A new report highlights the pervasive market failure in the antibiotics space and proposes a globally aligned, value-based, fully-delinked pull incentive to future-proof antibiotic innovation. The mechanism would involve payers paying manufacturers a pre-specified subscription fee, based on the value of the antibiotic, over a pre-specified period, regardless of the volume of antibiotics used. The report suggests that the size of a global pull incentive should be calculated by aggregating revenue from all countries where the product is sold, with a 10-year ‘subscription’ type payment estimated to be $4.2 billion. Eligible products should be selected based on globally aligned criteria, including the unmet need to be addressed and a target product profile. Value assessment must be local, and its methodology must distinguish between higher and lower value products. The report concludes that investment in research is needed in the short term to develop communities of practice around economic modelling for antibiotics with a view to generating methods and finding evidence sources that will enable population benefits to be estimated using QALY-based modelling with appropriate adjustment for risk aversion.