These organizations consist of companies, states, private benefactors, universities, institutes and they take over when the regular pharmaceutical industry is not up to the task of developing new antibiotics. Until now, nobody in the world has studied them in depth, explains business economist Francesco Ciabuschi.

- It is a completely new type of organization for this sector. They are extremely complex and extremely innovation-driven. They are definitely breaking new ground in a number of respects, says Francesco Ciabuschi, who is a professor at Uppsala University.

Multi-resistant bacteria, which today's antibiotics don't work on, risk becoming a global health crisis, could become even more serious than covid-19. Without effective antibiotics, we can die from infected wounds. Routine operations on legs and hip joints may become impossible to perform.

The problem has been known for a long time, yet new drugs are conspicuous by their absence. The pharmaceutical companies can't get the deal together.

- A medicine that we should use as little as possible and for short periods. No company wants to invest in it with the enormous financial risks it entails, says Francesco Ciabuschi.

A couple of years ago, an American pharmaceutical company developed a new antibiotic that stood against one of the bacteria on the WHO's list of resistant bacteria. It did not sell well enough and the company went bankrupt after about six months.

Instead, global collaborations between companies, states and universities are emerging and where super philanthropists such as the Bill and Melinda Gates Foundation play an important role. In these hybrid not-for-profit organizations, cutting-edge knowledge and the hundreds of millions of dollars required to develop new antibiotics are allocated.

Francesco Ciabuschi calls them IMSP, International multisectoral partnerships. He and his collaborators have gained access to the three largest; Carb-X, located in Boston with support from, among others, the USA, Germany as well as the Bill and Melinda Gates Foundation, GardP, which is connected to the WHO and Enable, which is based in Uppsala.

These are not loose networks but strictly organized units with hard outward boundaries and where everyone has a given role to fill. They have a strong attraction and attract the very sharpest minds and companies. As an example, 21 companies and 24 universities, spread across the world, collaborate in Enable.

- It is very attractive for a company to be let into the heat. It shows that they are among the very best. There is also a strong sense that what they do is important.
In the RJ project, the researchers investigate how the actors come together around innovation, how they open up to each other, how the large sums of money required flow in and are distributed.

- We are deeply involved in their business. We have access to detailed information and can make observations in real time, says Francesco Ciabuschi.

He is particularly interested in innovative thinking in organizing pharmaceutical research. These partnerships break many industry rules and challenge the traditionally aloof attitude of the pharmaceutical industry towards trust and openness.

- It could change pharmaceutical research in a big way, believes Francesco Ciabuschi.

Right now, the research group is doing a number of qualitative studies. They will then develop simulations to obtain more general information. So far, there has been no breakthrough in terms of new antibiotics, but important drug candidates are under development.

- The need is enormous and several are on the right track. But much more needs to be done. We would need one or two new drugs within the next few years, says Francesco Ciabuschi.

The project: Value creation in the fight against antibiotic resistance: An investigation of the roles of business actors in cross-sector international partnerships.

TEXT: Thomas Heldmark