Support from a Boston University-based global nonprofit that’s leading the fight against antibiotic resistance significantly boosts the chances of novel drugs and preventatives making it to clinical development, according to an independent analysis of its impact.
In a peer-reviewed study published in the journal Health Affairs Scholar , researchers found projects backed by the Combating Antibiotic-Resistant Bacteria Biopharmaceutical Accelerator (CARB-X) were nearly five times more likely to advance to the clinical development stage than those that didn’t receive its support.
Since its 2016 launch at BU, the public-private partnership has supported 123 projects in 15 countries; of those, 28 have moved into clinical trials. The CARB-X team provides financial and technical support for promising therapeutics, preventatives, and rapid diagnostics with the potential to counter antimicrobial resistance (AMR). It has so far committed more than $1 billion in funding.
The World Health Organization counts AMR—which occurs when common medicines to treat infections and disease start failing to take down bacteria and viruses—as one of the planet’s biggest health and development threats . Driven by the over- and misuse of antibiotics, it causes millions of deaths a year and can turn previously routine surgeries and diseases into potential killers.
The study of CARB-X was conducted by Rena Conti , a BU Questrom School of Business professor of markets, public policy, and law, and researchers at Harvard University’s John F. Kennedy School of Government. The CARB-X team shared data with the researchers, but were not part of the study’s design or interpretation of results.
"The success of CARB-X helps address the AMR crisis by creating more promising drug candidates in the early part of the pipeline,” wrote Conti and her colleagues in sharing their findings.
Addressing the AMR Challenge
To study CARB-X’s effectiveness, the researchers analyzed outcomes from preventative and therapeutic projects funded during its first three years, comparing results to efforts that didn’t have the nonprofit’s backing. Of the 77 funded projects they looked at, just over half moved to the next stage of development, with 17.3 percent making it to clinical trials; it also led to the award of 160 patents. By comparison, among the 59 nonfunded projects, less than a quarter advanced, though nine projects—16.4 percent—did move into clinical trials. The researchers said the study is the first to “evaluate empirically the effect of new incentives to address the global AMR challenge.”
In their paper, they concluded that “results suggest that CARB-X support was positively and statistically significantly associated with advancement” to the next stage of development and “positively but not statistically significantly associated with patent filing and award, and continued operations of the application and firm compared to their non-funded counterparts.”
They added that future AMR-related initiatives might “aim to shore up resources to support CARB-X” and similar efforts.
“We now have independent evidence that shows the CARB-X public private partnership materially bends the curve in antibacterial innovation—significantly increasing the odds that life-saving products reach patients,” says Kevin Outterson , CARB-X’s executive director and Austin B. Fletcher Professor of Law at BU School of Law. “Sustaining this momentum will require continued global commitment. To fully realize the potential of antibacterial incentives, governments and partners must stay engaged and invest at the scale needed to address the growing threat of drug-resistant infections.”
CARB-X was founded at BU in partnership with the Biomedical Advanced Research and Development Authority within the US Department of Health and Human Services and global charitable foundation Wellcome. It’s funded by a consortium of governments and foundations, including six of the G7 governments, the European Commission, Wellcome, the Gates Foundation, and the Novo Nordisk Foundation. It also receives in-kind services from the National Institute of Allergy and Infectious Diseases.
“CARB‑X is built to identify and support the most promising science in an environment defined by scientific uncertainty and extreme market volatility,” says Richard Alm, the nonprofit’s chief of research and development. “Our strategic approach ensures that high impact projects receive not only funding, but the expert guidance needed to survive and advance to the clinic. In many cases, CARB‑X provides a critical lifeline—helping innovative programs navigate a challenging ecosystem while addressing the urgent and evolving threat of antimicrobial resistance.”
Health Affairs Scholar
Data/statistical analysis
Not applicable
An evaluation of the US public–private Combating Antibiotic-Resistant Bacteria Accelerator (CARB-X) initiative
2-Jul-2026
Please see the ICMJE forms for author conflicts of interest. These have been provided as supplementary materials.