Public contributions to the development of antibiotics: two successful and two failed investments.

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.