1 Alexander Fleming, Penicillin, Nobel Lecture, 83, 93 (Dec. 11, 1945), http://www.nobelprize.org/nobel_prizes/medicine/laureates/1945/fleming-lecture.pdf [http://perma.cc/U6BE-AZ9T].

2 See World Health Org. [WHO], Worldwide Country Situation Analysis: Response to Antimicrobial Resistance, 1 (Apr. 2015), http://apps.who.int/iris/bitstream/10665/163468/1/9789241564946_eng.pdf [http://perma.cc/9K2E-BZYE] (reporting on “the extent to which effective practices and structures to address antimicrobial resistance were already in place and where gaps remained” in certain countries and recommending “[c]omprehensive national plans, based on multisectoral approach and with sustainable financing”).

3 The UK Prime Minister commissioned the Review on Antimicrobial Resistance to address the growing global problem of drug-resistant infections See Securing New Drugs for Future Generations: The Pipeline of Antibiotics, The Review on Antimicrobial Resistance (May 2015), http://amr-review.org/sites/default/files/SECURING%20NEW%20DRUGS%20FOR%20FUTURE%20GENERATIONS%20FINAL%20WEB_0.pdf [http://perma.cc/9Y57-T3KX].

4 E.g., Nathan, Carl & Cars, Otto, Antibiotic Resistance — Problems, Progress, and Prospects, 371 New Eng. J. Med. 1761 (2014)Google Scholar; Outterson, Kevin et al., Repairing The Broken Market for Antibiotic Innovation, 34 Health Aff. 277 (2015)Google Scholar; So, Anthony D. et al., 3Rs for Innovating Novel Antibiotics: Sharing Resources, Risks, and Rewards, 344 Brit. Med. J. 22 (2012)Google Scholar.

5 See Elias Mossialos et al., Policies and Incentives for Promoting Innovation in Antibiotic Research, European Observatory on Health Systems & Policies, Eur. Observatory on Health Sys. & Policies (2010), http://www.euro.who.int/__data/assets/pdf_file/0011/120143/E94241.pdf [http://perma.cc/RP5L-Z4QW] (reviewing commonly discussed reward mechanisms and incentives).

6 See Kevin Outterson, New Business Models for Sustainable Antibiotics, Chatham House 1, 21-22 (2014), https://www.chathamhouse.org/sites/files/chathamhouse/public/Research/Global%20Health/0214SustainableAntibiotics.pdf [http://perma.cc/U5DH-UBFF] (outlining various economic models to develop antibiotic research).

7 See Doshi, Peter, Speeding New Antibiotics to Market: A Fake Fix, 350 Brit. Med. J. 17, 18 (2015)Google Scholar (questioning whether the new relaxed regime of approving antibiotics is “fulfilling the vision to treat infections that were previously untreatable because of resistant organisms”).

8 See e.g., Kesselheim, Aaron S. & Outterson, Kevin, Fighting Antibiotic Resistance: Marrying New Financial Incentives to Meeting Public Health Goals, 29 Health Aff. 1689 (2010)Google Scholar; Renwick, Matthew J. et al., A Systematic Review and Critical Assessment of Incentive Strategies for Discovery and Development of Novel Antibiotics, 69 J. Antibiotics 73 (2016)Google Scholar; Chantal Morel, Exploring Responses to the Need for New Antibiotics: How Do Different Incentives Compare?, in Collaboration for Innovation: The Urgent Need for New Antibiotics (ReAct policy seminar), Brussels, Belgium (2011) http://www.reactgroup.org/uploads/publications/react-publications/Exploring-Responses-to-the-need-for-new-antibiotics.pdf [http://perma.cc/WX5F-PMZF].

9 Bryson, John M., What to Do When Stakeholders Matter, 6 Pub. Mgmt. Rev. 21 (2004)Google Scholar.

10 See, e.g., Mayer, Michael & Whittington, Richard, Economics, Politics and Nations: Resistance to the Multidivisional Form in France, Germany and the United Kingdom, 1983—1993, 41 J. Mgmt. Stud. 1057 (2004)Google Scholar.

11 See, e.g., Collinson, Simon & Wilson, David C. Inertia in Japanese Organizations: Knowledge Management Routines and Failure to Innovate, 27 ORG. STUD. 1359 (2006)Google Scholar.

12 See, e.g., Adang, Eddy M.M. & Wensing, Michel, Economic Barriers to Implementation of Innovations in Health Care: Is the Long Run-Short Run Efficiency Discrepancy a Paradox?, 88 Health Pol’y 236 (2008)Google Scholar.

13 See, e.g., Everett M. Rogers, Diffusion of Innovations (4th ed. 1995); Grol, Richard & Wensing, Michel, What Drives Change? Barriers to and Incentives for Achieving Evidence-Based Practice, 180 Med. J. Austl. S57 (2004)Google Scholar.

14 See, e.g., Rogers, supra note 13; Joe Tidd et al., Managing Innovation, Integrating Technological, Market and Organizational Change (2d ed. 2001); Andrew H. Van de Ven et al., The Innovation Journey (2008); Coombs, Rod & Hull, Richard, “Knowledge Management Practices” and Path-Dependency in Innovation, 27 Res. Pol’y 237, 252 (1998)Google Scholar.

15 Works that adopt such a process perspective include the following: HÅkan HÅkansson et al., Business in Networks (2009); Thomas P. Hughes, Networks of Power: Electrification in Western Society, 1880- 1930 461-67 (1983); Bruno Latour, Science in Action (1987); Nathan Rosenberg, Inside the Black Box: Technology and Economics 193-245 (1982); Van de Ven et al., supra note 14.

16 See Utterback, James M. & Abernathy, William J., A Dynamic Model of Process and Product Innovation, 3 Omega Int’l J. Mgmt. Sci. 639, 640 (1975)Google Scholar.

17 For a detailed discussion of the three settings of developing, producing and using, see Håkansson, Håkan & Waluszewski, Alexandra, Economic Decisions Regarding Development, Production and Use of a Specific Resource, in Knowledge and Innovation in Business and Industry 152 (Håkansson, Håkan & Waluszewski, Alexandra eds., 2007)Google Scholar; Baraldi, Enrico et al., Network Evolution and the Embedding of Complex Technical Solutions: The Case of the Leaf House Network, 40 Indus. Marketing Mgmt. 838, 849 (2011)Google Scholar.

18 See Rosenberg, supra note 15, at 193-245; Hughes, supra note 15, at 461-67.

19 Taking Place: The Spatial Contexts of Science, Technology and Business 3-351 (Enrico Baraldi et al. eds., 2006); see Making Space for Science: Territorial Themes in the Shaping of Knowledge 281-312 (Crosbie Smith & Jon Agar eds., 1998).

20 See Vander Stichele, R. H. et al., European Surveillance of Antimicrobial Consumption (ESAC): Data Collection Performance and Methodological Approach, 58 Brit. J. Clinical Pharmacology 419, 419-28 (2004)Google Scholar.

21 See Jabes, Daniela, The Antibiotic R&D Pipeline: An Update, 14 Current Opinion Microbiology 564, 564-69 (2011)Google Scholar.

22 Kinch, Michael S. et al., An Analysis of FDA-Approved Drugs for Infectious Disease: Antibacterial Agents, 19 Drug Discovery Today 1283, 1283-87 (2014)Google Scholar. For an overview of the antibiotics under development and of the declining numbers of large pharmaceutical companies involved in their development, see Theuretzbacher, Ursula, Future Antibiotics Scenarios: Is the Tide Starting to Turn?, 34 Int’l J. Antimicrobial Agents 15, 15–20 (2009)Google Scholar.

23 See Baraldi et al., supra note 17, at 838-52.

24 See DRIVE-AB, http://drive-ab.eu/ (last visited May 18, 2016) (detailing the DRIVE-AB project).

25 See Cornelia Korber, Antibacterial Drug Development in European SMEs: Roles, Challenges, Solutions, (June 2015) (unpublished M.A. Thesis, University of Gothenburg) (on file with author).

26 See Enrico Baraldi et al., DRIVE-AB Stakeholder Meeting: European Small and Medium Enterprises focused on Antibacterial Drug Research and Development, Innovative Medicines Initiative [IMI] 5-6 (2014).

27 See id. at 1-2.

28 See Jonn-Arne Rottingen, Dir., Nor. Inst. of Pub. Health, New Economic Models Addressing Antibiotic Resistance (Jun. 2, 2015).

29 Uppsala Health Summit, A World Without Antibiotics: Conclusions from Uppsala Health Summit 2-3 June 2015, at 12 (2015).

30 See Baraldi et al., supra note 17, at 848-50; Utterback & Abernathy, supra note 16, at 655.

31 See Utterback.& Abernathy, supra note 16, at 655.

32 See infra Part IV.

33 See Baraldi et al., supra note 26, at 27-28.

34 The heterogeneity within each actor group also implies that the reactions and obstacles of individual actors (e.g., company A as opposed to company B) to any given mechanism are likely to be different. Therefore, we identify obstacles as potential, and their generalizability depends on how representative the actor mentioning an obstacle is of the entire actor group to which it belongs.

35 See infra Part III.

36 See infra Part II.

37 Id.

38 Id.

39 Sabatier, Valérie et al., From Recipe to Dinner: Business Model Portfolios in the European Biopharmaceutical Industry, 43 Long Range Planning 431–447 (2010)Google Scholar (discussing the business models of small and medium sized pharmaceutical enterprises (SMEs)).

40 See Thomson, Christopher J. et al., Antibacterial research and development in the 21 st Century - An industry perspective of the challenges, 7 Current Opinion in Microbiology 445, 445–50 (2004)Google Scholar (providing an overview of the roles of various industrial actors in drug R&D); Kaitin, Kenneth, Deconstructing the Drug Development Process: The New Face of Innovation, 87 Clinical Pharmacology & Therapeutics 356, 356–361 (2010)Google Scholar.

41 See Busse, Reinhard et al., Diagnosis-Related Groups in Europe: Moving towards transparency, efficiency and quality in hospitals 93–113 (2011)Google Scholar (outlining payment and efficiency within the pharmaceutical and hospital setting).

42 See Worldwide Country Situation Analysis, supra note 2, at 25 (“All countries that are members of the European Union undertake surveillance of resistance in bacteria through EARS-Net, which is facilitated by the European Centre for Disease Prevention and Control.”).

43 Governments are the funders of some of the mechanisms investigated in this paper. However, this paper focuses on the reactions, and in particular the obstacles, of other actors to these mechanisms, rather than the decision by government whether to finance them. This holds also for philanthropic organizations.

44 See Brogan, David M. & Mossialos, Elias, Incentives for New Antibiotics: The Options Market for Antibiotics (OMA) Model, 9 Globalization & Health 1, 2 (2013)Google Scholar (citing the cost and technical effort required to find new antibiotics that may have discouraged research participation in the past). These factors may have coincided with the decline in the rate of discovery of new classes of antibiotics such that “[f]urther exploration … coupled with newer technologies … did not produce any novel drug classes in the past 20+ years.” Aminov, Rustam I., A Brief History of the Antibiotic Era: Lessons Learned and Challenges for the Future, 1 Frontiers Microbiology 1, 4 (2010)Google Scholar; but see Kaitlin, KI, Deconstructing the Drug Development Process: The New Face of Innovation, 87 Clinical Pharmacology & Therapeutics 356, 360 (2010)Google Scholar (“[A]cademic research centers in the United States are increasingly being viewed as essential players—and potential partners—in Pharmaceutical innovation.”).

45 See Antibiotic Resistance 2013: The Antibiotics Development Pipeline and Strategies to Combat Antibiotic Resistance, PRNewswire (Aug. 13, 2013), http://www.prnewswire.com/news-releases/antibiotic-resistance-2013-the-antibiotics-development-pipeline-and-strategies-to-combat-antibiotic-resistance-219482771.html [http://perma.cc/TA4S-EUBC] (“This report gives a detailed overview of 113 antibiotic molecules in the pipeline including … the identification of 144 companies (37 large companies, 107 SMEs) involved in the development of new antibiotics or with marketed products ….”).

46 For instance, the newly constituted BEAM Alliance gathers forty companies from eleven different European countries. See Beam Alliance Position Paper, Beam Alliance, 1 (2015), http://beam-alliance.eu/assets/2015-Position-Paper.pdf [http://perma.cc/YF2G-ABA8] (“The BEAM Alliance (Biotechs of Europe innovating in Anti-Microbial Resistance) is a group of 40 small and medium biopharmaceutical companies from 11 European countries committed to fending off antibiotic-resistant pathogens by developing innovative products.”).

47 See Kinch et al., supra note 22, at 1285 (“Of the 28 active and independent organizations remaining after consolidation, at least 17 have made strategic decisions to leave the field. Of the top ten most successful companies (in terms of the number of NMEs awarded), four continue to demonstrate active research into NMEs.”).

48 See generally Projan, Steven J., Why is Big Pharma Getting Out of Antibacterial Drug Discovery? 6 Current Opinion Microbiology 427 (2003)Google Scholar.

49 See The Review on Antimicrobial Resistance, supra note 3, at 26 (noting that the EMA and FDA has worked to “streamline approval procedures for antimicrobials to make it easier for drug companies,” however more could be done).

50 See generally Doshi, supra note 7, at 19 (noting that the Promise for Antibiotics and Therapeutics for Health (PATH) Act would relax FDA requirements for new antibiotics specifically by allowing small clinical data sets).

51 See Kaitin, supra note 40, at 356 (describing payers and other third-party providers as trying “to stem rising health-care costs” by requiring proof that a drug company's product “offer[s] therapeutic or cost advantages over competitors’ products and nonpharmaceutical treatment options”).

52 See Quentin, Wilm et al., Hospital Payment Based on Diagnosis-Related Groups Differs in Europe and Holds Lessons for the United States, 32 Health Aff. 713, 713 (2013)Google Scholar (defining diagnosis-related groups (“DRGs”) as grouping together “patients with similar clinical characteristics and comparable costs” and DRG-based payments as “a flat fee for each DRG that reflected national average treatment costs of patients in that grouping”).

53 See European Ctr. for Disease Prevention & Control, Combating Resistance to Last-Line Antibiotics in the EU Still a Priority, (Nov. 16, 2015), http://ecdc.europa.eu/en/press/news/_layouts/forms/News_DispForm.aspx?ID=1318&List=8db7286c-fe2d-476c-9133-18ff4cb1b568&Source=http%3A%2F%2Fecdc%2Eeuropa%2Eeu%2Fen%2Fhealthtopics%2Fantimicrobial%5Fresistance%2Fpages%2Findex%2Easpx [http://perma.cc/SDZ4-GW7Y] (noting that European Antibiotic Awareness Day is an effort by the EU to diminish the misuse of antibiotics and the rise in antibiotic resistance); World Health Org., Antimicrobial Resistance, (Apr. 2015), http://www.who.int/mediacentre/factsheets/fs194/en/ [http://perma.cc/DX9B-5EPN] (noting that the World Health Organization has a policy of guiding and providing technical support for Member States faced with the varied issues of antibiotic resistance).

54 See Renwick et al., supra note 8, at 73 (describing push mechanisms as “reduc[ing] a firm’s cost of researching and developing new drugs by distributing expenditures across multiple parties” and pull mechanisms as “reward[ing] successful development of a drug by increasing or ensuring future revenue”).

55 See The Review on Antimicrobial Resistance, supra note 3 (describing the efforts of The Review on Antimicrobial Resistance, an official body chaired by Jim O’Neill, which is currently proposing a set of mechanisms in this area); see also Morel, Chantal & Mossialos, Elias, Stoking the Antibiotic Pipeline, 340 Brit. Med. J. 1115 (2010)Google Scholar; Mossialos et al., supra note 5; Outterson et al., supra note 4; Renwick et al., supra note 8,

56 See The Review on Antimicrobial Resistance, supra note 3, at 2 (proposing a change to the antibiotic pipeline by “bringing forward the financial reward to new antibiotics that address drug resistance” and “achieving 15 new antibiotics a decade”).

57 See, e.g., Mossialos et al., supra note 5, at 6 (“Incentive combinations may provide a crucial impetus to overcome developer reticence at the different (possibly key) stages of product development: early stage push funding provides greater financial space to explore early discovery ideas without needing to understand their full potential at the outset; the larger pull element entices the developer to undertake the latter phases of development, including expensive Phase III trials.”).

58 See id. at 79 (describing tax credits as “increasingly and overwhelmingly predominant” and “a specified deduction (percentage) against final tax liability”).

59 See id. (noting tax credits and allowances are similar because they both “apply to current expenditures, reduce the after tax costs of R&D and limit a company's annual claim”; but, unlike tax credits, “allowances enable companies to deduct more from their taxable income than they actually spend on R&D”).

60 See id. (describing deferrals as one of the three forms of tax incentives for R&D); Renwick et al., supra note 8, at 75 (describing tax deferral as a tax incentive “tied to early R&D and reduc[ing] a developer's current tax liability”).

61 See, e.g., Mossialos et al., supra note 5, at 94 (describing milestone prizes as an incentive scheme that “rewards researchers for reaching certain milestones within the product development process” and as particularly attractive for smaller companies because “they receive earlier reimbursment of development costs”); Renwick et al., supra note 8, at 80 (defining milestone prizes as “incremental monetary rewards paid at various stages of the development process”).

62 See Renwick et al., supra note 8, at 85 (noting that, in order to be attractive, end prizes “must be sufficiently large” and calculated in “such a way to minimize waste while providing sufficient incentive [which] may prove difficult”).

63 Any mechanism based on licensing to assure the right of usage, including pertinent designs of Advanced Purchase Agreements could for example qualify under this category.

64 Forsyth, Caitlin, Repairing the Antibiotic Pipeline: Can the GAIN Act Do It?, 9 Wash. J.L. Tech. & Arts 1, 6 (2013)Google Scholar; see also Drug Price Competition and Patent Term Restoration Act of 1984, Pub. L. No. 98-417, 98 Stat. 1585.

65 H.R. 2182, 112th Cong. § 7 (2011); Forsyth, supra note 64, at 6.

66 H.R. 2182, 112th Cong. § 4 (2011); Forsyth, supra note 64, at 6.

67 H.R. 2182, 112th Cong. § 4 (2011); Sonderholm, Jorn, Wild-Card Patent Extensions as a Means to Incentivize Research and Development of Antibiotics, 37 J.L. Med. & Ethics 240, 241 (2009)Google Scholar.

68 H.R. 2182, 112th Cong. § 7 (2011) [EN: R 12}]; Steve Usdin, GAIN Act, FDA Stance Only First Steps to Refilling Antibiotic Pipeline in U.S. Antibiotics Reset, BioCentury (Nov. 19, 2012), http://www.biocentury.com/biotech-pharma-news/coverstory/2012-11-19/gain-act-fda-stance-only-first-steps-to-refilling-antibiotic-pipeline-in-us-a1 [http://perma.cc/G659-KJCA].

69 Elias Mossialos et al., Policies and Incentives for Promoting Innovation in Antibiotic Research 89 (2010).

70 Id.

71 Id. at 121.

72 PATH: Driving Transformative Innovation to Save Lives, http://www.path.org/ (last visited May 18, 2016).

73 MMV: Meds. for Malaria Venture, Product Development Partnership Model, http://www.mmv.org/partnering/product-development-partnership-model (last visited May 18, 2016).

74 Id.; see also Mossialos et al., supra note 69, at 67, 89.

75 See Innovative Meds. Initiative, European Gram Negative AntiBacterial Engine ENABLE, http://nd4bb-enable.eu/ [http://perma.cc/3KK6-QPD8].

76 See generally Combatting Bacterial Resistance in Europe, Combacte (Jan. 31, 2016), http://www.combacte.com/ [http://perma.cc/CD7V-PSWA].

77 See Brogan & Mossialos, supra note 44, at 2-10.

78 Id.

79 Id.; see also Mossialos et al., supra note 69, at 67, 89.

80 See supra Part II.

81 See supra Part II.

82 See infra Table 1; infra Table 2.

83 See infra Table 1; infra Table 2.

84 See Antibiotic Resistance, supra note 45.

85 See Towse, Adrian & Sharma, Priya, Incentives for R&D for New Antimicrobial Drugs, 18 Int’l J. Econ. Bus. 331, 331-50 (2011)Google Scholar.

86 See id.

87 See Cooper, Matthew A. & Shales, David, Fix the Antibiotics Pipeline, 472 Nature 32, 32–33 (2011)Google Scholar.

88 See de Vrueh, R. et al., Priority Medicines for Europe and the World: “A Public Health Approach to Innovation,” 4, 11–38 (Mar. 12, 2013)Google Scholar, http://www.who.int/medicines/areas/priority_medicines/BP6_19Rare.pdf.

89 See Gamper, Catherine & Charbit, Claire, Coordination of Infrastructure Investment Across Levels of Government 11–12 (Int’l Ctr. for Pub. Policy, Working Paper No. 14-16, 2014)Google Scholar.

90 See, e.g., Uwondo, Gilbert et al., Cash Flow Management Utilization by Small Medium Enterprises (SMEs) in Northern Uganda, 1 Merit Res. J. Acct. Auditing Econ. & Fin. 67, 68 (2013)Google Scholar.

91 See House, Chatham, Towards a New Global Business Model for Antibiotics: Delinking Revenues from Sales, 5 (Oct. 2015)Google Scholar.

92 See id.

93 Id.

94 See Elias Mossialos et al., supra note 69, at 79-80.

95 See Agitha, T. G., Alternative Incentive Models Delinking R&D Costs from Pharmaceutical Product Price, 18 J. Intell. Prop. Rts. 491, 495-96 (2013)Google Scholar.

96 Id. at 495.

97 Matthew Renwick et al., A Critical Assessment of Incentive Strategies for Development of Novel Antibiotics 8 (2014).

98 Id.

99 See Mossialos et al., supra note 69, at 150.

100 See Aylin Sertkaya et al., Analytical Framework for Examining the Value of Antibacterial Products 6-1, 6-2 (2014).

101 See Lemley, Mark A., Are Universities Patent Trolls?, 18 Fordham Intell. Prop. Media & Ent. L.J. 611, 614-15 (2008)Google Scholar (noting that universities increasingly have technology transfer offices dedicated to university patenting).

102 See Sertkaya et al., supra note 100, at 6-1, 6-2.

103 See Renwick et al., supra note 97, at 10.

104 U.S. Food & Drug Admin., Abbreviated New Drug Application (ANDA): Generics, FDA.Gov, http://www.fda.gov/Drugs/DevelopmentApprovalProcess/HowDrugsareDevelopedandApproved/ApprovalApplications/AbbreviatedNewDrugApplicationANDAGenerics/ [http://perma.cc/35TH-ZFU8] (explaining the nature of ANDAs and the regulatory practice).

105 Id.

106 See Aylin Sertkaya et al., Analytical Framework for Examining the Value of Antibacterial Products, Office of the Assistant Sec’y for Planning and Evaluation, http://aspe.hhs.gov/sp/reports/2014/antibacterials/rpt_antibacterials.cfm [http://perma.cc/7MGJ-B2FJ] (portraying the effects on the NPV in Table 3).

107 Id. (illustrating the incentives as larger than the NPV because Table 3 has many incentive types).

108 Id.

109 Id.

110 Id. (describing data exclusivity as a possible market barrier for generic competitors).

111 Priya Sharma & Adrian Towse, New Drugs to Tackle Antimicrobial Resistance 40 (2011) (defining wildcard patent extensions as a successful way to entice pharmaceutical companies to invest in antimicrobrial R&D).

112 See id.

113 Id. at 41 (“Outterson et al. contend that IP extensions function as a tax on consumers by charging higher prices during a drug’s patent life and are an insufficient method of subsidizing antibacterial research.”).

114 Sharma & Towse, supra note 111, at 41 (“[I]n European tax-based and social insurance based systems, the cost increase will be passed onto the health care system and not the patients using the drugs that attracts the IP extension.”).

115 Rietveld, Ad H. & Haaijer-Ruskamp, Flora M., Policy Options for Cost Containment Pharmaceuticals, in Drugs and Money: Prices, Affordability, and Cost Containment 29, 29–32 (2003)Google Scholar (comparing the pricing models of pharmaceutical drugs and the effects of different pricing methodology).

116 Id. at 35 (explaining the risks and rewards of fixed costs, like fees per prescription).

117 See id.

118 Id. at 30 (defining four methods of cost containment procedures that range from the manufacturer to the pharmacist level of the pharmaceutical system and how that applies to the patient population, including Diagnosis Related Group).

119 See Ashiru-Oredope, Diane et al., Improving the Quality of Antibiotic Prescribing in the NHS by Developing a New Antimicrobial Stewardship Programme: Start Smart—Then Focus, 67 J. Antimicrobial Chemotherapy i51, i52 (2012)Google Scholar (indicating that KPIs could be used to help “[d]efine safe and optimal antimicrobial usage by identifying … antimicrobial prescribing and consumption … in primary, secondary and tertiary care.”).

120 For instance, this is the case in the IMI-financed PDP COMBACTE. See Combatting Bacterial Resistance in Europe, supra note 76 (describing COMBACTE).

121 See Enrico Baraldi et al., supra note 26, at 3 (“Negotiations over intellectual property rights particularly in the context of exit and buyouts – and sometimes in respect of the creation of collaborative platforms with peer organizations.”).

122 See, e.g., Brandão, L. E. et al., Using Binomial Decision Trees to Solve Real-Option Valuation Problems, 2 Decision Analysis 69 (2005)Google Scholar.

123 See Brogan & Mossialos, supra note 44, at 8 (explaining that “the decision to invest … would rely heavily on full disclosure of all relevant documents”).

124 See id. (“International purchasers would need to hire people with specific skills in financing, project valuation and/or real options valuation (ROV) assessment. However, it is reasonable to believe that if information is shared appropriately, the skills of the purchasers could closely match those of the drug developers in this area.”).

125 See, e.g., id. at 5, 6 (indicating that third party payers, including government agencies like NHSs, would need to determine whether to purchase options for antibiotics, which could potentially involve a complex “value maximization approach” based on an assessment of various pricing variables).

126 See supra Part IV.

127 See infra Tables 1 and 2 for an overview of such obstacles.

128 See sources cited, supra note 8.

129 See supra Part IV.H.

130 See id.

131 See id.

132 See id.

133 It is premature to say anything about the possible success of these mechanisms based solely on the potential actor-specific and systemic obstacles we identified. A full cost-benefit analysis would be necessary for each mechanism and each actor, that is, an analysis which quantifies the obstacles into costs and also considers the advantages of each mechanisms for particular actors—two aspects that were explicitly excluded from this Article.