The O'Neill Report called for the promotion of new, rapid diagnostics. POC and Rapid Diagnostics are seen by many within the health field as an opportunity to support the reduction in antibiotics yet the barrier to take up still exists. This is partly down to funding and data, however recent examples of diagnostics in action have led to many health professionals lobbying the government for investment. Having rapid, low-cost and readily available diagnostics is an essential part of the solution to the global challenge of AMR.

Even if we manage to reduce the unnecessary use of antimicrobials over the next decade, with a growing world population and continuing improvements in access to healthcare, the world will need a functioning R&D pipeline of new antimicrobials if we are to meet the Sustainable Development Goals (SDGs) agreed in the UN in 2015. But achieving a functioning pipeline will depend on aligning public and private incentives to invest in R&D with public health needs, drawing on the expertise and creativity of research teams in all countries. Opening the playing field, bringing down barriers to entry into research, and rewarding success wherever it comes from are crucial.

There is insufficient private and public investment in R&D in support of new drugs and other areas relevant to the global AMR challenge. The funding that does exist is not always as focused and coordinated (particularly across national borders) as it could be to maximise its impact. However, we are seeing emerging funding from relationships between the UK and China, alongside this we have the GARD programme. Although progress is being made there is still a lot needed to close the substantial gap in R&D funding between AMR and the best-funded areas of medical science. We must also figure out how we better align spending with global priorities for R&D on AMR.

Surveillance is the foundation of infectious disease management, yet is often ignored or given less importance than treatment in the fight against infectious diseases. improving the surveillance of AMR is vital. A recent report, recommended a total investment of 4.5 billion USD per year to improve national pandemic preparedness capabilities, including significant improvements to global disease surveillance capabilities. Without good surveillance, we cannot effectively counter the threat that antimicrobial resistance poses to health systems and people all over the world.

There are clearly circumstances where antibiotics are required in agriculture and aquaculture. Their proper use can maintain animal health and welfare, as well as food security. However, much of their global use is not for treating sick animals, but instead either to prevent infections (sometimes to compensate for poor farming practices) or simply to promote growth. The quantity of antibiotics used in livestock is vast, and often includes those medicines that are important for humans. Although gaps in the evidence undoubtedly remain, there is an increasingly robust consensus that unnecessary use of antibiotics in animals and agriculture is a significant concern for human health. There is a compelling case for action now to reduce unnecessary use, as there also is in the unnecessary human use of antibiotics.

The current pipeline of new antibiotics shows that there is a mismatch between the drugs the world needs, given emerging levels of drug resistance, and the number and quality of new antibiotics that are being researched. Antibiotic discovery and development is not an attractive proposition for commercial drug developers. without large-scale intervention, the commercial rewards necessary to reverse the long-term disinvestment from antibiotic research and development will not exist and the products that we need to respond to the emerging risks of greatest concern will not be developed.