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    Sustainability

    Traveling into the future to find an antidote to antibiotic resistance 

    by Knut Haanaes, Carlos Cordon Published January 20, 2025 in Sustainability • 8 min read

    With millions of lives at risk, resistance to antibiotics is one of the most pressing health challenges of our time. Our ‘Future Back’ approach to problem-solving could help find a cure.

    Antibiotic resistance – sometimes known as antimicrobial resistance – occurs when antibiotics become ineffective in treating infections, often due to their overuse or presence in food. Responsible for millions of deaths, it is among the most critical threats to human health. According to the World Health Organization, if left unchecked, it could result in 10 million lives lost annually and $1tn in additional healthcare costs globally by 2050. Yet action to prevent this catastrophic future has been slower than the crisis demands, and most traditional approaches are reactive, risking a “too little, too late” scenario.

    With each passing year, the problem becomes more complex. Several companies dedicated to developing and commercializing new antibiotics have gone bankrupt, and most big pharmaceutical companies have dropped plans to develop antibiotics, unable to find a good business case. Although these corporations have created the $1bn AMR Action Fund to encourage the development of new antibiotics, the fund recognizes that it will not fix the challenges that threaten a sustainable antibiotic pipeline.

    Wouldn’t it be great if time travel were possible to see whether humanity succeeds in conquering this and other major crises such as climate change and the scourge of plastic waste? Fortunately, there is a kind of time machine available. The Future Back approach is a transformative solution pioneered by Thomas Malnight, Professor Emeritus of Strategy and General Management at IMD, which we are implementing in our teaching to help chart a clear path to overcoming tough challenges such as antibiotic resistance.

    The Future Back method allows you to avoid being trapped by current challenges and constraints, instead focusing on the opportunities and innovations needed to shape a more positive future.

    Applying the Future Back approach to antibiotic resistance

    This Future-back methodology diverges from conventional problem-solving processes, which start from the present and work toward the future. Instead, you are invited to envision an ideal future outcome – in this case, a world where antibiotic resistance is no longer a critical threat – and then work backward to identify the essential steps, collaborations, and innovations necessary to achieve that outcome. This method allows you to avoid being trapped by current challenges and constraints, instead focusing on the opportunities and innovations needed to shape a more positive future.

    The learnings from our sessions on addressing antibiotic resistance are accompanied by an IMD mini case called, “It is 2033, and antibiotic resistance is no longer a threat. How did we get there?”

    Each session begins with a presentation outlining the global antibiotic resistance crisis, which emphasizes the situation’s urgency and explains how existing strategies were insufficient to combat the rapid rise in resistant bacteria.

    Participants are divided into smaller groups to facilitate focused discussions, each addressing two key questions: (1) We are in 2033 and succeeded in addressing antibiotic resistance – how did that play out as a timeline? and (2) Who were the main stakeholders involved? Groups are further split into proactive teams, which develop strategies, and reactive teams, which respond to big events that force action. The questions and framing encourage holistic thinking, integrating scientific and medical advances with the political, economic, and societal shifts required to make progress. Teams visually outline their proposed solutions on posters, and each session concludes with a readout, synthesizing group insights and fostering reflection on emerging themes and strategies.

    “Antibiotic resistance is not only a scientific problem but also an economic one.”

    Back to the future: lessons learned so far

    Our recent Future Back sessions yielded several key insights into the challenge of antibiotic resistance. These lessons helped shape a comprehensive strategy for addressing the issue by 2033.

    1 – Addressing market failures: the business model challenge

    Antibiotic resistance is not only a scientific problem but also an economic one. Developing new antibiotics is costly, with little financial incentive for pharmaceutical companies to invest. This is because new antibiotics are typically reserved for last-resort use, making them less profitable than medications used more frequently. Overcoming this market failure is crucial to addressing antibiotic resistance. Innovative business models are needed to incentivize new antibiotic research and development investment. This could include public subsidies, government-backed prize funds, or new regulations ensuring companies are compensated for investing in essential but less profitable medications.

    2 – Collaboration and proactive action: the key to success

    While the means to address antibiotic resistance already exist, these efforts require coordination and a proactive approach. Individual countries and organizations need help to solve the problem; global cooperation among governments, pharmaceutical companies, healthcare providers, and civil society is required. Reactive measures, such as responding to crises after they arise, will only increase human suffering and financial costs. Instead, proactive steps – including promoting responsible antibiotic use, strengthening global surveillance of drug resistance, and investing in prevention – are essential.

    3 – Technology and research: no longer the bottleneck

    Despite the costs and challenges associated with antibiotic development, advances in genomics, artificial intelligence, and biotechnology have accelerated drug discovery processes and made identifying novel antibiotics and treatment alternatives easier. AI, for example, enables the rapid simulation of millions of experiments to find new antibiotics. However, technology alone is insufficient; successful implementation requires robust systems, strategic partnerships, and sustainable financial models.

    4 – The cost of inaction: human and financial burden

    It is increasingly clear that addressing antibiotic resistance reactively – after it has spiraled into a full-blown crisis – would result in staggering costs, both in human lives and financially. The burden of drug-resistant infections, which cause more extended hospital stays and more intensive treatments, would cripple healthcare systems.

    5 – The need for system leadership: aligning global efforts

    The complexity of antibiotic resistance demands system leadership, which involves coordinating multiple sectors and stakeholders toward a unified goal. Strong leadership at national and international levels is necessary to implement the comprehensive strategies needed to combat antibiotic resistance. This includes aligning the goals of the public health sector, regulatory bodies, the pharmaceutical industry, and global organizations like the World Health Organization.

    6 – Public-private partnerships: essential to the solution

    Robust public-private partnerships are among the most promising paths to address antibiotic resistance. The scale of the problem means that governments and private companies need help to solve it. Collaboration between the public and private sectors, supported by global frameworks and agreements, would enable the pooling of resources, expertise, and funding necessary to develop new antibiotics, improve diagnostics, and implement global surveillance systems.

    Finally, we recognize the crucial role of crises as catalysts for decisive action. The most positive and fastest outcomes typically arise when triggers, supported by prior preparation and investments, lead to fast and assertive action.

    With these insights in hand, we now have a better understanding of what it will take to prevent antibiotic resistance from becoming the global catastrophe it once threatened to be.

    The power of starting from a desired outcome

    While the scale of challenges like the climate and biodiversity crises and antibacterial resistance might feel paralyzing, the Future Back approach fosters a “can do” mindset. By focusing on a future where a complex challenge has been successfully addressed, participants can overcome the limitations of current thinking and explore innovative solutions. This mindset fosters a sense of possibility and optimism, encouraging creative thought and bold action, revealing that even seemingly impossible challenges can be tackled with the right mindset and strategic planning.

    The road to overcoming antibiotic resistance remains challenging, but the Future Back method allows us to envision a world where this threat has been mitigated and maps out a clear and actionable path for getting there, including the key strategies that address market failures, foster collaboration, leverage technological advances, and enable proactive, preventive actions. The need for strong leadership and public-private partnerships is also a central theme. With these insights in hand, we now have a better understanding of what it will take to prevent antibiotic resistance from becoming the global catastrophe it once threatened to be.

     

    The fact base of these Future Back sessions was developed out of The Antibiotic Ecosystem Conundrum, an IMD case written by Carlos Cordon, Patrick Itterbeek, Roberto Matta, Inger Anne Torsheim, and Brigitta Vos. We would also like to recognize IMD Emeritus Professor Thomas Malnight as an important inspiration for the Future Back approach.

    You can read more about the antibiotic resistance challenge here.

    Authors

    Knut Haanaes

    Knut Haanaes

    Lundin Chair Professor of Sustainability at IMD

    Knut Haanaes is a former Dean of the Global Leadership Institute at the World Economic Forum. He was previously a Senior Partner at the Boston Consulting Group and founded their first sustainability practice. At IMD he teaches in many of the key programs, including the MBA, and is Co-Director of the Leading Sustainable Business Transformation program (LSBT) and the Driving Sustainability from the Boardroom (DSB) program. His research interests are related to strategy, digital transformation, and sustainability.

    Supply chain

    Carlos Cordon

    Professor of Strategy and Supply Chain Management

    Carlos Cordon is a Professor of Strategy and Supply Chain Management. Professor Cordon’s areas of interest are digital value chains, supply and demand chain management, digital lean, and process management. At IMD, he is Director of the Strategies for Supply Chain Digitalization program.

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