Fleming’s accidental discovery of penicillin in 1928 heralded one of medicine’s greatest revolutions. The subsequent golden era of antibiotic discovery transformed treatment of previously fatal infections, enabling decades of safe surgery, and advances in immunosuppressive cancer care. However, emerging antibiotic resistance threatens to undo decades of medical progress rendering our existing medicines ineffective. Confronting this growing risk requires access to the right antibiotics at the right time, yet most major pharmaceutical companies have abandoned antibiotic research and production. Innovation now relies on financially fragile biotech companies while low profit margins are driving shortages of essential generic antibiotics. As a result, the entire antibiotic investment ecosystem is being reshaped by market logics that determine which antibiotics survive, which supply chains remain viable, and ultimately who gets access to life saving treatment. An additional emerging risk of disruption to global antibiotic infrastructure is being driven by contemporary pharmaceutical trade wars.