A British government-backed review released on Thursday (14 May) is seeking billions of dollars to fund the development of 15 new antibiotics to counter antibiotic resistance.
The review, led by former Goldman Sachs chief economist Jim O'Neill, said the lump sum payments could add up to $16-$37bn (£10-23.5bn) over 10 years, but should only be made when companies have fully developed a successful bug-killing drug.
"Seen in a global context, and compared to the cost of inaction, it's actually peanuts. Critically linked to that we're also calling for an innovation fund, about $2bn perhaps over five years, that the pharmaceutical industry itself essentially finances,' O'Neill said.
The review says that companies that develop new antibiotics should be awarded prize money of up to $3.5bn for each new drug, instead of selling the medication at a profit.
"Because if you come up with the specific incentives and rewards we're suggesting to get them to produce more drugs, it's essentially giving them a lot of financial relief. So we think it's only right that they play a role in financing the research at the early stage," O'Neill added.
The prizes, of between $1.5bn and $3.5bn, should be funded in part by the pharma industry itself, O'Neill said, probably also with input from national governments and "the global taxpayer".
"I think the proposal we're suggesting is better than what the pharma industry would like itself, which is much higher prices so they can just charge a lot more for it. I don't think that would be a better option for every individual in this country and elsewhere in the world," he said.
The successful drugmaker would then be required to make no profit from its sales of the drugs to governments and healthcare providers around the world, O'Neill added, saying this approach would "de-link" the profitability of a drug from its volume of sales.
"I think there are two core problems. There's a demand problem and a supply problem. The paper we've published today focuses all about the supply issues of getting more drugs," he said
In recent years, bugs resistant to multiple drugs have evolved at the same time as drugmakers have cut back investment in finding new ways to fight them, creating a global health threat as superbug strains of infections like tuberculosis and gonorrhoea have become untreatable.
O'Neill, who was asked last year by British Prime Minister David Cameron to take an economist's view of the problem, said far too little is currently invested in hunting for new drugs against drug-resistant infections.
In his initial report, O'Neill estimated that anti-microbial resistance (AMR) could kill an extra 10 million people a year and cost up to $100tn by 2050 if it is not brought under control.
O'Neill has also proposed that a $2bn innovation fund financed by drug companies should be created to invest in early-stage research and speed up development of new medicines to fight drug-resistant superbugs.
Sally Davies, the UK government's chief medical adviser, welcomed O'Neill's latest report, saying it would "stimulate important conversations between governments, pharmaceutical companies and other funders."