[Jonathan J. Darrow, Michael S. Sinha and Aaron S. Kesselheim] Abstract: New antibiotics and vaccines aimed at treating or preventing infectious diseases can be highly valuable public health innovations, particularly when these products address unmet medical needs. Although patents are considered the primary means of incentivizing new product development, reduced private investment in this area has led policymakers to create new and sometimes costly supplemental incentive schemes for antibiotics. But the legislative initiatives launched over the past 15 years to overcome the shortcomings of the patent system have had limited success, in part because they do not adequately address the reasons underlying the disconnect between patents and the antimicrobial market.