There is an old riddle about two princes whose dying father declares that whichever one's horse arrives last in a race across the desert will inherit the kingdom. The princes are paralysed, each slowing down, stopping, and waiting the other out. Then a wise advisor whispers two words: switch horses. Instantly, both princes race as fast as they can, because now the faster you ride, the later your own horse arrives. The problem did not change. The resources did not change. The incentives did.

Antimicrobial development is stuck in its own desert. And we may have been riding the wrong horse.

For over a decade, the AMR policy community has coalesced around delinkage: separate developer revenue from sales volume and you resolve the tension between stewardship and commercial viability. Elegant in theory. In practice, the UK's subscription pilot offered roughly £10 million per drug per year, acknowledged as insufficient. The PASTEUR Act has been introduced in the US Congress five times without reaching a floor vote. The international pooled funding that every serious analysis says is necessary has not materialised. The pattern is not bad luck. It is a collective action problem baked into the design: every country has a rational incentive to let others pay for a global public good.

So here is a provocation. What if, instead of paying developers not to sell their drugs, we committed to actually using them?

We have been developing a proposal for a peer-reviewed publication that takes a demand-side approach. Healthcare systems would commit in advance to adopting qualifying novel antimicrobials as first line therapy for specified indications, but only agents demonstrating superiority over current first-line treatments in adequately powered RCTs, with a genuinely novel mechanism of action. No new legislation, no international treaties, no public subsidies. Just a commitment to follow the evidence when it points to a better drug.

The economics are simple. First-line prescribing volumes for common infections are enormous. A novel agent replacing a generic at a price reflecting human therapeutic value would generate revenue sufficient to sustain development investment through normal market mechanisms.

The immediate objection is stewardship: will broad use accelerate resistance? First-line substitution does not increase total antimicrobial consumption; it redirects existing prescriptions. And the deeper question is whether we have been too pessimistic about the discoverable target space. The golden age of antibiotic discovery used tools we would now consider primitive. The subsequent drought coincides with the withdrawal of industry investment, not with evidence that biology ran out of targets. If new classes can be discovered at a reasonable rate under the right conditions, the priority shifts from hoarding individual agents to sustaining the pipeline that produces them.

There is a bonus. A novel antimicrobial priced for human medicine becomes economically prohibitive for agricultural use, the single largest driver of resistance by volume. No regulatory enforcement needed, the price does the work.

Most importantly, this sidesteps the free rider problem. Adopting a demonstrably superior first-line agent is independently rational for any healthcare system, because it delivers better outcomes regardless of what other countries do. The R and D incentive is a positive externality of a decision justified on purely domestic clinical grounds.

We are not claiming this solves everything. Access in low and middle-income settings needs tiered pricing. The size of the discoverable antimicrobial space is an empirical question. And the superiority bar means not every new agent would qualify.

But after a decade of pilot programmes, failed legislation, and a worsening pipeline, it may be time to ask whether the answer has been hiding in plain sight.

We would welcome your thoughts, especially if you see a fatal flaw we have missed.