Delink antibiotic revenue from sales volume through subscription payments

Public purchasers should offer fixed or value-banded payments for access to selected priority antibiotics, independent of prescription volume. Contracts should require reliable supply, surveillance support, stewardship, appropriate promotion, regulatory maintenance and equitable access commitments.

Delinkage can make conservation compatible with commercial viability, but payment levels and selection criteria must be transparent. Programmes should evaluate whether they improve product availability, developer investment and patient access rather than only transferring financial risk to governments.