A WORLD WITHOUT antibiotics is horrible to contemplate. They underpin much of modern medicine and are essential for patients undergoing chemotherapy for cancer, organ transplants or common surgeries such as caesarean sections. Yet the global rise of antimicrobial resistance, exemplified by the spread of Candida auris—the latest infection terrorising hospitals—and super-resistant gonorrhoea, is alarming. Resistance could kill 10m people a year by 2050, up from 700,000 today. This week a UN commission recommended immediate and co-ordinated action to avoid a calamity whose economic cost, the World Bank reckons, could rival that of the financial crisis of 2008-09.

That the pharmaceutical market does not always work well is hardly news. It has failed to develop many kinds of drugs, including new vaccines and treatments for diseases that mainly afflict the poor. But when it comes to antibiotics, matters are particularly bad. To prevent microbes from developing resistance to them, novel antibiotics tend to be reserved for use by doctors as a last line of defence and used for short periods. Hence volumes are meagre. That would not matter if prices were high. But unlike new drugs for cancer or rare diseases, prices of antibiotics are kept low in many countries, creating little incentive for drug companies to develop new ones. As a result, investors avoid new antibiotic firms and are fearful that they will run out of cash. The recent bankruptcy of Achaogen, a biotech firm, suggests they are right to fret (see article). Big drug companies have largely bowed out of the game.

Governments and charities have scrambled to stimulate activity by putting money into basic research, giving grants to drugs startups and taking equity stakes in them, but that has not been enough. Bringing a drug from the laboratory to the clinic typically takes a decade and costs around $1bn. A more extreme option would be to nationalise antibiotic production, but that would only cause private-sector innovation to shrivel even further. Instead, stimulating the development of new antibiotics requires governments to embrace two ideas.