Manica Balasegaram: “Multi-resistant bacteria are just as threatening”

20 Apr 2020

(This article originally appeared in Le Temps on 16 April 2020)

The COVID-19 pandemic was anticipated and could have been avoided. Faced with antibiotic resistance, pharmaceuticals and governments could be doing much more, warns Manica Balasegaram, Executive Director of GARDP, a Geneva-based organization.

By Richard Etienne

The current pandemic could have been avoided if measures had been taken to prevent it and if the pharmaceutical companies had been encouraged to find treatments. In the same vein, other equally inevitable global health problems could have been countered if we had acted earlier. This includes antibiotic-resistant bacteria in particular, a growing threat to humanity against which pharmaceutical companies are not doing much. This is the opinion of Manica Balasegaram, a British and Swiss doctor who has treated patients in the four corners of the globe before joining the Global Antibiotic Research and Development Partnership (GARDP), a Swiss foundation created in 2019 in Geneva. Interview.

Le Temps: Why is the fight against antibiotic-resistant bacteria important in the context of COVID-19? 

Manica Balasegaram: We knew that a pandemic was going to happen sooner or later. COVID-19 is an example of a disease in which greater investments were needed in terms of money and international collaboration. Ditto for multi-resistant bacteria: we know that these infections are on the rise and that they will cause illness and death. Some economists anticipate global and serious consequences. It will be less spectacular than COVID-19, but we know it will come and we are not preparing.

How threatening are these drug-resistant bacteria?

This is one of the problems: we lack precise data. A study has shown that between 200,000 and 300,000 babies die each year from resistant bacteria. We know that the threat is growing, that there are infections around the world, but also in Europe, especially in northern Italy last year. In Switzerland, there are still few cases, no doubt because the government has taken steps to address it, with its Antimicrobial Resistance Strategy, and the health system is solid. There are bacteria that resist all antibiotics, and others that require strong, toxic, not necessarily accessible antibiotics.

What solutions does GARDP propose to tackle this threat? 

We scientifically support and finance research and development (R&D) projects, from phase 2 and 3 clinical trials to possible commercialization. We forge partnerships with academia, hospitals, governments, pharmaceuticals and biotechs. By 2025, we aim to develop five treatments with these partners that target the most resistant infections identified by the WHO, such as sepsis and gonorrhoea. The biggest challenge is not R&D per se, but getting medicines to everyone who needs them.

How do we make the treatments accessible?

We are asking governments to ensure businesses remain financially viable. Governments must ensure that these drugs are created – they must encourage companies to get involved – and that everyone can benefit from them. In countries with less means, we can request licenses from companies to have their products manufactured and distributed with other partners. Research is funded on the condition that licenses are granted in exchange or that companies can show a solid access plan and accept a development plan that serves public health.

If there is a threat, there should be demand, a market and financial incentives. Isn’t that the case with multi-resistant bacteria? 

No, because antibiotics against such bacteria must be used as sparingly as possible – thus generating limited sales – and research to develop them is always more complicated and expensive. This is hardly compatible with the prevailing business model in pharma as it encourages rapid returns on investment. Multi-resistant bacteria is long term. Addressing this issue requires increased public-private collaboration through organizations such as GARDP.

Do international organizations exist to make up for the shortcomings of pharma’s economic model?

International organizations like WHO can provide guidance and priorities for R&D. And public-private partnerships, such as GARDP, must ensure that R&D is carried out and that treatments are accessible. We have to be frank: there are gaps. Pharmaceutical companies, often listed on the stock market, have obligations to their shareholders. The system works this way and it is not always compatible with global health issues.

How do we fix this?

Governments must support us more. Switzerland needs to support us more. Both politically and financially. To date, we have raised 100 million francs, especially from Germany, the United Kingdom and the Netherlands, and also from Switzerland. We would like to have a budget of 500 million francs by 2025. We also need more collaboration at the highest level, which is what is lacking against COVID-19. We need to educate the public, get closer to the people, maybe do some crowdfunding. GARDP could belong to the public. The private sector must also invest more in these less profitable fields. It often benefits from excellent market conditions and should do more for the community. Investing in global health prevention can also be in their interest: how much will they lose when they stop their research programmes and activities during this pandemic?

Concretely, what can such public-private partnerships look like?

The models can vary according to needs, treatments and with each partner – like an SME for example. Governments can set up mechanisms to support research and development, such as GARDP. They can also set up reimbursement for antibiotics, according to their intrinsic value and not according to their selling price. The United States and the United Kingdom have taken steps in this direction. We could develop subscriptions for certain treatments, which would generate income regardless of the volume of sales. They will not be blockbusters, but there will still be a return for pharmaceuticals and for SMEs, which are behind most of the innovations. There are no ready-made solutions. You have to find different solutions depending on each case, but they will go through public-private partnerships.

 Is GARDP the only organization to fund R&D for drug-resistant bacteria?

The US government is also active. An association in Boston, CARB-X, is funding R&D before the end of phase 1 clinical trials. But if we were created [editor’s note: in 2016 by the WHO and the Drugs for Neglected Diseases initiative before becoming an independent entity in 2019], it is to fill the gap, particularly for phase 2 and 3 clinical trials and patient access.

There is a very large number of international organizations in Geneva focusing on global health. Do they manage to collaborate effectively? 

I am Executive Director of GARDP, but also a member of the scientific committee of FIND (Foundation for Innovative New Diagnostics) and member of the board of Medicines Patent Pool, two organizations which are also based in Geneva. GARDP was created by WHO and DNDi in Geneva. Collaboration in this ecosystem doesn’t always work perfectly, but being so close geographically to each other in a neutral country is a huge advantage. Switzerland and the canton of Geneva should be proud of this Geneva hub and promote it more.


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