2 April 2020

PLEASE NOTE: The Viewpoints on our website are to be read and freely shared by all. If they are republished, the following text should be used: “This Viewpoint was originally published on the REVIVE website revive.gardp.org, an activity of the Global Antibiotic Research & Development Partnership (GARDP).”

The spectre of an infectious disease pandemic killing tens of thousands of people across the globe is no longer a theoretical nightmare scenario. The World Health Organization’s ‘Disease X’ is here and despite consistent efforts by WHO and others to keep the political focus on this threat, the world has been caught largely unprepared.

If there are lessons already to be learned from the coronavirus disease (COVID-19) pandemic, it is that too many political decisions are based on short-term thinking that ignores laws of nature. Biology dictates how organisms evolve, particularly when we put pressure on them. With our growing advances into the previously undisturbed natural world, viruses will continue to jump into human populations with devastating impact. It also means that with the large scale and inappropriate use of antibiotics, bacterial infections will become increasingly drug-resistant. Importantly, this includes those associated as secondary infections to novel viruses.

The link between COVID-19 and drug-resistant infections is more troubling than many realize. Antibiotics, while not effective against viruses, are being used frequently in people with COVID-19 to prevent or treat suspected or confirmed secondary bacterial infections. According to an early study from China, secondary infections causing bacterial pneumonia, bloodstream infections, sepsis and hospital-acquired infections were present in half of all deceased COVID-19 patients1.

The link between COVID-19 and drug-resistant infections is more troubling than many realize.

Antibiotics are in high demand and many of these infections are increasingly resistant to existing antibiotics. There are also growing concerns that the increased use of antibiotics, coupled with disrupted supply chains, could lead to critical shortages of these key drugs within months.

There is another impact of COVID-19 that is less well understood. As governments and health care infrastructures focus on the pandemic response, numerous research efforts to fight drug-resistant infections are slowing down or coming to a halt. This is compounded by closure of laboratories and during the current crisis the inability of people to participate in non-COVID-19 related clinical trials including of new antibiotics.

In the medium and long term, the economic shock resulting from the pandemic may mean financial resources are diverted from critical health systems investments including antimicrobial research and development. The consequence of this would be catastrophic – ranging from significant delays or even cancellations of critical research and development programmes, to the closure of research organizations and biotechs working on diagnostics, vaccines and treatments. Ultimately, it could mean the preventable loss of lives.

As a global health community, we must learn the lessons of COVID-19 and also take action to fight drug-resistant infections. COVID-19 caught us off guard, so we need to prepare for the next potential pandemic and drug-resistant infections.

Ensuring the effective use of antibiotics can save lives now and during future disease outbreaks. In terms of better understanding and addressing the impact between COVID-19 and bacterial infections, there are steps that can be taken by governments, policymakers, funders and researchers, such as:

  1. Assess how secondary bacterial infections, antibiotic use and drug resistance affect the survival or death of COVID-19 patients.
  2. Protect global access and supply of critical antibiotics required by healthcare systems, especially while these systems are coming under intense pressure.
  3. Prioritize the development of treatments to tackle drug-resistant infections. It is essential that such efforts are supported during this difficult period and accelerated once the pandemic subsides.

COVID-19 is a loud call for the entire global health community. There is a clear need to invest further in public health and healthcare systems, as well as collaborative research and development. Antibiotics, the backbone of our ability to respond to disease outbreaks, are also under threat. New, effective interventions are already needed now and this demand will increase.

If there are lessons already to be learned from the coronavirus disease (COVID-19) pandemic, it is that too many political decisions are based on short-term thinking that ignores laws of nature.

This is exactly why the Global Antibiotic Research and Development Partnership (GARDP), a not-for-profit that develops new treatments for drug-resistant infections, believes its mission is more important than ever. It is why we have developed a business continuity strategy with our partners to ensure we can mitigate where possible the effects of COVID-19 and accelerate our activities when the situation allows.

By fostering partnerships between the private and public sectors, GARDP is positioned to accelerate the development of critically needed treatments that are accessible in a sustainable and responsible manner.

Just like COVID-19, antibiotic resistance is a health security crisis that moves silently within populations and knows no boundaries. No single country, company or organization can fight drug resistance alone. It can only be done in partnership. We must act now to prevent drug-resistant infections from becoming the next global public health emergency. Governments must take steps to accelerate the introduction of necessary interventions, including the development of new treatments for bacterial infections.


  1. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z et al., Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-1062. 

Manica Balasegaram trained as a medical doctor at the University of Nottingham, UK from where he started his career in internal and emergency medicine. From 2001 onwards, he worked as a doctor and researcher in several countries in Sub- Saharan Africa and Southern Asia. He also gained significant experience working in humanitarian emergencies and responses, largely with Médecins sans Frontières (MSF).

At the end of 2007 he joined the Drugs for Neglected Diseases initiative as Head of Leishmaniasis Clinical Program – a position he held for four years before returning to MSF as Executive Director of their Access Campaign. He was appointed director of GARDP in June 2016. He is also currently a board member of the Medicines Patent Pool as well as of FIND’s Scientific Advisory Committee.

Manica’s experience spans clinical and public health practice in infectious diseases, international work on health policy & access to medicines where he has served on numerous international technical and health policy panels and experts groups. He also has substantial experience in clinical trials and drug development working as a site investigator, principal investigator, and project manager.