Francesco Ciabuschi

Value Creation in the Fight Against Antibiotic Resistance: Exploring the roles of Business Actors in International Multi-sectoral Partnerships

Rapidly increasing anti-microbial resistance (AMR) constitutes a global threat. In combination with a quick decline in antibacterial drug development by pharmaceutical firms, a number of “international multi-sectorial partnerships” (IMSPs) have been founded to address this urgent threat. These partnerships consist of actors from different countries ranging from business and government to academia and civil society. Received research knows little about what influences the success or failure of this new and complex kind of partnership. Thus our aim is to understand how differences between actors from different sectors, potential conflicts of interest, and the international dimension to such organizations are related to their value creation processes and outcomes. Specifically, in this project we will map the different roles that business partners play in IMSPs. The project will utilize a multiple-case study, a survey, and a computer agent-based model to analyze cases where “business partner” involvement and their relationships with other types of actors has furthered or hindered the creation of value in IMSPs. The findings will shed much needed light on influential factors that determine the functioning of IMSPs and their success to fight AMR. The scientific output will be a number of publications in peer-reviewed journals and will also be communicated to politicians and policymakers within health and industry in Sweden, the EU, and internationally (e.g. WHO and UN).
Final report
1. Project purpose
The project investigated International Multi-Sectorial Partnerships (IMSPs) operating in the antibiotic field. These partnerships have been founded to address the urgent threat of antibiotic resistance and consist of actors from several countries ranging from business and government to academia and civil society. The purpose of the project was to study how, on the one hand, core organizational elements of IMSPs and, on the other hand, different types of business actors influence value creation processes and outcomes. The project utilized qualitative data (from two large IMSPs) and quantitative data about innovation projects and specific developers in the global antibiotic field.

The findings shed much needed light on the key factors that influence the functioning of IMSPs and their role in creating value in the antibiotic field. Most importantly, we have identified a new type of governance mode unique for IMSPs in the antibiotic field. Moreover, we have pointed out how IMSPs and other policies influence the innovativeness of specific types of firms (SMEs vs. large firms) in different ways and with different effects in terms of value creation. Further, we have identified the relevance of different features of IMSPs, such as actors’ roles, network temporality, specific control mechanisms and interactions for value creation. We have also showed how interorganizational interactions can be managed to achieve value creation and in particular a relevant social impact.

Our project has unfolded several new relevant research issues and questions related to IMSPs, public policies, network functioning, and global challenges. The scientific output is represented by several publications in international journals and conference papers.

2. Short overview of project activities
During the project, after an initial literature review, we have collected both qualitative and quantitative data and performed various types of analyses on this data. Specifically, a comparative qualitative case study of two IMSPs, based on both interviews and archival data, and statistical analysis of quantitative data on a large number of R&D projects have been performed.

The case studies concerned CARB-X and ENABLE. CARB-X is a US-based IMSP hosted by Boston University. CARB-X works together with firms, governments, civil society, and academic experts with the mission to accelerate the global development of a diverse portfolio of critically needed antibacterial products towards clinical development. ENABLE is an EU-based IMSP hosted by Uppsala University in Sweden. Similar to CARB-X, ENABLE created and managed a drug discovery platform for testing and optimizing molecules that are still in the earlier stages of drug discovery but which have the potential to become valuable future drugs. In terms of specific research activities, we first mapped the different roles and characteristics of the partners involved in the two partnerships. We then conducted a series of in-depth interviews with representatives from both IMSPs. Based on these interviews, background case stories were written up. The qualitative results have also been presented at conferences and used in all the published papers. The qualitative data collected was also used to guide the quantitative data collection and to refine the research questions.

Subsequently, we have collected data about antibiotics R&D projects and built a comprehensive database of the early R&D pipeline in the worldwide antibiotics field. Relevant variables were measured and hypotheses were tested. The quantitative data analysis has been included in two papers (one still under review) and has been important to identify new venues for further research. Compared to the original project plan, we have further refined the research focus by advancing our conceptualization of value creation, including also social impact, and identified “governance” as a particular feature of IMSPs deserving more research attention.

3. Most significant research findings and contributions
The main results in terms of theoretical development are as follows: we have advanced the conceptualization of value creation in relation to IMSPs; we clearly distinguished the effects that IMSPs have on small as opposed to large business partners; we identified the impact of time-constraints on value creation in inter-organizational network settings; and we singled out the specificities of the novel governance mode utilized by IMSPs in the antibiotic field.

A first contribution we want to highlight concerns how organizational actors with different interests and seeking different kinds of value still do interact within shared value creation processes. For instance, we found that the intended output of an IMSP in terms of value creation influences the choice of management mechanisms and orients the kind of interactions occurring within the network of partners. Specifically, in one of our papers, we show how the underlying value-creating system differs according to the specific goals of the IMSP. This is an important first step to link research on value creation (typically focused on single firms or relationships) to the empirical context of IMSPs, and particularly to the network level of IMSPs.

A second important contribution is having identified a unique and novel type of governance characterizing antibiotics IMSPs, different from others discussed in previous research. Specifically, antibiotics IMSPs are interorganizational structures showing great governance complexity, strong centralized control, strict boundaries, and formalization of roles and rules. This type of governance is different from that of other IMSPs dealing, for instance, with global environmental challenges, and it can be useful in other contexts where uncertain, risky, urgent, and complex goals similar to antibiotics R&D need to be achieved.

A third key contribution concerns discerning the potential paradigm shift in how R&D and inter-organizational collaboration are organized within the antibiotics field. Our project specifically identified key factors behind this shift: for instance, in antibiotic IMSPs, public and philanthropic funders take on the costs and risks of conducting expensive and uncertain drug R&D activities, which traditionally have been taken on predominantly by private capital. Moreover, antibiotic IMSPs introduce strong coordination between single organizations and centralized governance, which are new to the antibiotics field. Such coordination also entails very different opportunities for actors who are inside as opposed to those who are outside the network which is created within the IMSP. Finally, the growth of antibiotic IMSPs means also that secrecy and exclusive intellectual property ownership can no longer be the dominant norm in this field. All in all, our research findings indicate how pharmaceutical R&D could be re-organized and managed in the future through IMSPs.

4. New research questions generated by the project
Due to the centrality of value creation with high social impact for these IMSPs, further research is needed to understand the origin and the process of ex-ante defining their expected outcomes, because the expected goals will influence the creation of the IMSP, its management, the network configuration, and the interorganizational interactions that will follow. Another aspect deserving more research efforts is the governance of IMSPs. The project’s findings clearly point to unique features in terms of the governance modes of antibiotics IMSPs. Consequently, new relevant questions concern understanding how the specific governance relates with different types of value creation. Finally, further investigation of the potential role of IMSPs also for other purposes that are relevant for sustaining value creation for antibiotics is warranted. In fact, while this project has studied IMSPs exclusively involved with R&D and innovation, their reach goes beyond this purpose and they can be important policy tools to also re-configure interactions, resources, and activities concerning other dimensions of value creation such as equitable access to antibiotics and more restrictive antibiotics use. These are, in addition to innovation, two other critical issues related to antibiotic resistance.

5. Disseminated results and international presence
Collaborations with other research groups have been initiated during the project. For instance, our project activities have reinforced the relationship with scholars at Boston University (research group headed by Prof. Kevin Outtersson) and Copenhagen University (Prof. Timo Minssen) with the possibility to conduct high-impact studies and publications together in the future. Also, new multi-disciplinary collaborations were initiated within Uppsala University thanks to the interaction with other scholars at the Uppsala Antibiotic Center. During the project, we were also able to interact and create closer relationships with public authorities, specifically with the Swedish Public Health Agency (FoHM) and the G20 Global AMR Hub in Berlin.

Within the project timeframe, we have published four papers in international peer-reviewed journals and one book chapter. We also have three papers under review in international peer-reviewed journals and two additional one to be submitted. Moreover, we have had several invited talks at foreign and Swedish universities, as well as conference presentations. Two of the conference papers received awards. One of the journal articles, published in Academy of Management Perspectives, has been very well received and results have been widely diffused through podcast, social media, and magazines. The project findings have been also integrated into teaching activities at doctoral and master levels (e.g., lectures and seminars).
Grant administrator
Uppsala University
Reference number
SEK 6,541,000
RJ Projects
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