How the Pipeline Ran Dry: Towards a Critical Historiography of the Antibiotic Pipeline (1980-2020)

This dissertation analyses the factors behind the breakdown of antibiotic innovation between 1980 and 2020 and the rise of the ‘empty antibiotic pipeline’ as a key structuring principle for attempts to restore research and development via public incentives and public-private initiatives. The first part of the dissertation is based on a semi-inductive quantitative literature survey of innovation articles in the Web of Science as well as a review of industry and political debates on antibiotic innovation since 1980 alongside oral history interviews and witness seminars with relevant expert stakeholders in governmental and non-governmental organisations. The second part of the dissertation examines how identified trends in thinking about innovation and designing policy interventions relate to actual R&D via two drug biographies of recently developed antimicrobials (daptomycin and fosfomycin). The interlayered quantitative and qualitative analysis reveals no single reason for the lack of new antibiotics. Instead, several overlapping causes have emerged, such as declining attention to infectious diseases, underwhelming targeted drug development expectations, and significant structural changes due to the pharmaceutical industry's financialisation since the 1980s. In an attempt to explain stalling innovation and galvanise public investment, industry and policy actors began to employ the metaphor of the 'empty pipeline’ from the late 1990s onwards. The dissertation shows how the pipeline metaphor’s focus on 'market failure’ and narrow linear conceptualisation of proprietary molecular innovation suited industry and Global Health actors during a time of growing reliance on incentives-based public-private initiatives to address significant health issues such as antimicrobial resistance (AMR). While the pipeline metaphor successfully galvanised attention and investment, its highly selective focus on market-based solutions neglected questions of access in poorer parts of the world, alternative non-profit innovation models and failed to resolve the increasing divide between shareholder-driven industry concepts of value and public health needs.