Henry Skinner, PhD, CEO of the AMR Action Fund, reflects on how Russia’s invasion of Ukraine has exacerbated the issue of antimicrobial resistance (AMR), highlighting the need for rapid diagnostics and new antibiotics.
Those who are wondering what a post-antibiotic world could look like would do well to pay attention to Ukraine. From the earliest days of Russia’s full-scale invasion, antibiotic-resistant ‘superbugs’ have been plaguing soldiers injured on the frontlines and civilians seeking refuge.
Now, nearly four years into the deadliest conflict in Europe since World War II, the situation is rapidly deteriorating. Researchers from Ukraine’s Sumy State University recently published a study showing that 85% of infections they examined among injured Ukrainian combatants were caused by bacteria that were resistant to multiple types of antibiotics. The most prevalent pathogen in that study was Acinetobacter baumannii – a difficult-to-treat superbug that the World Health Organization has deemed a critical threat. Meanwhile, a study from 2024 described numerous infections caused by a strain of hypervirulent pan-resistant Klebsiella pneumoniae, meaning it is resistant to all available classes of antibiotics.
While these infections are already harming and killing patients in Ukraine, their epidemiological ascent poses an escalating threat to European health systems far beyond the front lines and will inevitably spread around the world. That’s why investing in antibiotic innovation is not only a health priority but a strategic necessity to enhance Europe’s defence readiness. The loss of effective antibiotics exposes a hidden vulnerability in Europe’s collective security, and developing and ensuring access to new antibiotics should be integral to the EU’s strategies around readiness, security, and industrial policy.
The need for rapid diagnostics
Even under optimal conditions, treating an antibiotic-resistant infection is difficult. Clinicians need to match the right drug to the right patient and carefully monitor the dosage and duration of treatment to cure the infection. But the diagnostics on which most doctors rely, to know what type of bacteria are causing the infection and what antibiotics the bacteria are susceptible to, are too slow to guide immediate patient care.
In a war zone, rapid point-of-care diagnostics would offer significant benefit to injured combatants and go a long way toward improving appropriate use of our precious antibiotics. Given the supply chain and infrastructural and financial challenges that war engenders, not to mention the myriad competing priorities health authorities in Ukraine are up against, it is no wonder that advanced diagnostics are not available. What is surprising, however, is that such diagnostics remain underutilised throughout much of Europe where they should be readily accessible, with wide disparities among countries in their uptake, according to the European Centre for Disease Prevention and Control.
New antibiotics
Even when doctors know what pathogen they’re fighting, they may lack access to the medicines that can actually treat it – not just in Ukraine but across the continent. Consider the antibiotic sulbactam/durlobactam, which the U.S. Food and Drug Administration approved in 2025 for certain infections caused by Acinetobacter baumannii – the same species of bacteria that was shown to be plaguing injured combatants. To date, the company that makes this antibiotic has not filed it for approval with the European Medicines Agency (EMA) and it is unclear whether that will change in the future.
Other antibiotics, including lefamulin and eravacycline, have been approved by the EMA but their manufacturers delayed commercialising the drugs in Europe for years. Why? Because there’s little chance drugmakers will see enough return on investment to justify the substantial costs that come along with obtaining regulatory approval, satisfying post-approval requirements, and registering and commercialising new antibiotics in different markets.
Unlike obesity or cholesterol drugs, new antibiotics are often prescribed sparingly and for short durations, which limits their sales. It can cost more than $1bn to develop a new antibiotic, but research shows that the median annual revenue from new antibiotics is only $16m.
The United Kingdom and Italy have taken steps to address this economic market failure by enacting pull incentives, which provide financial incentives to invest in the development of new, innovative antibiotics. And the European Union is nearing the final stages of adoption for the General Pharmaceutical Legislation, which includes a pull incentive for antibiotic R&D. That’s encouraging.
Lack of innovation
But after decades of underinvestment, the pipeline of antibiotics is depressingly thin, shrinking, and not aligned with emerging threats. In October, the World Health Organization issued a report showing that the number of antibacterials in the clinical pipeline decreased from 97 in 2023 to 90 in 2025 and warned that the pipeline faces a dual crisis: scarcity and lack of innovation.
It will take billions of dollars and several decades of unwavering R&D efforts to dig ourselves out of this deficit of innovation. And with casualties mounting each day in Ukraine and new infections emerging on the battlefield and spilling over borders, that may be time we don’t have.
Please note, this article will also appear in the 24th edition of our quarterly publication.
