Speaker 1: That's saying we are what we eat. Well, there's truth
Speaker 1: to it. We ingest bacteria constantly when we're eating and
Speaker 1: drinking our stomach acid helps bend off disease causing germs,
Speaker 1: but bugs often make it through to the intestines. They
Speaker 1: can become established as part of our normal gut Bacteria,
Speaker 1: the microbes that help digest food, make vitamins, and support
Speaker 1: the immune system. Increasingly, the bugs taking up residents in
Speaker 1: our intestines possess special powers. They're developing resistance to antibiotics,
Speaker 1: in large part because of the overuse of those medicines.
Speaker 1: The risk of harboring drug evading bowel dwelling bacteria varies
Speaker 1: from country to country depending on where we travel. We
Speaker 1: can return from a trip with some unwanted guests. Sometimes
Speaker 1: the threat is right on our our step. Welcome to Prognosis,
Speaker 1: a podcast about health and science, medical technology, and the
Speaker 1: changes that are underway across the globe. I'm your host,
Speaker 1: Michelle fay Cortes. This season, we've been focusing on the
Speaker 1: loss of our infection fighting medications because of antimicrobial resistance,
Speaker 1: and we've been exploring how we can find new ways
Speaker 1: to battle the crisis. In this final episode, Bloomberg's Jason
Speaker 1: Gale takes us to Copenhagen to investigate an unlikely way
Speaker 1: researchers are tracking this problem. He looks at what happened
Speaker 1: when one country found the threat lurked in refrigerators and
Speaker 1: on countertops and took bold action to stop superbugs at
Speaker 1: their source. And he hears from Dame Sally Davies, England's
Speaker 1: top medical advisor, about why she's optimistic that we can
Speaker 1: mitigate the global superbug crisis. Here's Jason helpful. Authorities have
Speaker 1: been warning for years that the world is losing its
Speaker 1: most precious weapons against bacterial infections because of antibiotic resistance.
Speaker 1: Around seven hundred thousand people worldwide diannually as a consequence
Speaker 1: of superbugs. That number is predicted to climb to ten
Speaker 1: million by and one of the biggest challenges researchers have
Speaker 1: faced is tracking their spread outside of hospitals, carried around
Speaker 1: in the digestive tracks of healthy people. First of all,
Speaker 1: we have always at this need of doing a global
Speaker 1: monitoring offensive acropal assistance. It's basically that if you don't
Speaker 1: know where you are, you have no clue where you're going.
Speaker 1: That's Frank Austro. He's a professor at the Technical University
Speaker 1: of Denmark and heads the Reference Laboratory on anti microbial
Speaker 1: resistance for the European Union, the World Health Organization and
Speaker 1: the Food and Agriculture Organization of the United Nations. He's
Speaker 1: been studying the rise of superbugs for almost twenty five
Speaker 1: years with his team in Copenhagen. One of Professor Austri's
Speaker 1: goals is being figuring out how to get around this
Speaker 1: global tracking problem. The biggest issue, he says, is acquiring
Speaker 1: samples that are representative of large numbers of people. When
Speaker 1: he says samples by the way, he means human feces.
Speaker 1: To do global monitoring, well, that's requires that you go
Speaker 1: out and get samples from other countries and that can
Speaker 1: actually be associated with a lot of time delays and
Speaker 1: problems logistics. Until recently, researches can only grasp the superbug
Speaker 1: problem by the infections hospital patients get. But that's an
Speaker 1: incomplete picture because healthy people also have a multi drug
Speaker 1: resistant germs in their digestive tracks. Because when it comes
Speaker 1: to resistance, it is really a silent epidemics where it
Speaker 1: is spreading in that the normal god flora is spreading
Speaker 1: between you know, healthy people, and then it's only occasionally
Speaker 1: that if you see it's a upping up in the
Speaker 1: clinicalized relates in the critical sick people. So if you're
Speaker 1: only monitoring critically sick people at hospitals, then we are
Speaker 1: really missing what is actually happening in the population as
Speaker 1: a whole, where most of the evolution probably is taking place.
Speaker 1: Said Professor a Strap. Had a two pronged problem. He
Speaker 1: needed samples from across the world, and samples not just
Speaker 1: from sick people. So we were a little bit of
Speaker 1: frustrated to say, okay, how could we in an easy
Speaker 1: way obtain samples from all around the world. Then it
Speaker 1: dawned on him. Airplane waste tanks are repositories of a
Speaker 1: pulled sample of fickle bacteria, and the specimens can be
Speaker 1: tested in real time and can't be traced back to
Speaker 1: their original donors, so there's no need to get permission
Speaker 1: or ethics approval. It was something of a light bulb
Speaker 1: moment for Professor Austrap. Oh wow, couldn't just be a
Speaker 1: way of actually doing monitory So you could be sitting
Speaker 1: here in Copenhagen and then just let all the samples
Speaker 1: come to you. So I simply pick up the phone
Speaker 1: and give a call to airport and Copenhagen and said,
Speaker 1: do you know anyone that's taken care of the toilet
Speaker 1: waist there? And I think that was Friday. Friday morning
Speaker 1: I called, and Friday afternoon we had a meeting and
Speaker 1: then they said, okay, well that's that sounds cool. Let's
Speaker 1: let's go ahead. Professor Alster looked for flights long enough
Speaker 1: to a mass sufficient testing material, and he settled on
Speaker 1: studying the raw sewage from eighteen long haul flights arriving
Speaker 1: in Copenhagen from nine cities across three regions. The results
Speaker 1: were pretty consistent among flights from each region. In general,
Speaker 1: planes arriving from Asia carried more drug resistant bacteria. The
Speaker 1: biggest surprise was this a vague clear peasant and also
Speaker 1: that there was more resistance than we had expected. There
Speaker 1: was a very very clear patent at where we had
Speaker 1: most resistance. That was in South Asia, then a little
Speaker 1: bit less in Northern Asia, and then the lowest occurrence
Speaker 1: of resistance was actually in flights coming in from North America.
Speaker 1: The results were published in a scientific journal over four
Speaker 1: years ago. It was just the start of Professor A.
Speaker 1: Strops work on this global superbug tracking system. Based on
Speaker 1: the positive results of the long distance flights and our
Speaker 1: results there, but then we decided to go out and
Speaker 1: collect sewage from from cities around the world. Next, Professor A.
Speaker 1: Strop sent out a request to collaborators around the world
Speaker 1: asking for samples of raw sewage. He was delivered sludge
Speaker 1: from the sewers of seventy cities in sixty countries. Once again,
Speaker 1: he looked for drug resistance genes carried by bacteria. It
Speaker 1: gave him an even better idea of how superbugs were
Speaker 1: spread out across the planet. We are purified to d
Speaker 1: in the sequence data and analyze the data and try
Speaker 1: to look at, okay, what is the patterns of antimicrob
Speaker 1: resistance around the world, and basically to a large the center,
Speaker 1: verifying also what we saw and expanding on what we
Speaker 1: saw in our long distance flights study, we could see
Speaker 1: that there was a very last difference in occurrence of
Speaker 1: resistance around the world. Those results were published in March.
Speaker 1: They showed the globe can be divided into two basic
Speaker 1: groups based on their superbugs. There's Africa, South America and
Speaker 1: Asia that's like one group, and then there's a North America, Europe,
Speaker 1: and you see Land Australia in another group. And that
Speaker 1: there was a little bit of a surprise for us
Speaker 1: that we have this clear separation in the diversity and
Speaker 1: prevalence of resistance around the world. It was already known
Speaker 1: that antibiotic use drives drug resistance, but Professor Alsto discovered
Speaker 1: something else. The main explanation in terms of occurrence of
Speaker 1: resistance that is, apparently it's related to sanitation. So how
Speaker 1: good is your sensation system, your how much do you
Speaker 1: wasted your sewage system, the health system and how well
Speaker 1: that is functioning, and then actually also parameters related to education.
Speaker 1: So we're a little bit surprisedful this because I've really
Speaker 1: learned that it is all about use of antimcrobial agents,
Speaker 1: but it seems to be that artifacts was also play
Speaker 1: a large role here. Professor Alstrop gave researchers a better
Speaker 1: idea of how superbugs spread around the world. But once
Speaker 1: you know where they are and where they're going, what
Speaker 1: can a country do about it? One answer is in
Speaker 1: the Netherlands, a little over a decade ago, the Netherlands
Speaker 1: faxed and intriguing but worrying problem. Famous for its windmills
Speaker 1: and eat um cheese, the country had a pristine track
Speaker 1: record from prescribing antibiotics. Doctors administered them judiciously, hospitals were
Speaker 1: good at preventing infections from spreading from patient to patient,
Speaker 1: and yet more and more people were getting sick with
Speaker 1: a particular type of super bug. Ordinarily, health officials could
Speaker 1: point to the overuse of antibiotics and humans as the cause,
Speaker 1: but in the Netherlands, Young client Monts says it was
Speaker 1: hard to make that connection, and biotic used a humans
Speaker 1: traditionally has been very restricted. We have used, but if
Speaker 1: you look at the European rankings were always at the bottom.
Speaker 1: Dr Klip Monts is a consultant microbiologist and a professor
Speaker 1: of epidemiology at the University of Utrecht in the Netherlands.
Speaker 1: He focuses on healthcare related infections. I was trying to
Speaker 1: find the source of the drug resistant bacteria in his patients.
Speaker 1: It was puzzling because they didn't appear to be getting
Speaker 1: these jams from traveling to a superbug hotspot. It wasn't
Speaker 1: a single bacterium that was the problem, but a gene
Speaker 1: that e coal iron other intestinal bacteria were harboring. That
Speaker 1: gene provides the recipe for an enzyme that destroys most
Speaker 1: penicillin based antibiotics. That enzyme is called extended spectrum beta lactoms.
Speaker 1: Scientists usually referred to it simply as E S b L.
Speaker 1: It made headlines after an elderly woman died from her infection.
Speaker 1: The superbuc E s b l is performed the indoor
Speaker 1: lusting from Scientists had been given something of a tip
Speaker 1: off about a possible source. Years earlier, a toddler in
Speaker 1: the Netherlands tested positive for m R s a mercer
Speaker 1: or methocillin resistant Staphylococcus aureus. It's a very common superbug
Speaker 1: that causes deadly infections, except this child's gam was remarkably different.
Speaker 1: It was resistant to a group of broad spectrum antibiotics
Speaker 1: called tetracycling. This was remarkable because tetracycle clean drugs aren't
Speaker 1: used to treat staph infections in people, but they were
Speaker 1: used in pigs, and the girl's parents were pig farmers.
Speaker 1: When scientists look to see if the same unusual variant
Speaker 1: was in their hogs, they were alarmed to find it
Speaker 1: was there also and in more people. The reason it
Speaker 1: was in the pigs was because swine like most farm animals.
Speaker 1: In the Netherlands, we're getting a lot of antibiotics in animals,
Speaker 1: and bioticus has been high. We were among the higher
Speaker 1: users in Europe. Farmers would give antibiotics to livestock to
Speaker 1: prevent disease and make the animals gain weight faster, and
Speaker 1: for a while the Dutch were doling out more than
Speaker 1: five hundred tons a year of the drugs to animals.
Speaker 1: Professor Client monstercalls a student visiting his lab who culture
Speaker 1: bacteria from meat products. It was meant to be a
Speaker 1: small experiment, but it turned into a survey of hundred
Speaker 1: of fresh chicken, beef, pork, and ground meat samples brought
Speaker 1: from grocery stores in the southern Netherlands. The researchers analyzed
Speaker 1: the DNA fingerprints of SBL jeans and E. Coli specimens
Speaker 1: collected from both patients and meat, and they looked to
Speaker 1: see if there were any genetic similarities. One variant was
Speaker 1: very often silent in chickens, so we call that the
Speaker 1: chicken ees bell. And this variant was found in that
Speaker 1: false woman who died from head. Of all the meat
Speaker 1: types tested for E. S. Bills, poultry had the most.
Speaker 1: In fact, the poultry meat tested harbored these multi drug
Speaker 1: resistant bacteria. The infections of their cause are usually cured
Speaker 1: with the last line antibiotic known as carbon pennum. The
Speaker 1: main concern with E. S. B Ls is that they
Speaker 1: drive up the use of carbon penems, and that in
Speaker 1: turn makes more deadly carbon penem resistant bacteria even more prevalent.
Speaker 1: In the Netherlands, the presence of E. S. B ls
Speaker 1: in bacteria in poultry was growing rapidly, and these germs
Speaker 1: seemed to be spilling over from animals to humans. Thorough
Speaker 1: cooking kills bacteria, but microbs spread in other ways. When
Speaker 1: raw meat comes in contact with chopping boards, cooking utensils,
Speaker 1: and the hands, things bugs can cross contaminate food, such
Speaker 1: as salad. The rising presence of E. S. B l
Speaker 1: s and meat was more bad news for Dutch farmers.
Speaker 1: Around the same time, thousands of people had become sick
Speaker 1: from an unprecedented outbreak of a disease from goats called
Speaker 1: q fever. Coming after the pig mercer. The public had
Speaker 1: become increasingly suspicious of the way farm animals were being
Speaker 1: intensively raised in the Netherlands. The link between antibiodic use
Speaker 1: and chickens and superbugs in people heightened that concern and
Speaker 1: that was I think the game changer and had a
Speaker 1: huge impact, saying that it was clear to the farmers
Speaker 1: that they wouldn't get away with this one. The EU
Speaker 1: banned the use of antibiotics as growth promoters in two
Speaker 1: thousand and six, but in the Netherlands farmers continued to
Speaker 1: administer them anyway, saying they were for therapeutic purposes. But
Speaker 1: the studies implicating antibiotic use on farms in causing hard
Speaker 1: to treat infections and people change that and pretty swiftly.
Speaker 1: Politicians wanted to get farmers to kick their antibiotic habit
Speaker 1: and do it fast, but Christian Abruska, the Netherlands Chief
Speaker 1: veterinary Officer for the past decade, says farmers and veterinarians
Speaker 1: worried how it would affect their incomes and animal welfare.
Speaker 1: Action wasn't happening fast enough, and political pressure was increasing,
Speaker 1: and one day the ministers just declared in the Parliament
Speaker 1: that we would require from the sector to decrease antibiotics
Speaker 1: with then the parliament had emotion and they said now
Speaker 1: is not enough. It should be Dutch farmers realized the
Speaker 1: game was up. The use of antibiotics had become a
Speaker 1: crutch that enabled them to deal with animal health problems
Speaker 1: that would otherwise require changes in animal husbandry. The animal
Speaker 1: feed sector stopped adding antibiotics to prepared fodder. Certain critical
Speaker 1: antibiotics were banned or restricted for veterinary use, and systems
Speaker 1: were put in place to track the amount of antibiotics
Speaker 1: used by each industry and by each farm. The number
Speaker 1: of prescriptions dispensed by veterinarian was counted by an independent
Speaker 1: authority plus Dr Bruska says legislation was introduced to strengthen
Speaker 1: the position of veterinarians. The United States, for a comparison,
Speaker 1: has implemented restrictions too. As of two thousand and seventeen,
Speaker 1: drugs that are important to human health aren't allowed to
Speaker 1: be used for growth promotion or feed efficiency. There are
Speaker 1: signs it's led to a reduction in antibiotic sales. Still,
Speaker 1: the latest date to show injectable antibiotics are used on
Speaker 1: almost nine of US peak farms and of cattle feed lots,
Speaker 1: and the US lacks the level of oversight and control
Speaker 1: that the Netherlands has put in place. For example, a
Speaker 1: farmer has to have one dedicated veterinarian who works on
Speaker 1: his farm, and he's not allowed to have somebody else.
Speaker 1: So a farmer is not allowed to go shopping like
Speaker 1: if I can't get it with my own veterinarian, I'll
Speaker 1: go to somebody else. That's not possible anymore. In just
Speaker 1: a couple of years, the Netherlands managed to reduce by
Speaker 1: half the volume of antibiotics used on farms. That showed
Speaker 1: us that a fifty percent reduction didn't have to be
Speaker 1: the end. It was like the lower hanging fruit, and
Speaker 1: the concerns some of the farmers and veterinarian's voiced about
Speaker 1: the economic and animal health impact also turned out to
Speaker 1: be unfounded. Antibiotic volumes have fallen by two thirds over
Speaker 1: the past decade without any discernible impact on farm economics
Speaker 1: or animal welfare. But more importantly, the superbugs that were
Speaker 1: being detected on poultry mate they have declined to So
Speaker 1: when we started this policy, we hoped that the resistance
Speaker 1: levels wouldn't further increase, But what we've seen is that
Speaker 1: over the years consistently every year the resistance levels go down.
Speaker 1: Surveys have found that about two out of every five
Speaker 1: samples of raw chicken meat bought from Dutch retailers harbor
Speaker 1: these espl producing germs. That's down from four out of
Speaker 1: five samples ten years ago. Professor Young Klipmant says there
Speaker 1: is wide variation across brands, but overall, the policy of
Speaker 1: reducing the use of antibiotics on farms has had a
Speaker 1: beneficial impact and it's sparing the Dutch government to continue
Speaker 1: to look for ways to drive down usage. The Netherlands
Speaker 1: isn't exactly unique or the first to reduce the use
Speaker 1: of antibiotics on farms. Nordic countries where pioneers on this front,
Speaker 1: but still there's a lot of interest from other countries
Speaker 1: about the Dutch experience and what it can teach them.
Speaker 1: Dr Bruska says it's just one example of how the
Speaker 1: drug resistance crisis can be mitigated where there is the
Speaker 1: political will to reduce antibiotic use. Other country are following. France, Germany,
Speaker 1: and the UK have implemented measures to curb antibiotic use
Speaker 1: on farms. In the United States, a five year action
Speaker 1: plan for supporting anti microbial stewardship and Animal Health was
Speaker 1: released twelve months ago, but experts say the country is
Speaker 1: lagging behind. I asked James Johnson, a professor of medicine
Speaker 1: at the University of Minnesota and Minneapolis. He's also an
Speaker 1: infectious disease consultant at the city's Veterans Affairs Medical Center,
Speaker 1: and he's been working in the field for more than
Speaker 1: thirty years. He says there's a dearth of data to
Speaker 1: indicate what role antibodic use on farms is playing in
Speaker 1: the spread of superbugs in people. So there isn't the
Speaker 1: same level of public outcry that led the Netherlands to
Speaker 1: wean its farmers off antibiotics. An absence of data doesn't
Speaker 1: mean an absence of a link, perhaps more reticence to
Speaker 1: study it. This is a challenge in the US. The
Speaker 1: producers have been very good about I would say, stone
Speaker 1: walling and putting out a smoke screen about there's nothing,
Speaker 1: no problem here, farms have nothing to do with it,
Speaker 1: Leave us alone. The evidence just isn't there, and they're
Speaker 1: doing their best to keep anyone from doing the science
Speaker 1: that would be able to answer the questions that would
Speaker 1: lead maybe clarify some of the uncertainty. In the US
Speaker 1: and most parts of the world, it's impossible to know
Speaker 1: exactly where superbugs are coming from, whether it's from drug
Speaker 1: resistance caused by the antibilotics we humans take all the
Speaker 1: ones we give to farm animals. Locating the source of
Speaker 1: these bugs and stopping them from spreading at two of
Speaker 1: the biggest challenges in the fight against anti microbial resistance,
Speaker 1: and time is crucial in this fight. Millions more lives
Speaker 1: are predicted to be lost as a result of superbugs
Speaker 1: in the coming years. Multi drug resistant bacteria and not
Speaker 1: only claiming lives through vicious infections, but making treatments such
Speaker 1: as chemotherapy even riskier. In countries like India, cancer patients
Speaker 1: are dying from infections as a result of their chemo.
Speaker 1: These tragic cases could soon become common in more countries.
Speaker 1: I have predicted for some years now we would get
Speaker 1: to the point where doctors would be saying to cancer patients,
Speaker 1: m I could cure your cancer, but you'll get an
Speaker 1: infection that might kill you. In some parts of the world,
Speaker 1: as as you have heard, that is becoming a reality
Speaker 1: because we all carry bacteria in our guts and some
Speaker 1: of them may well be resistant to standard treatments, but
Speaker 1: we can stop that happening. We can get new antibiotics
Speaker 1: if we only invest in the pipeline. This is Professor
Speaker 1: Sally dave Yes. She leads her post as the UK's
Speaker 1: Chief Medical Officer at the end of September, but she'll
Speaker 1: continued to tackle the global problem as her government's Special
Speaker 1: Envoy on anti microbial resistance. Dames Sally says there's also
Speaker 1: a financial cost to the rise of superbugs. The global
Speaker 1: economy is predicted to lose one hundred trillion dollars in
Speaker 1: economic output by But despite the lives at stake and
Speaker 1: the devastating effect anti microbial resistance could have on the economy,
Speaker 1: Dames Sally is optimistic about our ability to beat back superbugs.
Speaker 1: A review her government commissioned three years ago found the
Speaker 1: calamity could be avoided, but it requires spending forty two
Speaker 1: billion dollars over a decade on new medical and pharmaceutical
Speaker 1: tools and promoting ways to curb antibiotic use. That's a
Speaker 1: frak of the amount spent rescuing banks during the global
Speaker 1: financial crisis. The return on investment is clear. If we
Speaker 1: invest now in infection prevention control. If we invest now
Speaker 1: in better diagnostics, if we invest now in new treatments,
Speaker 1: it will pay off dramatically, not just in human lives
Speaker 1: and suffering, but actually in keeping our hospitals open and
Speaker 1: working so that we can look after patients. A crucial
Speaker 1: peace of that financing, she says, needs to go toward
Speaker 1: developing new antibiotics and other treatments. And when I talked
Speaker 1: to the experts, it was absolutely clear they could all
Speaker 1: articulate the problem, but none of them could see a
Speaker 1: way through that problem. And for them, the amounts of
Speaker 1: money seemed immense, whereas we know, compared with what was
Speaker 1: given to banks to bail them out, or what's spent
Speaker 1: on making a blockbuster film, it is not immense. It
Speaker 1: is proportionate, and the life saves could be amazing. So
Speaker 1: I thought someone needed to take some action, and I
Speaker 1: decided to push our government to take action. Dames Sally
Speaker 1: says there's been progress, but we can't afford to lose
Speaker 1: the momentum. In England, anti bider use on farms as
Speaker 1: decreased in four years. Internationally, drug resistance is being discussed
Speaker 1: by world leaders, including at the United Nations General Assembly.
Speaker 1: Countries are developing national action plans and more money is
Speaker 1: being spent on fighting anti microbial resistance. What's more, the
Speaker 1: crisis is garnering media attention that's raising the alarm that
Speaker 1: people everywhere are dying from infections once cured with a
Speaker 1: handful of pills and Dames Sally says, public outrage over
Speaker 1: the spread of superbugs will motivate governments to do more
Speaker 1: to tackle this global threat. I believe we can get
Speaker 1: on top of this, and there are good signs. We
Speaker 1: know that it's a natural phenomenon for effective organisms to
Speaker 1: develop resistance and then they multiply. So what we have
Speaker 1: to do is use much less of the anti infected
Speaker 1: the antibiotics for bacteria. Just as superbugs have adapted to
Speaker 1: our treatments, we have to find new ways to adapt
Speaker 1: to their resistance. Maybe it's doing work like Bill Gates,
Speaker 1: the Microsoft co founder, is investing in waterless toilets to
Speaker 1: stop spreading bacteria through sewage, or its hospitals like the
Speaker 1: Austin in Melbourne, where doctors are using simple practices that
Speaker 1: went out of style as we became more reliant on antibiotics.
Speaker 1: Now the Austin uses bleached to clean and kill superbugs
Speaker 1: and isolates patients harboring them. In the age of evolving superbugs,
Speaker 1: we have to evolve too. And that's it for this
Speaker 1: season of Prognosis. Thanks so much for listening. Do you
Speaker 1: have a story about healthcare in the US or around
Speaker 1: the world we want to hear from you. Find me
Speaker 1: on Twitter at p Cortes or email m Cortes at
Speaker 1: Bloomberg dot net. If you were a fan of this episode,
Speaker 1: please take a moment to rate and review us. It
Speaker 1: really helps new listeners find the show, and don't forget
Speaker 1: to subscribe. This episode was produced by Top Foreheads. Our
Speaker 1: story editor was Rick Shine. Special thanks to Drew Armstrong.
Speaker 1: Our healthcare team leader, Francesca Levi, is head of Bloomberg Podcasts.
Speaker 1: We'll be back with a new episode soon, but until then,
Speaker 1: you can see what our health team is up to
Speaker 1: by going to www dot Bloomberg dot com slash Prognosis.
Speaker 1: See you soon.