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by Alison Culpan, ABPI Scotland
28 March 2024
Associate Feature: A prescription for the future: adopting an innovative  payment model for antimicrobials in Scotland

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Associate Feature: A prescription for the future: adopting an innovative payment model for antimicrobials in Scotland

When Alexander Fleming introduced penicillin to the world, he warned about the potential problem of resistance, a prediction that has been proven correct. Indeed, Antimicrobial resistance (AMR) now poses a grave threat to global health, undermining the efficacy of antimicrobials which are the cornerstone of modern medicine. With the rise of antibiotic-resistant infections, there is an urgent need for researchers and health systems to work together to find innovative solutions.

Finding a new way to stimulate antimicrobial research while protecting new treatments from overuse is a leading example of such innovation. Between 2019 and 2023, NHS England and the National Institute for Health and Care Excellence (NICE) developed and ran a successful “subscription model” pilot south of the border. The pilot identified and secured access to two antimicrobials for appropriate use by the NHS – one new medicine and one existing medicine - and provided a guaranteed return on investment for the companies which developed them. 

The pilot was a world first, designed to fix the “broken market” for new, desperately needed antibiotics. A vicious circle had developed, whereby the high costs involved in the research and development process had become almost impossible for companies to recoup, because of essential restrictions on the use of new antibiotics to slow AMR. As a result, no new antibiotic classes had been approved in the UK since 1987. 

The subscription model pays pharmaceutical companies a fixed amount for delivering each antibiotic that meets strict eligibility criteria and offers value for money to the NHS, irrespective of the volumes used. This encourages responsible antibiotic use and incentivises companies to research and develop new treatments. The learnings from the pilot have now been adapted into a proposal to expand the approach to Scotland, Wales and Northern Ireland, emphasising the importance of responsible antibiotic use and the need for continued investment in antibiotic innovation. 

The UK-wide expansion of the model was subject to a public consultation last year and represents a highly innovative approach to tackling AMR. It has been designed in a way that specifically enables the health systems in all four UK nations to participate. [1]

There now is a compelling case for rapid adoption of the subscription model in Scotland, Wales and Northern Ireland. Doing so will reduce duplication of effort in combatting AMR and ensure equity of access to these scarce and valuable medicines for NHS patients, wherever they live. 

Demonstrating the success of a co-ordinated, UK-wide approach will also bolster other global efforts to stimulate antibiotic innovation. The subscription model offers a viable way to encourage the development of new antibiotics elsewhere, and highlights the need for a comprehensive approach that includes public awareness, responsible antibiotic use and international collaboration. 

With AMR projected to cause millions more deaths annually by 2050 [2], surpassing those caused by cancer and diabetes, the need for countries to develop and export solutions and learn from each other cannot be overstated. The global pledge for antibiotic incentives, including a $1 billion pharmaceutical industry-led investment fund called the AMR Action Fund [3], underscores the importance of nations with advanced health systems working together to avert a world health crisis.

In an increasingly fractured world, we do well to remember that AMR knows no borders. By joining forces with England and the other UK nations, Scotland can play a leadership role in building a scalable, sustainable solution to the global challenge of AMR - preserving the effectiveness of antibiotics today and the potential for infection control tomorrow.

[1] The Antimicrobial Products Subscription Model: consultation on proposals - NHS England - Citizen Space
[2] WHO, New report calls for urgent action to avert antimicrobial resistance crisis (
[3] Antimicrobial Resistance Research & Development - AMR Action Fund

This article is sponsored by ABPI Scotland

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