Data Challenge: Misaligned Urgency: A Cross-Domain Analysis of Global Antibiotic R&D Investment Against Antimicrobial Resistance Trajectories

Despite decades of global effort, antimicrobial resistance (AMR) continues to accelerate, projected to become the leading cause of death by 2050. A structurally underexplored question is: does the current global antibiotic development pipeline target the pathogens and regions where resistance is escalating most rapidly? Existing surveillance has focused on describing resistance trends, while drug development investment has proceeded largely independently of granular resistance trajectory data particularly in low- and middle-income countries (LMICs) in South Asia and sub-Saharan Africa. This misalignment directly weakens antibiotic stewardship efforts, undermines informed public health practice, and leaves clinicians in high-burden regions without effective therapeutic options ultimately compromising patient outcomes. To address this gap, we propose a novel cross-domain gap analysis quantitatively aligning global antibiotic R&D investment with resistance urgency across WHO ESKAPE priority pathogens Acinetobacter baumannii, Pseudomonas aeruginosa, carbapenem-resistant Enterobacterales, MRSA, and Streptococcus pneumoniae. We will use the Pfizer ATLAS dataset (2004–2024, 83 countries, 917,049 isolates), supplemented by Paratek KEYSTONE and Venatorx GEARS, to construct a Resistance Urgency Index per pathogen incorporating current resistance prevalence, annual rate of increase, and geographic spread. This will be integrated with pipeline data from the Global AMR R&D Hub Dashboard, categorized by target pathogen, drug class, mechanism of action, and developer region. A quadrant gap analysis will classify pathogen-investment combinations as well-matched, neglected, over-invested, or low-priority, with sub-analyses focused on South Asia and sub-Saharan Africa. All outputs, an open-access interactive policy dashboard, reproducible analytical pipeline on GitHub, and a structured priority recommendation framework will be publicly released. Findings will deliver actionable guidance for international AMR funders, the WHO priority pathogen review process, national stewardship programs, and health system planners in LMICs directly informing where therapeutic development must accelerate to protect patients most at risk.