Antimicrobial effectiveness within a new paradigm of infrastructure.

Antimicrobials form the backbone of modern medicine and represent a foundational pillar of economic productivity. Overuse and misuse have led to a rising trend of antimicrobial resistance (AMR), depleting the efficacy of existing antimicrobials, necessitating conservation through stewardship and renewal through innovation. Poor global access exacerbates these challenges. We introduce the concept of antimicrobial effectiveness (AME) as a system in which antimicrobials are clinically and microbiologically efficacious against infectious pathogens and accessible for appropriate use. We frame AME as a global economic infrastructure, demonstrating its role as a key input to health, social, and economic outcomes and driver of positive spillovers. We investigate the balance between capacity constraints imposed by AMR and the benefits of maximizing non-discriminatory sharing of AME, exploring how a sustainable management approach comprised of infection prevention, universal access, stewardship, surveillance, and innovation can conserve AME. We explore economic mechanisms such as internalized healthcare overheads and hypothecated taxes to align contributions with benefits, ensuring that patients, hospitals, and businesses who rely on AME help to conserve it. Through identifying social value, patterns of payoffs, and downstream beneficiaries of AME, infrastructure framing provides a coherent axis to structure action, align incentives, and mobilize investment across sectors and scales.