ArticleThe Lancet regional health. Europe2026
Designing eligibility and evaluation criteria for antibacterial pull incentives: a comparative review of implemented and emerging initiatives.
Article in The Lancet regional health. Europe, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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11 authors.
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Abstract
Background: Pull incentives aim to improve the commercial viability of antibacterials, but the criteria determining which products and companies qualify have not been compared across countries. We compared product and company eligibility and evaluation criteria across these incentives. Methods: We conducted an umbrella review of MEDLINE and Embase for English-language reviews of pull incentives targeting antibacterial innovation and access (2014 to 14 October 2024), supplemented by grey literature searches and the Global AMR R&D Hub dashboard (December 2025). Two reviewers independently extracted criteria from official documentation, using a framework of six product domains (high-priority medical need, relative effectiveness, unmet clinical need, innovative characteristics, health-system impact, and other) and five company domains (antibacterial sustainability, patient access, environmental health, economic criteria, and other). Findings: We identified 28 pull incentives: 20 implemented (UK, Sweden, Germany, France, Italy, US, Japan, and EU) and 8 proposed or in development (US, Japan, Canada, Australia, Switzerland, and EU). As mechanisms overlapped within countries, the 20 implemented incentives were analysed as nine groups. All nine targeted high-priority medical need and seven (78%) included unmet clinical need. Relative effectiveness featured in six (67%), economic criteria in five (56%), and innovative characteristics, health-system impact, patient access, and antibacterial sustainability in four each (44%); environmental health in two (22%). The UK Subscription Model applied all 11 domains and Sweden's Annual Revenue Guarantee eight (73%). Priority pathogen lists were widely referenced but varied in breadth. Interpretation: Eligibility and evaluation criteria vary substantially across countries in scope and specificity. Company-level obligations on stewardship, access, and environmental safeguards are applied inconsistently, and most comprehensive in the UK and Swedish models. Greater international alignment around a shared core of criteria, while retaining flexibility for national context and operational feasibility, could reduce uncertainty for developers and strengthen the global incentive ecosystem. Funding: World Health Organization Regional Office for Europe.
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