Paradoxes of the antibiotic pipeline

The growing threat of antimicrobial resistance (AMR) has prompted a rise in global research and policy discussion about replenishing an empty antibiotic pipeline. The empty pipeline metaphor, however, is riddled with paradoxes. This comment article, based on critical social sciences and humanities research on pharmaceutical innovation, proposes five important paradoxes that govern modern innovation discourse: Was the so-called “golden age” of antibiotics truly golden? Was rational medication design indeed sensible in terms of antibiotic development? Was the antibiotic pipeline really founded on scientific achievements by a select handful of (male) inventors? How can antibiotics, which are potent emblems of industrial might, be viewed as market failures? How may the antibiotic crisis turn into the golden age of policing? Rather than dissecting each paradox, the article seeks to confound typical problem diagnoses and stimulate novel conceptualizations of inclusive antimicrobial innovation.