1 00:00:10,560 --> 00:00:14,160 Speaker 1: That's saying we are what we eat. Well, there's truth 2 00:00:14,200 --> 00:00:17,840 Speaker 1: to it. We ingest bacteria constantly when we're eating and 3 00:00:17,920 --> 00:00:21,759 Speaker 1: drinking our stomach acid helps bend off disease causing germs, 4 00:00:22,079 --> 00:00:25,480 Speaker 1: but bugs often make it through to the intestines. They 5 00:00:25,480 --> 00:00:28,320 Speaker 1: can become established as part of our normal gut Bacteria, 6 00:00:28,840 --> 00:00:32,440 Speaker 1: the microbes that help digest food, make vitamins, and support 7 00:00:32,479 --> 00:00:36,760 Speaker 1: the immune system. Increasingly, the bugs taking up residents in 8 00:00:36,800 --> 00:00:42,720 Speaker 1: our intestines possess special powers. They're developing resistance to antibiotics, 9 00:00:43,200 --> 00:00:45,840 Speaker 1: in large part because of the overuse of those medicines. 10 00:00:46,880 --> 00:00:50,640 Speaker 1: The risk of harboring drug evading bowel dwelling bacteria varies 11 00:00:50,760 --> 00:00:54,200 Speaker 1: from country to country depending on where we travel. We 12 00:00:54,240 --> 00:00:58,440 Speaker 1: can return from a trip with some unwanted guests. Sometimes 13 00:00:58,680 --> 00:01:05,680 Speaker 1: the threat is right on our our step. Welcome to Prognosis, 14 00:01:05,920 --> 00:01:09,360 Speaker 1: a podcast about health and science, medical technology, and the 15 00:01:09,480 --> 00:01:12,680 Speaker 1: changes that are underway across the globe. I'm your host, 16 00:01:12,840 --> 00:01:17,120 Speaker 1: Michelle fay Cortes. This season, we've been focusing on the 17 00:01:17,160 --> 00:01:21,360 Speaker 1: loss of our infection fighting medications because of antimicrobial resistance, 18 00:01:22,000 --> 00:01:24,279 Speaker 1: and we've been exploring how we can find new ways 19 00:01:24,319 --> 00:01:28,600 Speaker 1: to battle the crisis. In this final episode, Bloomberg's Jason 20 00:01:28,640 --> 00:01:32,200 Speaker 1: Gale takes us to Copenhagen to investigate an unlikely way 21 00:01:32,280 --> 00:01:35,959 Speaker 1: researchers are tracking this problem. He looks at what happened 22 00:01:35,959 --> 00:01:38,959 Speaker 1: when one country found the threat lurked in refrigerators and 23 00:01:39,040 --> 00:01:43,040 Speaker 1: on countertops and took bold action to stop superbugs at 24 00:01:43,080 --> 00:01:47,800 Speaker 1: their source. And he hears from Dame Sally Davies, England's 25 00:01:47,840 --> 00:01:51,200 Speaker 1: top medical advisor, about why she's optimistic that we can 26 00:01:51,200 --> 00:01:58,760 Speaker 1: mitigate the global superbug crisis. Here's Jason helpful. Authorities have 27 00:01:58,880 --> 00:02:02,000 Speaker 1: been warning for years that the world is losing its 28 00:02:02,080 --> 00:02:07,200 Speaker 1: most precious weapons against bacterial infections because of antibiotic resistance. 29 00:02:07,880 --> 00:02:13,600 Speaker 1: Around seven hundred thousand people worldwide diannually as a consequence 30 00:02:13,600 --> 00:02:17,840 Speaker 1: of superbugs. That number is predicted to climb to ten 31 00:02:17,960 --> 00:02:22,440 Speaker 1: million by and one of the biggest challenges researchers have 32 00:02:22,560 --> 00:02:27,080 Speaker 1: faced is tracking their spread outside of hospitals, carried around 33 00:02:27,120 --> 00:02:30,760 Speaker 1: in the digestive tracks of healthy people. First of all, 34 00:02:31,280 --> 00:02:34,800 Speaker 1: we have always at this need of doing a global 35 00:02:34,880 --> 00:02:38,799 Speaker 1: monitoring offensive acropal assistance. It's basically that if you don't 36 00:02:38,800 --> 00:02:41,200 Speaker 1: know where you are, you have no clue where you're going. 37 00:02:41,600 --> 00:02:45,399 Speaker 1: That's Frank Austro. He's a professor at the Technical University 38 00:02:45,440 --> 00:02:49,160 Speaker 1: of Denmark and heads the Reference Laboratory on anti microbial 39 00:02:49,240 --> 00:02:53,840 Speaker 1: resistance for the European Union, the World Health Organization and 40 00:02:53,880 --> 00:02:58,160 Speaker 1: the Food and Agriculture Organization of the United Nations. He's 41 00:02:58,160 --> 00:03:01,320 Speaker 1: been studying the rise of superbugs for almost twenty five 42 00:03:01,400 --> 00:03:04,519 Speaker 1: years with his team in Copenhagen. One of Professor Austri's 43 00:03:04,560 --> 00:03:07,360 Speaker 1: goals is being figuring out how to get around this 44 00:03:07,440 --> 00:03:11,919 Speaker 1: global tracking problem. The biggest issue, he says, is acquiring 45 00:03:12,000 --> 00:03:16,320 Speaker 1: samples that are representative of large numbers of people. When 46 00:03:16,320 --> 00:03:19,200 Speaker 1: he says samples by the way, he means human feces. 47 00:03:19,680 --> 00:03:22,760 Speaker 1: To do global monitoring, well, that's requires that you go 48 00:03:22,840 --> 00:03:25,679 Speaker 1: out and get samples from other countries and that can 49 00:03:25,720 --> 00:03:29,560 Speaker 1: actually be associated with a lot of time delays and 50 00:03:29,680 --> 00:03:35,120 Speaker 1: problems logistics. Until recently, researches can only grasp the superbug 51 00:03:35,240 --> 00:03:39,560 Speaker 1: problem by the infections hospital patients get. But that's an 52 00:03:39,600 --> 00:03:43,400 Speaker 1: incomplete picture because healthy people also have a multi drug 53 00:03:43,440 --> 00:03:47,240 Speaker 1: resistant germs in their digestive tracks. Because when it comes 54 00:03:47,240 --> 00:03:51,320 Speaker 1: to resistance, it is really a silent epidemics where it 55 00:03:51,440 --> 00:03:54,680 Speaker 1: is spreading in that the normal god flora is spreading 56 00:03:54,720 --> 00:03:58,320 Speaker 1: between you know, healthy people, and then it's only occasionally 57 00:03:58,400 --> 00:04:00,920 Speaker 1: that if you see it's a upping up in the 58 00:04:01,120 --> 00:04:04,280 Speaker 1: clinicalized relates in the critical sick people. So if you're 59 00:04:04,320 --> 00:04:08,120 Speaker 1: only monitoring critically sick people at hospitals, then we are 60 00:04:08,160 --> 00:04:11,440 Speaker 1: really missing what is actually happening in the population as 61 00:04:11,440 --> 00:04:14,560 Speaker 1: a whole, where most of the evolution probably is taking place. 62 00:04:18,680 --> 00:04:22,080 Speaker 1: Said Professor a Strap. Had a two pronged problem. He 63 00:04:22,200 --> 00:04:26,279 Speaker 1: needed samples from across the world, and samples not just 64 00:04:26,520 --> 00:04:28,360 Speaker 1: from sick people. So we were a little bit of 65 00:04:28,480 --> 00:04:30,960 Speaker 1: frustrated to say, okay, how could we in an easy 66 00:04:31,000 --> 00:04:35,359 Speaker 1: way obtain samples from all around the world. Then it 67 00:04:35,600 --> 00:04:39,599 Speaker 1: dawned on him. Airplane waste tanks are repositories of a 68 00:04:39,760 --> 00:04:43,880 Speaker 1: pulled sample of fickle bacteria, and the specimens can be 69 00:04:43,960 --> 00:04:47,159 Speaker 1: tested in real time and can't be traced back to 70 00:04:47,200 --> 00:04:50,520 Speaker 1: their original donors, so there's no need to get permission 71 00:04:50,640 --> 00:04:53,960 Speaker 1: or ethics approval. It was something of a light bulb 72 00:04:54,080 --> 00:04:57,760 Speaker 1: moment for Professor Austrap. Oh wow, couldn't just be a 73 00:04:57,760 --> 00:05:01,760 Speaker 1: way of actually doing monitory So you could be sitting 74 00:05:01,760 --> 00:05:05,000 Speaker 1: here in Copenhagen and then just let all the samples 75 00:05:05,600 --> 00:05:11,440 Speaker 1: come to you. So I simply pick up the phone 76 00:05:11,440 --> 00:05:14,279 Speaker 1: and give a call to airport and Copenhagen and said, 77 00:05:14,320 --> 00:05:16,599 Speaker 1: do you know anyone that's taken care of the toilet 78 00:05:16,640 --> 00:05:20,840 Speaker 1: waist there? And I think that was Friday. Friday morning 79 00:05:20,880 --> 00:05:23,800 Speaker 1: I called, and Friday afternoon we had a meeting and 80 00:05:23,839 --> 00:05:26,560 Speaker 1: then they said, okay, well that's that sounds cool. Let's 81 00:05:26,600 --> 00:05:31,839 Speaker 1: let's go ahead. Professor Alster looked for flights long enough 82 00:05:31,880 --> 00:05:35,680 Speaker 1: to a mass sufficient testing material, and he settled on 83 00:05:35,880 --> 00:05:39,960 Speaker 1: studying the raw sewage from eighteen long haul flights arriving 84 00:05:39,960 --> 00:05:44,560 Speaker 1: in Copenhagen from nine cities across three regions. The results 85 00:05:44,600 --> 00:05:48,719 Speaker 1: were pretty consistent among flights from each region. In general, 86 00:05:49,160 --> 00:05:53,440 Speaker 1: planes arriving from Asia carried more drug resistant bacteria. The 87 00:05:53,480 --> 00:05:57,000 Speaker 1: biggest surprise was this a vague clear peasant and also 88 00:05:57,080 --> 00:06:00,600 Speaker 1: that there was more resistance than we had expected. There 89 00:06:00,640 --> 00:06:02,680 Speaker 1: was a very very clear patent at where we had 90 00:06:03,040 --> 00:06:07,080 Speaker 1: most resistance. That was in South Asia, then a little 91 00:06:07,080 --> 00:06:10,120 Speaker 1: bit less in Northern Asia, and then the lowest occurrence 92 00:06:10,160 --> 00:06:13,960 Speaker 1: of resistance was actually in flights coming in from North America. 93 00:06:14,600 --> 00:06:17,760 Speaker 1: The results were published in a scientific journal over four 94 00:06:17,880 --> 00:06:21,320 Speaker 1: years ago. It was just the start of Professor A. 95 00:06:21,440 --> 00:06:25,560 Speaker 1: Strops work on this global superbug tracking system. Based on 96 00:06:25,600 --> 00:06:28,400 Speaker 1: the positive results of the long distance flights and our 97 00:06:28,560 --> 00:06:31,280 Speaker 1: results there, but then we decided to go out and 98 00:06:31,520 --> 00:06:36,520 Speaker 1: collect sewage from from cities around the world. Next, Professor A. 99 00:06:36,600 --> 00:06:39,400 Speaker 1: Strop sent out a request to collaborators around the world 100 00:06:39,520 --> 00:06:44,000 Speaker 1: asking for samples of raw sewage. He was delivered sludge 101 00:06:44,040 --> 00:06:49,200 Speaker 1: from the sewers of seventy cities in sixty countries. Once again, 102 00:06:49,640 --> 00:06:53,640 Speaker 1: he looked for drug resistance genes carried by bacteria. It 103 00:06:53,760 --> 00:06:56,880 Speaker 1: gave him an even better idea of how superbugs were 104 00:06:56,920 --> 00:06:59,840 Speaker 1: spread out across the planet. We are purified to d 105 00:07:00,000 --> 00:07:03,320 Speaker 1: in the sequence data and analyze the data and try 106 00:07:03,400 --> 00:07:05,680 Speaker 1: to look at, okay, what is the patterns of antimicrob 107 00:07:05,800 --> 00:07:09,560 Speaker 1: resistance around the world, and basically to a large the center, 108 00:07:09,800 --> 00:07:12,960 Speaker 1: verifying also what we saw and expanding on what we 109 00:07:13,000 --> 00:07:16,200 Speaker 1: saw in our long distance flights study, we could see 110 00:07:16,440 --> 00:07:18,760 Speaker 1: that there was a very last difference in occurrence of 111 00:07:18,840 --> 00:07:22,200 Speaker 1: resistance around the world. Those results were published in March. 112 00:07:22,880 --> 00:07:25,960 Speaker 1: They showed the globe can be divided into two basic 113 00:07:26,080 --> 00:07:31,080 Speaker 1: groups based on their superbugs. There's Africa, South America and 114 00:07:31,200 --> 00:07:35,440 Speaker 1: Asia that's like one group, and then there's a North America, Europe, 115 00:07:35,560 --> 00:07:39,400 Speaker 1: and you see Land Australia in another group. And that 116 00:07:39,520 --> 00:07:41,000 Speaker 1: there was a little bit of a surprise for us 117 00:07:41,000 --> 00:07:43,840 Speaker 1: that we have this clear separation in the diversity and 118 00:07:44,800 --> 00:07:48,640 Speaker 1: prevalence of resistance around the world. It was already known 119 00:07:48,680 --> 00:07:53,880 Speaker 1: that antibiotic use drives drug resistance, but Professor Alsto discovered 120 00:07:53,920 --> 00:07:57,920 Speaker 1: something else. The main explanation in terms of occurrence of 121 00:07:58,000 --> 00:08:02,440 Speaker 1: resistance that is, apparently it's related to sanitation. So how 122 00:08:02,480 --> 00:08:05,880 Speaker 1: good is your sensation system, your how much do you 123 00:08:06,000 --> 00:08:09,360 Speaker 1: wasted your sewage system, the health system and how well 124 00:08:09,400 --> 00:08:13,520 Speaker 1: that is functioning, and then actually also parameters related to education. 125 00:08:14,080 --> 00:08:16,160 Speaker 1: So we're a little bit surprisedful this because I've really 126 00:08:16,240 --> 00:08:19,400 Speaker 1: learned that it is all about use of antimcrobial agents, 127 00:08:19,400 --> 00:08:22,440 Speaker 1: but it seems to be that artifacts was also play 128 00:08:22,520 --> 00:08:26,960 Speaker 1: a large role here. Professor Alstrop gave researchers a better 129 00:08:27,000 --> 00:08:30,720 Speaker 1: idea of how superbugs spread around the world. But once 130 00:08:30,840 --> 00:08:34,320 Speaker 1: you know where they are and where they're going, what 131 00:08:34,400 --> 00:08:38,120 Speaker 1: can a country do about it? One answer is in 132 00:08:38,160 --> 00:08:46,079 Speaker 1: the Netherlands, a little over a decade ago, the Netherlands 133 00:08:46,080 --> 00:08:51,319 Speaker 1: faxed and intriguing but worrying problem. Famous for its windmills 134 00:08:51,320 --> 00:08:54,560 Speaker 1: and eat um cheese, the country had a pristine track 135 00:08:54,679 --> 00:09:01,000 Speaker 1: record from prescribing antibiotics. Doctors administered them judiciously, hospitals were 136 00:09:01,160 --> 00:09:04,600 Speaker 1: good at preventing infections from spreading from patient to patient, 137 00:09:05,280 --> 00:09:08,360 Speaker 1: and yet more and more people were getting sick with 138 00:09:08,440 --> 00:09:13,120 Speaker 1: a particular type of super bug. Ordinarily, health officials could 139 00:09:13,240 --> 00:09:16,600 Speaker 1: point to the overuse of antibiotics and humans as the cause, 140 00:09:17,480 --> 00:09:21,120 Speaker 1: but in the Netherlands, Young client Monts says it was 141 00:09:21,520 --> 00:09:25,840 Speaker 1: hard to make that connection, and biotic used a humans 142 00:09:25,960 --> 00:09:31,800 Speaker 1: traditionally has been very restricted. We have used, but if 143 00:09:31,800 --> 00:09:35,960 Speaker 1: you look at the European rankings were always at the bottom. 144 00:09:36,120 --> 00:09:40,280 Speaker 1: Dr Klip Monts is a consultant microbiologist and a professor 145 00:09:40,320 --> 00:09:43,439 Speaker 1: of epidemiology at the University of Utrecht in the Netherlands. 146 00:09:44,000 --> 00:09:48,240 Speaker 1: He focuses on healthcare related infections. I was trying to 147 00:09:48,280 --> 00:09:51,800 Speaker 1: find the source of the drug resistant bacteria in his patients. 148 00:09:52,520 --> 00:09:55,560 Speaker 1: It was puzzling because they didn't appear to be getting 149 00:09:55,559 --> 00:09:59,600 Speaker 1: these jams from traveling to a superbug hotspot. It wasn't 150 00:09:59,600 --> 00:10:02,960 Speaker 1: a single bacterium that was the problem, but a gene 151 00:10:03,000 --> 00:10:07,640 Speaker 1: that e coal iron other intestinal bacteria were harboring. That 152 00:10:07,720 --> 00:10:11,640 Speaker 1: gene provides the recipe for an enzyme that destroys most 153 00:10:11,720 --> 00:10:18,280 Speaker 1: penicillin based antibiotics. That enzyme is called extended spectrum beta lactoms. 154 00:10:18,600 --> 00:10:21,679 Speaker 1: Scientists usually referred to it simply as E S b L. 155 00:10:22,320 --> 00:10:26,080 Speaker 1: It made headlines after an elderly woman died from her infection. 156 00:10:26,440 --> 00:10:29,480 Speaker 1: The superbuc E s b l is performed the indoor 157 00:10:29,600 --> 00:10:32,880 Speaker 1: lusting from Scientists had been given something of a tip 158 00:10:32,880 --> 00:10:37,200 Speaker 1: off about a possible source. Years earlier, a toddler in 159 00:10:37,200 --> 00:10:40,440 Speaker 1: the Netherlands tested positive for m R s a mercer 160 00:10:40,640 --> 00:10:46,040 Speaker 1: or methocillin resistant Staphylococcus aureus. It's a very common superbug 161 00:10:46,040 --> 00:10:51,600 Speaker 1: that causes deadly infections, except this child's gam was remarkably different. 162 00:10:52,160 --> 00:10:55,400 Speaker 1: It was resistant to a group of broad spectrum antibiotics 163 00:10:55,440 --> 00:11:00,840 Speaker 1: called tetracycling. This was remarkable because tetracycle clean drugs aren't 164 00:11:00,920 --> 00:11:04,520 Speaker 1: used to treat staph infections in people, but they were 165 00:11:04,640 --> 00:11:08,520 Speaker 1: used in pigs, and the girl's parents were pig farmers. 166 00:11:09,240 --> 00:11:12,800 Speaker 1: When scientists look to see if the same unusual variant 167 00:11:12,920 --> 00:11:15,600 Speaker 1: was in their hogs, they were alarmed to find it 168 00:11:15,640 --> 00:11:20,000 Speaker 1: was there also and in more people. The reason it 169 00:11:20,080 --> 00:11:23,960 Speaker 1: was in the pigs was because swine like most farm animals. 170 00:11:23,960 --> 00:11:28,920 Speaker 1: In the Netherlands, we're getting a lot of antibiotics in animals, 171 00:11:29,240 --> 00:11:34,040 Speaker 1: and bioticus has been high. We were among the higher 172 00:11:34,160 --> 00:11:38,280 Speaker 1: users in Europe. Farmers would give antibiotics to livestock to 173 00:11:38,440 --> 00:11:42,040 Speaker 1: prevent disease and make the animals gain weight faster, and 174 00:11:42,120 --> 00:11:45,080 Speaker 1: for a while the Dutch were doling out more than 175 00:11:45,240 --> 00:11:48,360 Speaker 1: five hundred tons a year of the drugs to animals. 176 00:11:49,040 --> 00:11:52,520 Speaker 1: Professor Client monstercalls a student visiting his lab who culture 177 00:11:52,559 --> 00:11:55,920 Speaker 1: bacteria from meat products. It was meant to be a 178 00:11:56,000 --> 00:11:59,920 Speaker 1: small experiment, but it turned into a survey of hundred 179 00:12:00,040 --> 00:12:03,960 Speaker 1: of fresh chicken, beef, pork, and ground meat samples brought 180 00:12:04,000 --> 00:12:07,880 Speaker 1: from grocery stores in the southern Netherlands. The researchers analyzed 181 00:12:07,960 --> 00:12:12,080 Speaker 1: the DNA fingerprints of SBL jeans and E. Coli specimens 182 00:12:12,080 --> 00:12:15,400 Speaker 1: collected from both patients and meat, and they looked to 183 00:12:15,400 --> 00:12:19,520 Speaker 1: see if there were any genetic similarities. One variant was 184 00:12:19,679 --> 00:12:22,040 Speaker 1: very often silent in chickens, so we call that the 185 00:12:22,200 --> 00:12:26,959 Speaker 1: chicken ees bell. And this variant was found in that 186 00:12:27,400 --> 00:12:30,480 Speaker 1: false woman who died from head. Of all the meat 187 00:12:30,520 --> 00:12:34,280 Speaker 1: types tested for E. S. Bills, poultry had the most. 188 00:12:34,880 --> 00:12:39,400 Speaker 1: In fact, the poultry meat tested harbored these multi drug 189 00:12:39,480 --> 00:12:43,640 Speaker 1: resistant bacteria. The infections of their cause are usually cured 190 00:12:43,679 --> 00:12:47,520 Speaker 1: with the last line antibiotic known as carbon pennum. The 191 00:12:47,600 --> 00:12:50,480 Speaker 1: main concern with E. S. B Ls is that they 192 00:12:50,640 --> 00:12:53,160 Speaker 1: drive up the use of carbon penems, and that in 193 00:12:53,200 --> 00:12:58,160 Speaker 1: turn makes more deadly carbon penem resistant bacteria even more prevalent. 194 00:12:58,920 --> 00:13:01,520 Speaker 1: In the Netherlands, the presence of E. S. B ls 195 00:13:01,520 --> 00:13:06,520 Speaker 1: in bacteria in poultry was growing rapidly, and these germs 196 00:13:06,960 --> 00:13:20,280 Speaker 1: seemed to be spilling over from animals to humans. Thorough 197 00:13:20,280 --> 00:13:24,800 Speaker 1: cooking kills bacteria, but microbs spread in other ways. When 198 00:13:25,000 --> 00:13:29,079 Speaker 1: raw meat comes in contact with chopping boards, cooking utensils, 199 00:13:29,120 --> 00:13:33,000 Speaker 1: and the hands, things bugs can cross contaminate food, such 200 00:13:33,040 --> 00:13:36,640 Speaker 1: as salad. The rising presence of E. S. B l 201 00:13:36,720 --> 00:13:39,680 Speaker 1: s and meat was more bad news for Dutch farmers. 202 00:13:40,400 --> 00:13:44,480 Speaker 1: Around the same time, thousands of people had become sick 203 00:13:44,600 --> 00:13:48,400 Speaker 1: from an unprecedented outbreak of a disease from goats called 204 00:13:48,559 --> 00:13:52,679 Speaker 1: q fever. Coming after the pig mercer. The public had 205 00:13:52,720 --> 00:13:56,439 Speaker 1: become increasingly suspicious of the way farm animals were being 206 00:13:56,440 --> 00:14:01,079 Speaker 1: intensively raised in the Netherlands. The link between antibiodic use 207 00:14:01,120 --> 00:14:07,480 Speaker 1: and chickens and superbugs in people heightened that concern and 208 00:14:07,559 --> 00:14:10,680 Speaker 1: that was I think the game changer and had a 209 00:14:10,760 --> 00:14:15,200 Speaker 1: huge impact, saying that it was clear to the farmers 210 00:14:15,200 --> 00:14:19,920 Speaker 1: that they wouldn't get away with this one. The EU 211 00:14:20,040 --> 00:14:23,240 Speaker 1: banned the use of antibiotics as growth promoters in two 212 00:14:23,320 --> 00:14:27,520 Speaker 1: thousand and six, but in the Netherlands farmers continued to 213 00:14:27,560 --> 00:14:32,080 Speaker 1: administer them anyway, saying they were for therapeutic purposes. But 214 00:14:32,160 --> 00:14:36,280 Speaker 1: the studies implicating antibiotic use on farms in causing hard 215 00:14:36,360 --> 00:14:40,520 Speaker 1: to treat infections and people change that and pretty swiftly. 216 00:14:41,080 --> 00:14:45,040 Speaker 1: Politicians wanted to get farmers to kick their antibiotic habit 217 00:14:45,520 --> 00:14:49,760 Speaker 1: and do it fast, but Christian Abruska, the Netherlands Chief 218 00:14:49,840 --> 00:14:53,760 Speaker 1: veterinary Officer for the past decade, says farmers and veterinarians 219 00:14:53,880 --> 00:14:57,080 Speaker 1: worried how it would affect their incomes and animal welfare. 220 00:14:57,680 --> 00:15:02,400 Speaker 1: Action wasn't happening fast enough, and political pressure was increasing, 221 00:15:02,880 --> 00:15:07,400 Speaker 1: and one day the ministers just declared in the Parliament 222 00:15:07,560 --> 00:15:13,520 Speaker 1: that we would require from the sector to decrease antibiotics 223 00:15:13,600 --> 00:15:22,440 Speaker 1: with then the parliament had emotion and they said now 224 00:15:23,080 --> 00:15:26,960 Speaker 1: is not enough. It should be Dutch farmers realized the 225 00:15:27,080 --> 00:15:31,120 Speaker 1: game was up. The use of antibiotics had become a 226 00:15:31,200 --> 00:15:35,200 Speaker 1: crutch that enabled them to deal with animal health problems 227 00:15:35,240 --> 00:15:39,720 Speaker 1: that would otherwise require changes in animal husbandry. The animal 228 00:15:39,800 --> 00:15:44,800 Speaker 1: feed sector stopped adding antibiotics to prepared fodder. Certain critical 229 00:15:44,840 --> 00:15:49,640 Speaker 1: antibiotics were banned or restricted for veterinary use, and systems 230 00:15:49,680 --> 00:15:52,840 Speaker 1: were put in place to track the amount of antibiotics 231 00:15:52,960 --> 00:15:57,320 Speaker 1: used by each industry and by each farm. The number 232 00:15:57,360 --> 00:16:02,000 Speaker 1: of prescriptions dispensed by veterinarian was counted by an independent 233 00:16:02,040 --> 00:16:07,280 Speaker 1: authority plus Dr Bruska says legislation was introduced to strengthen 234 00:16:07,320 --> 00:16:11,000 Speaker 1: the position of veterinarians. The United States, for a comparison, 235 00:16:11,520 --> 00:16:16,000 Speaker 1: has implemented restrictions too. As of two thousand and seventeen, 236 00:16:16,520 --> 00:16:19,920 Speaker 1: drugs that are important to human health aren't allowed to 237 00:16:19,960 --> 00:16:24,040 Speaker 1: be used for growth promotion or feed efficiency. There are 238 00:16:24,080 --> 00:16:28,600 Speaker 1: signs it's led to a reduction in antibiotic sales. Still, 239 00:16:28,840 --> 00:16:33,080 Speaker 1: the latest date to show injectable antibiotics are used on 240 00:16:33,160 --> 00:16:38,800 Speaker 1: almost nine of US peak farms and of cattle feed lots, 241 00:16:39,120 --> 00:16:42,360 Speaker 1: and the US lacks the level of oversight and control 242 00:16:42,440 --> 00:16:45,920 Speaker 1: that the Netherlands has put in place. For example, a 243 00:16:45,960 --> 00:16:51,400 Speaker 1: farmer has to have one dedicated veterinarian who works on 244 00:16:51,520 --> 00:16:54,640 Speaker 1: his farm, and he's not allowed to have somebody else. 245 00:16:54,680 --> 00:16:58,720 Speaker 1: So a farmer is not allowed to go shopping like 246 00:16:58,960 --> 00:17:01,880 Speaker 1: if I can't get it with my own veterinarian, I'll 247 00:17:01,920 --> 00:17:05,399 Speaker 1: go to somebody else. That's not possible anymore. In just 248 00:17:05,520 --> 00:17:09,240 Speaker 1: a couple of years, the Netherlands managed to reduce by 249 00:17:09,320 --> 00:17:13,480 Speaker 1: half the volume of antibiotics used on farms. That showed 250 00:17:13,560 --> 00:17:18,679 Speaker 1: us that a fifty percent reduction didn't have to be 251 00:17:18,720 --> 00:17:22,520 Speaker 1: the end. It was like the lower hanging fruit, and 252 00:17:22,560 --> 00:17:25,680 Speaker 1: the concerns some of the farmers and veterinarian's voiced about 253 00:17:25,760 --> 00:17:29,399 Speaker 1: the economic and animal health impact also turned out to 254 00:17:29,440 --> 00:17:34,200 Speaker 1: be unfounded. Antibiotic volumes have fallen by two thirds over 255 00:17:34,240 --> 00:17:38,720 Speaker 1: the past decade without any discernible impact on farm economics 256 00:17:38,800 --> 00:17:43,080 Speaker 1: or animal welfare. But more importantly, the superbugs that were 257 00:17:43,080 --> 00:17:46,880 Speaker 1: being detected on poultry mate they have declined to So 258 00:17:47,040 --> 00:17:51,639 Speaker 1: when we started this policy, we hoped that the resistance 259 00:17:51,720 --> 00:17:55,960 Speaker 1: levels wouldn't further increase, But what we've seen is that 260 00:17:56,600 --> 00:18:01,840 Speaker 1: over the years consistently every year the resistance levels go down. 261 00:18:02,240 --> 00:18:05,399 Speaker 1: Surveys have found that about two out of every five 262 00:18:05,480 --> 00:18:09,479 Speaker 1: samples of raw chicken meat bought from Dutch retailers harbor 263 00:18:09,560 --> 00:18:13,919 Speaker 1: these espl producing germs. That's down from four out of 264 00:18:13,960 --> 00:18:18,800 Speaker 1: five samples ten years ago. Professor Young Klipmant says there 265 00:18:18,960 --> 00:18:23,639 Speaker 1: is wide variation across brands, but overall, the policy of 266 00:18:23,720 --> 00:18:26,720 Speaker 1: reducing the use of antibiotics on farms has had a 267 00:18:26,720 --> 00:18:30,840 Speaker 1: beneficial impact and it's sparing the Dutch government to continue 268 00:18:30,840 --> 00:18:34,280 Speaker 1: to look for ways to drive down usage. The Netherlands 269 00:18:34,480 --> 00:18:37,760 Speaker 1: isn't exactly unique or the first to reduce the use 270 00:18:37,800 --> 00:18:42,119 Speaker 1: of antibiotics on farms. Nordic countries where pioneers on this front, 271 00:18:42,480 --> 00:18:45,400 Speaker 1: but still there's a lot of interest from other countries 272 00:18:45,440 --> 00:18:48,480 Speaker 1: about the Dutch experience and what it can teach them. 273 00:18:49,080 --> 00:18:52,159 Speaker 1: Dr Bruska says it's just one example of how the 274 00:18:52,240 --> 00:18:56,040 Speaker 1: drug resistance crisis can be mitigated where there is the 275 00:18:56,080 --> 00:19:09,439 Speaker 1: political will to reduce antibiotic use. Other country are following. France, Germany, 276 00:19:09,480 --> 00:19:13,640 Speaker 1: and the UK have implemented measures to curb antibiotic use 277 00:19:13,720 --> 00:19:17,439 Speaker 1: on farms. In the United States, a five year action 278 00:19:17,480 --> 00:19:21,520 Speaker 1: plan for supporting anti microbial stewardship and Animal Health was 279 00:19:21,560 --> 00:19:25,639 Speaker 1: released twelve months ago, but experts say the country is 280 00:19:25,720 --> 00:19:30,080 Speaker 1: lagging behind. I asked James Johnson, a professor of medicine 281 00:19:30,080 --> 00:19:33,760 Speaker 1: at the University of Minnesota and Minneapolis. He's also an 282 00:19:33,760 --> 00:19:37,840 Speaker 1: infectious disease consultant at the city's Veterans Affairs Medical Center, 283 00:19:38,200 --> 00:19:40,560 Speaker 1: and he's been working in the field for more than 284 00:19:40,640 --> 00:19:44,280 Speaker 1: thirty years. He says there's a dearth of data to 285 00:19:44,400 --> 00:19:48,680 Speaker 1: indicate what role antibodic use on farms is playing in 286 00:19:48,720 --> 00:19:52,480 Speaker 1: the spread of superbugs in people. So there isn't the 287 00:19:52,600 --> 00:19:56,119 Speaker 1: same level of public outcry that led the Netherlands to 288 00:19:56,240 --> 00:20:01,480 Speaker 1: wean its farmers off antibiotics. An absence of data doesn't 289 00:20:01,480 --> 00:20:05,080 Speaker 1: mean an absence of a link, perhaps more reticence to 290 00:20:05,160 --> 00:20:08,399 Speaker 1: study it. This is a challenge in the US. The 291 00:20:08,520 --> 00:20:12,479 Speaker 1: producers have been very good about I would say, stone 292 00:20:12,480 --> 00:20:15,000 Speaker 1: walling and putting out a smoke screen about there's nothing, 293 00:20:15,040 --> 00:20:17,560 Speaker 1: no problem here, farms have nothing to do with it, 294 00:20:17,640 --> 00:20:20,640 Speaker 1: Leave us alone. The evidence just isn't there, and they're 295 00:20:20,680 --> 00:20:23,120 Speaker 1: doing their best to keep anyone from doing the science 296 00:20:23,359 --> 00:20:26,280 Speaker 1: that would be able to answer the questions that would 297 00:20:26,480 --> 00:20:30,560 Speaker 1: lead maybe clarify some of the uncertainty. In the US 298 00:20:30,640 --> 00:20:33,680 Speaker 1: and most parts of the world, it's impossible to know 299 00:20:33,960 --> 00:20:37,920 Speaker 1: exactly where superbugs are coming from, whether it's from drug 300 00:20:37,960 --> 00:20:41,600 Speaker 1: resistance caused by the antibilotics we humans take all the 301 00:20:41,600 --> 00:20:45,080 Speaker 1: ones we give to farm animals. Locating the source of 302 00:20:45,119 --> 00:20:48,840 Speaker 1: these bugs and stopping them from spreading at two of 303 00:20:48,840 --> 00:20:52,480 Speaker 1: the biggest challenges in the fight against anti microbial resistance, 304 00:20:53,119 --> 00:20:56,800 Speaker 1: and time is crucial in this fight. Millions more lives 305 00:20:57,040 --> 00:21:00,159 Speaker 1: are predicted to be lost as a result of superbugs 306 00:21:00,200 --> 00:21:05,000 Speaker 1: in the coming years. Multi drug resistant bacteria and not 307 00:21:05,119 --> 00:21:09,400 Speaker 1: only claiming lives through vicious infections, but making treatments such 308 00:21:09,440 --> 00:21:15,919 Speaker 1: as chemotherapy even riskier. In countries like India, cancer patients 309 00:21:15,960 --> 00:21:18,840 Speaker 1: are dying from infections as a result of their chemo. 310 00:21:19,880 --> 00:21:24,600 Speaker 1: These tragic cases could soon become common in more countries. 311 00:21:25,600 --> 00:21:29,680 Speaker 1: I have predicted for some years now we would get 312 00:21:29,720 --> 00:21:32,800 Speaker 1: to the point where doctors would be saying to cancer patients, 313 00:21:33,320 --> 00:21:35,879 Speaker 1: m I could cure your cancer, but you'll get an 314 00:21:35,960 --> 00:21:39,439 Speaker 1: infection that might kill you. In some parts of the world, 315 00:21:39,480 --> 00:21:43,440 Speaker 1: as as you have heard, that is becoming a reality 316 00:21:43,880 --> 00:21:46,760 Speaker 1: because we all carry bacteria in our guts and some 317 00:21:46,920 --> 00:21:51,560 Speaker 1: of them may well be resistant to standard treatments, but 318 00:21:51,680 --> 00:21:55,800 Speaker 1: we can stop that happening. We can get new antibiotics 319 00:21:55,920 --> 00:21:59,320 Speaker 1: if we only invest in the pipeline. This is Professor 320 00:21:59,320 --> 00:22:02,760 Speaker 1: Sally dave Yes. She leads her post as the UK's 321 00:22:02,800 --> 00:22:06,160 Speaker 1: Chief Medical Officer at the end of September, but she'll 322 00:22:06,240 --> 00:22:09,960 Speaker 1: continued to tackle the global problem as her government's Special 323 00:22:10,119 --> 00:22:15,040 Speaker 1: Envoy on anti microbial resistance. Dames Sally says there's also 324 00:22:15,119 --> 00:22:18,720 Speaker 1: a financial cost to the rise of superbugs. The global 325 00:22:18,760 --> 00:22:23,280 Speaker 1: economy is predicted to lose one hundred trillion dollars in 326 00:22:23,440 --> 00:22:28,560 Speaker 1: economic output by But despite the lives at stake and 327 00:22:28,600 --> 00:22:34,000 Speaker 1: the devastating effect anti microbial resistance could have on the economy, 328 00:22:34,240 --> 00:22:38,320 Speaker 1: Dames Sally is optimistic about our ability to beat back superbugs. 329 00:22:43,600 --> 00:22:47,119 Speaker 1: A review her government commissioned three years ago found the 330 00:22:47,200 --> 00:22:51,880 Speaker 1: calamity could be avoided, but it requires spending forty two 331 00:22:51,880 --> 00:22:55,000 Speaker 1: billion dollars over a decade on new medical and pharmaceutical 332 00:22:55,040 --> 00:22:59,560 Speaker 1: tools and promoting ways to curb antibiotic use. That's a 333 00:22:59,600 --> 00:23:02,600 Speaker 1: frak of the amount spent rescuing banks during the global 334 00:23:02,680 --> 00:23:06,600 Speaker 1: financial crisis. The return on investment is clear. If we 335 00:23:06,680 --> 00:23:10,480 Speaker 1: invest now in infection prevention control. If we invest now 336 00:23:10,520 --> 00:23:14,760 Speaker 1: in better diagnostics, if we invest now in new treatments, 337 00:23:14,880 --> 00:23:18,600 Speaker 1: it will pay off dramatically, not just in human lives 338 00:23:18,600 --> 00:23:22,960 Speaker 1: and suffering, but actually in keeping our hospitals open and 339 00:23:23,160 --> 00:23:26,760 Speaker 1: working so that we can look after patients. A crucial 340 00:23:26,840 --> 00:23:30,600 Speaker 1: peace of that financing, she says, needs to go toward 341 00:23:30,720 --> 00:23:35,200 Speaker 1: developing new antibiotics and other treatments. And when I talked 342 00:23:35,280 --> 00:23:38,480 Speaker 1: to the experts, it was absolutely clear they could all 343 00:23:38,640 --> 00:23:42,320 Speaker 1: articulate the problem, but none of them could see a 344 00:23:42,400 --> 00:23:45,560 Speaker 1: way through that problem. And for them, the amounts of 345 00:23:45,600 --> 00:23:49,960 Speaker 1: money seemed immense, whereas we know, compared with what was 346 00:23:50,040 --> 00:23:53,280 Speaker 1: given to banks to bail them out, or what's spent 347 00:23:53,600 --> 00:23:59,520 Speaker 1: on making a blockbuster film, it is not immense. It 348 00:23:59,720 --> 00:24:03,840 Speaker 1: is proportionate, and the life saves could be amazing. So 349 00:24:03,880 --> 00:24:06,560 Speaker 1: I thought someone needed to take some action, and I 350 00:24:06,720 --> 00:24:12,320 Speaker 1: decided to push our government to take action. Dames Sally 351 00:24:12,440 --> 00:24:15,400 Speaker 1: says there's been progress, but we can't afford to lose 352 00:24:15,440 --> 00:24:19,600 Speaker 1: the momentum. In England, anti bider use on farms as 353 00:24:19,800 --> 00:24:26,320 Speaker 1: decreased in four years. Internationally, drug resistance is being discussed 354 00:24:26,320 --> 00:24:29,800 Speaker 1: by world leaders, including at the United Nations General Assembly. 355 00:24:30,520 --> 00:24:34,960 Speaker 1: Countries are developing national action plans and more money is 356 00:24:35,000 --> 00:24:39,720 Speaker 1: being spent on fighting anti microbial resistance. What's more, the 357 00:24:39,840 --> 00:24:44,679 Speaker 1: crisis is garnering media attention that's raising the alarm that 358 00:24:44,800 --> 00:24:49,159 Speaker 1: people everywhere are dying from infections once cured with a 359 00:24:49,200 --> 00:24:54,000 Speaker 1: handful of pills and Dames Sally says, public outrage over 360 00:24:54,040 --> 00:24:57,920 Speaker 1: the spread of superbugs will motivate governments to do more 361 00:24:58,000 --> 00:25:01,479 Speaker 1: to tackle this global threat. I believe we can get 362 00:25:01,640 --> 00:25:05,080 Speaker 1: on top of this, and there are good signs. We 363 00:25:05,240 --> 00:25:09,760 Speaker 1: know that it's a natural phenomenon for effective organisms to 364 00:25:09,960 --> 00:25:13,840 Speaker 1: develop resistance and then they multiply. So what we have 365 00:25:14,000 --> 00:25:19,160 Speaker 1: to do is use much less of the anti infected 366 00:25:19,359 --> 00:25:33,480 Speaker 1: the antibiotics for bacteria. Just as superbugs have adapted to 367 00:25:33,720 --> 00:25:37,400 Speaker 1: our treatments, we have to find new ways to adapt 368 00:25:37,400 --> 00:25:41,400 Speaker 1: to their resistance. Maybe it's doing work like Bill Gates, 369 00:25:41,960 --> 00:25:46,080 Speaker 1: the Microsoft co founder, is investing in waterless toilets to 370 00:25:46,200 --> 00:25:50,679 Speaker 1: stop spreading bacteria through sewage, or its hospitals like the 371 00:25:50,720 --> 00:25:54,439 Speaker 1: Austin in Melbourne, where doctors are using simple practices that 372 00:25:54,480 --> 00:25:57,840 Speaker 1: went out of style as we became more reliant on antibiotics. 373 00:25:58,760 --> 00:26:01,920 Speaker 1: Now the Austin uses bleached to clean and kill superbugs 374 00:26:02,400 --> 00:26:07,320 Speaker 1: and isolates patients harboring them. In the age of evolving superbugs, 375 00:26:07,800 --> 00:26:46,480 Speaker 1: we have to evolve too. And that's it for this 376 00:26:46,520 --> 00:26:49,879 Speaker 1: season of Prognosis. Thanks so much for listening. Do you 377 00:26:49,880 --> 00:26:51,840 Speaker 1: have a story about healthcare in the US or around 378 00:26:51,840 --> 00:26:54,359 Speaker 1: the world we want to hear from you. Find me 379 00:26:54,400 --> 00:26:57,840 Speaker 1: on Twitter at p Cortes or email m Cortes at 380 00:26:57,840 --> 00:27:00,720 Speaker 1: Bloomberg dot net. If you were a fan of this episode, 381 00:27:00,960 --> 00:27:03,360 Speaker 1: please take a moment to rate and review us. It 382 00:27:03,400 --> 00:27:06,560 Speaker 1: really helps new listeners find the show, and don't forget 383 00:27:06,600 --> 00:27:11,119 Speaker 1: to subscribe. This episode was produced by Top Foreheads. Our 384 00:27:11,160 --> 00:27:14,480 Speaker 1: story editor was Rick Shine. Special thanks to Drew Armstrong. 385 00:27:14,680 --> 00:27:18,800 Speaker 1: Our healthcare team leader, Francesca Levi, is head of Bloomberg Podcasts. 386 00:27:19,400 --> 00:27:22,080 Speaker 1: We'll be back with a new episode soon, but until then, 387 00:27:22,320 --> 00:27:23,760 Speaker 1: you can see what our health team is up to 388 00:27:24,000 --> 00:27:28,680 Speaker 1: by going to www dot Bloomberg dot com slash Prognosis. 389 00:27:29,280 --> 00:27:29,840 Speaker 1: See you soon.