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ANTIBIOTIC resistance has probably been around for a few billion years. After all, most modern antibiotics have their origins in bacteria and fungi (Balz 2007, Silver 2011), organisms that have long waged pharmacological warfare against one another. It is possible, for example, to find multidrug-resistant bacteria deep within caves that have been isolated for millions of years (Bhullar and others 2012). However, 65 years of widespread medical and veterinary antibiotic use has exerted strong evolutionary pressures on the populations of bacteria that human and veterinary health systems routinely encounter. Resistance has become more common and more troublesome; no longer a narrow technical problem for microbiologists and drug developers. In the past five years, antimicrobial drug resistance has climbed the political agenda (Davies 2011, Department of Health and Defra 2013) (Fig 1), with initiatives underway at the European level, in the USA, the UK, Holland, Denmark, and many other countries.
In 2014, the Prime Minister established an independent Review on Antimicrobial Resistance, the O'Neill Review. This was charged with analysing the situation and proposing concrete national and international actions to help tackle the problem (Review on Antimicrobial Resistance 2015). We, and colleagues at the Innogen Institute at Edinburgh university, were commissioned by the Economic and Social Research Council (ESRC) and the O'Neill Review to assess the barriers to the development and introduction of new antimicrobial drugs and diagnostics for both human and veterinary use (Tait and others 2014, Scannell and Bruce 2014). We focused on regulatory hurdles and on the challenges seen by commercial drug and diagnostics companies. We reviewed the literature, and …