Lord Jim O'Neill is recommending that pharmaceutical firms are given a $1-billion bonus for each new antibiotic they discover, as part of an attack plan against the global threat of antimicrobial resistance, which could eventually kill more people than cancer.

The long-awaited government-commissioned report warns that failure to tackle the rise of the superbug could propel the current annual death toll from 700,000 to 10 million by 2050, at a global cost of $100 trillion between now and then.

O'Neill has outlined four interventions critical to tackling AMR, with a global awareness campaign top of the list to educate on its risks. The campaign, which should start this summer, could help reign in the prescription of antibiotics to animals and ensure that policies to tackle AMR are taken forward.

Also crucial is accelerating progress in R&D to help beef up the current antibiotics arsenal, given that there hasn't been a new type in decades. As part of this, $1-billion market entry rewards have been suggested to encourage pharmaceutical firms to take on the challenge, as well as other measures, such as harmonisation of regulations and clinical trial networks, to help lower development costs and reinvigorate work in the area.

Progress in R&D could also be accelerated through a Global Innovation Fund, endowed with up to $2 billion over five years.

Thirdly, the report reiterates the necessity to use the existing antibiotics stockpile "sparingly", through a "step change" in the diagnostic technology available to healthcare professionals. "There aren't enough good and rapid tests to confirm the professional judgment of the doctor, and the tests that are available are often more expensive than prescribing the drugs 'just in case'," said O'Neill. The idea of a tax on antibiotics has also been suggested a means of securing their more appropriate use.

Also critical is a reduction in the extensive and unnecessary use of antibiotics in agriculture, through improved surveillance and target setting on a regional basis. In parallel there must be must faster progress on banning or restricting the use in animals of antibiotics that are vital for human health, the report stressed.

Wider measures include improved access to clean water and sanitation, as well as more effective use of vaccines to prevent infection.

"There can be no excuses from this point on - the health catastrophe unfolding around AMR has been set out clearly by the O'Neill Review team," said Neil Murray, chief executive go Redx Pharma. "There has been talk of the industry's moral duty to address this issue but the responsibility falls on all members of society to ensure that we avoid the drastic consequences of antibiotics failing".

"The pharma industry knows the challenges it faces and the recommendations around the Innovation Fund and new commercialisation models are a significant step forward. Critically, however, there is also a route map here for governments and the agencies governing both human and animal health around the world".

The Association of the British Pharmaceutical Industry (ABPI), the European Federation of Pharmaceutical Industries and Associations (EFPIA) and the International Federation of Pharmaceutical Manufacturers & Associations (IFPMA) have also welcomed the ambition for global action mapped out in the final plan.

Need for global co-ordination
"There is a clear need for global coordination of stewardship, conservation, hygiene, and the creation and use of new commercial and incentive models for antibiotics, vaccines and diagnostics, to be delivered through local action," they said in a joint statement, and warned "without collective action, we cannot expect real change".

Stressing that "industry hasn't been standing still with regard to developing new medicines to address drug resistance," the groups highlighted the 34 antibiotics and infection preventing vaccines in the global pipeline and that, in 2014 alone, it spent more than $137 billion collectively on all aspects of R&D, with 3.7% focused on anti-infectives.

"The investment, time and risk required by companies to discover and develop new antibiotics and vaccines needed for drug resistance is substantial and poses a unique challenge. For this reason, the industry has underscored the imperative need for a sustainable business model for these critical medicines, without which any interventions to develop new medicines will be limited".

But Dr Grania Brigden, TB and AMR Advisor, Médecins Sans Frontières/Doctors Without Borders (MSF) said the pharma industry's system for researching and developing medicines "is not always delivering the drugs, vaccines and diagnostics needed," and "when they are developed, they are often unaffordable or not suitable for the people who need them most".

"This report is an important first step in addressing this broad market failure, it does not go far enough. The O'Neill report proposes considerable new funding to overcome the failures of pharmaceutical Research and Development but the proposals do not necessarily ensure access to either existing tools or emerging new products; instead, in some cases, the report's solution is simply to subsidise higher prices rather than trying to overcome them".