Netherlands Organization for Health Research and Development, ZonMW | – |
| Research of National Center for Diseases Prevention and Control (CCM), Italian Ministry of Health | – |
| U.S. National Science Foundation | 388,652 |
| National Natural Science Foundation of China | – |
| European Union | 7,848,774 |
| Biomedical Advanced Research and Development Authority (BARDA) | 62,000,000 |
| TOTAL | 84,663,331 |
Note: The colours used in the table represent categories of funding.
Finally, Figure 2 looks at the breakdown by funder classification of the total funding amounts in $, where these could be ascertained. Although relatively small in terms of the number of grants, as Figure 1(A)–(D) shows, public-private partnerships formed the largest proportion of the total funding amount reported, accounting for 66%–73% of the total public funding amount across three of the four products. The exception was epetraborole, where no $ amounts could be ascertained (although we know of one public-private partnership source for this product, but unfortunately the amount was not traceable). National funding sources were, for three of the four antibiotics, a further considerable category in terms of the size of the contribution, accounting for between 25% and 77% of the total funding amounts. Local/regional funding and charitable/philanthropic donations played the least important role; however, this analysis shows that these funding sources are less likely to declare publicly the size of the financial support given and are likely for that reason an underestimate; acknowledgements in publications often indicated this support was considerable in nature, even though few $ amounts were traceable.
Figure 2.
Total amount of funding identified by type of funder and antibiotic product.
Discussion
We identified numerous public funding sources for the four antibiotics that we looked at in detail, covering all categories of public or philanthropic sources. We found that although most numerous in frequency of citation, national funder contributions were dwarfed by public-private partnership contributions to total funding, but this is largely likely to be a reflection of the fact that it was often not possible to trace the exact amount that national organisations had contributed, particularly governmental departments. This was also the case for regional/local funding support which was frequently acknowledged in grants or publications but as much of this was provided as in-kind support, we do not have corresponding monetary amounts available. However, it is notable that the phase 3 development of gepotidacin was borne out of a public-private partnership between GlaxoSmithKline, BARDA and the U.S. Defense Threat Reduction Agency. Similarly, the second successful antibiotic that we considered in this analysis – zoliflodacin – had been sidelined by Entasis Therapeutics despite a positive phase 2 trial until the GARDP stepped in to provide funding for a phase 3 programme in 2019. This shows that even when a product is considered to be a good candidate for superiority, there may still be market failure with the market unable or unwilling to further develop the product.
As our earlier work has also demonstrated (Schmidt et al., 2021, 2022; Schmidt & Wild, 2020), there is robust evidence for the existence of considerable public and philanthropic contributions made to the development of medical products (medicines and devices), particularly in the case of antibiotics. Since not all public investments lead to success, public and philanthropic contributions are risky investments with a certain probability of losing value. However, in contrast to private investments, no return on investment is expected by public and philanthropic funders. Following our previous work, we have documented available ways of identifying sources of funding, which we consider to be robust and comprehensive. Using information reported in the publications, we have previously identified approximately £128 million of public and philanthropic funding that may have contributed to the development of olaparib and we estimated total public and charitable research funding for the hepatitis C vaccine at € 77 million (Schmidt et al., 2021). At over $500 million, the public funding contribution to gepotidacin has been remarkable. The contribution from public sources of over $280 million for the other successful antibiotic, zoliflodacin, is similarly considerable. At the other end of the scale in terms of public funding amounts are the figures for the lesser successful antibiotics at $18 million and almost $85 million.
Despite our advances in detailing sources for identifying contributions and finding a way to classify contributions, the problem remains that there is no standardised reporting of direct and indirect financial contributions to R&D. We used a variety of sources to identify funding support but even when we were able to identify the name of the sponsor or supporter, finding the corresponding monetary values was often impossible, as there is no standardised reporting mechanism for disclosing financial support. This is particularly the case for government funding, local/regional support such as universities that often provide in-kind resources and charitable sources of funding. This may bias the results in that even more public funding is likely to have taken place than we could identify amounts for, given that we found several reports of public funding but no corresponding funding amounts. However, we think this is likely to have biased all four product accounts similarly.
Limitations
Some limitations need to be mentioned: where we were not able to identify specific monetary amounts, this does not mean that the monetary value of the funding was zero. It is a reflection of the lack of reporting around financial amounts. Data on both frequency of funding support (narrative) and amount of funding support (quantitative) are both required to give a more accurate view. Comparisons of the four antibiotics are descriptive and incomplete since missing data may bias observed patterns – although we think missing data will have affected all four product accounts similarly. Furthermore, we do not have accurate information on the amount of R&D investment put into the development of these four antibiotics by the pharmaceutical companies, so we are unable to set the private and public funding in relation to each other. It is difficult to identify contributions from around the world, apart from Europe and U.S.A. in part due to language difficulties. Finally, evidence is limited to four case studies of antibiotics, which are considered illustrative only, and not a comprehensive quantification of all public investments in antibiotics.
Conclusion
Our analysis of financial support for antibiotic development, focusing on four case studies – two successful and two unsuccessful at phase three – reveals critical insights into the dynamics of pharmaceutical R&D funding. Using our established methodology for source identification and funder classification, we uncovered compelling evidence of the essential role played by public and philanthropic funding in antibiotic development.
The development trajectories of the two successful antibiotics suggest that market forces alone may not have been sufficient for their completion. Despite promising clinical results, these products faced potential abandonment and were advanced through substantial public funding and robust public-private partnerships. This supports the World Health Organization reference to a ‘broken market’ regarding antibacterial development (WHO, 2025). National research funding agencies emerged as the predominant source of support, followed by local and regional contributions, often in the form of in-kind resources. Interestingly, the less successful antibiotics showed higher levels of charitable and philanthropic involvement compared to their successful counterparts. The small sample analysed in this paper prevents us from identifying and interpreting any characteristics explaining why some antibiotics received proportionally more charitable funding as a proportion of total public funding than others – the allocation of charity funds could reflect disease areas, with some disease areas more represented by charities with research budgets than others; it could also reflect charities stepping in and offering funding where public sector organisations have prioritised other disease areas and agents.
Our research highlighted significant disparities in funding transparency across different sources. Charitable/philanthropic contributions, local/regional support, and national governmental funding proved particularly challenging to quantify. However, where monetary values could be determined, public-private partnerships emerged as the largest single financial contributors in three of the four cases studied.
These findings carry broader implications for developments of medicinal products. They demonstrate that public and philanthropic funding plays a crucial role throughout the drug development process, bearing the financial burden of both successful and failed initiatives. Our estimates are likely to be an underestimate given the lack of publicly available data on public funding. Furthermore, our analysis suggests market failures in the pharmaceutical sector, particularly in antibiotic development, where potentially successful drugs could risk abandonment due to perceived insufficient profit potential. The case of gepotidacin is an example of how public sector intervention, through public-private partnerships, became essential to address these market failures and ensure the development of a crucial medication.
Competing interests
The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding Statement
This project has received funding from the European Union's Horizon Europe Research and Innovation programme under Grant Agreement number 101095593.
Availability of data and materials
All data supporting the results can be found in the main article.
Disclosure statement
No potential conflict of interest was reported by the authors.
References
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Associated Data
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Data Availability Statement
All data supporting the results can be found in the main article.