WEBVTT - Fighting Back Against Killer Superbugs 0:00:10.560 --> 0:00:14.160 That's saying we are what we eat. Well, there's truth 0:00:14.200 --> 0:00:17.840 to it. We ingest bacteria constantly when we're eating and 0:00:17.920 --> 0:00:21.759 drinking our stomach acid helps bend off disease causing germs, 0:00:22.079 --> 0:00:25.480 but bugs often make it through to the intestines. They 0:00:25.480 --> 0:00:28.320 can become established as part of our normal gut Bacteria, 0:00:28.840 --> 0:00:32.440 the microbes that help digest food, make vitamins, and support 0:00:32.479 --> 0:00:36.760 the immune system. Increasingly, the bugs taking up residents in 0:00:36.800 --> 0:00:42.720 our intestines possess special powers. They're developing resistance to antibiotics, 0:00:43.200 --> 0:00:45.840 in large part because of the overuse of those medicines. 0:00:46.880 --> 0:00:50.640 The risk of harboring drug evading bowel dwelling bacteria varies 0:00:50.760 --> 0:00:54.200 from country to country depending on where we travel. We 0:00:54.240 --> 0:00:58.440 can return from a trip with some unwanted guests. Sometimes 0:00:58.680 --> 0:01:05.680 the threat is right on our our step. Welcome to Prognosis, 0:01:05.920 --> 0:01:09.360 a podcast about health and science, medical technology, and the 0:01:09.480 --> 0:01:12.680 changes that are underway across the globe. I'm your host, 0:01:12.840 --> 0:01:17.120 Michelle fay Cortes. This season, we've been focusing on the 0:01:17.160 --> 0:01:21.360 loss of our infection fighting medications because of antimicrobial resistance, 0:01:22.000 --> 0:01:24.279 and we've been exploring how we can find new ways 0:01:24.319 --> 0:01:28.600 to battle the crisis. In this final episode, Bloomberg's Jason 0:01:28.640 --> 0:01:32.200 Gale takes us to Copenhagen to investigate an unlikely way 0:01:32.280 --> 0:01:35.959 researchers are tracking this problem. He looks at what happened 0:01:35.959 --> 0:01:38.959 when one country found the threat lurked in refrigerators and 0:01:39.040 --> 0:01:43.040 on countertops and took bold action to stop superbugs at 0:01:43.080 --> 0:01:47.800 their source. And he hears from Dame Sally Davies, England's 0:01:47.840 --> 0:01:51.200 top medical advisor, about why she's optimistic that we can 0:01:51.200 --> 0:01:58.760 mitigate the global superbug crisis. Here's Jason helpful. Authorities have 0:01:58.880 --> 0:02:02.000 been warning for years that the world is losing its 0:02:02.080 --> 0:02:07.200 most precious weapons against bacterial infections because of antibiotic resistance. 0:02:07.880 --> 0:02:13.600 Around seven hundred thousand people worldwide diannually as a consequence 0:02:13.600 --> 0:02:17.840 of superbugs. That number is predicted to climb to ten 0:02:17.960 --> 0:02:22.440 million by and one of the biggest challenges researchers have 0:02:22.560 --> 0:02:27.080 faced is tracking their spread outside of hospitals, carried around 0:02:27.120 --> 0:02:30.760 in the digestive tracks of healthy people. First of all, 0:02:31.280 --> 0:02:34.800 we have always at this need of doing a global 0:02:34.880 --> 0:02:38.799 monitoring offensive acropal assistance. It's basically that if you don't 0:02:38.800 --> 0:02:41.200 know where you are, you have no clue where you're going. 0:02:41.600 --> 0:02:45.399 That's Frank Austro. He's a professor at the Technical University 0:02:45.440 --> 0:02:49.160 of Denmark and heads the Reference Laboratory on anti microbial 0:02:49.240 --> 0:02:53.840 resistance for the European Union, the World Health Organization and 0:02:53.880 --> 0:02:58.160 the Food and Agriculture Organization of the United Nations. He's 0:02:58.160 --> 0:03:01.320 been studying the rise of superbugs for almost twenty five 0:03:01.400 --> 0:03:04.519 years with his team in Copenhagen. One of Professor Austri's 0:03:04.560 --> 0:03:07.360 goals is being figuring out how to get around this 0:03:07.440 --> 0:03:11.919 global tracking problem. The biggest issue, he says, is acquiring 0:03:12.000 --> 0:03:16.320 samples that are representative of large numbers of people. When 0:03:16.320 --> 0:03:19.200 he says samples by the way, he means human feces. 0:03:19.680 --> 0:03:22.760 To do global monitoring, well, that's requires that you go 0:03:22.840 --> 0:03:25.679 out and get samples from other countries and that can 0:03:25.720 --> 0:03:29.560 actually be associated with a lot of time delays and 0:03:29.680 --> 0:03:35.120 problems logistics. Until recently, researches can only grasp the superbug 0:03:35.240 --> 0:03:39.560 problem by the infections hospital patients get. But that's an 0:03:39.600 --> 0:03:43.400 incomplete picture because healthy people also have a multi drug 0:03:43.440 --> 0:03:47.240 resistant germs in their digestive tracks. Because when it comes 0:03:47.240 --> 0:03:51.320 to resistance, it is really a silent epidemics where it 0:03:51.440 --> 0:03:54.680 is spreading in that the normal god flora is spreading 0:03:54.720 --> 0:03:58.320 between you know, healthy people, and then it's only occasionally 0:03:58.400 --> 0:04:00.920 that if you see it's a upping up in the 0:04:01.120 --> 0:04:04.280 clinicalized relates in the critical sick people. So if you're 0:04:04.320 --> 0:04:08.120 only monitoring critically sick people at hospitals, then we are 0:04:08.160 --> 0:04:11.440 really missing what is actually happening in the population as 0:04:11.440 --> 0:04:14.560 a whole, where most of the evolution probably is taking place. 0:04:18.680 --> 0:04:22.080 Said Professor a Strap. Had a two pronged problem. He 0:04:22.200 --> 0:04:26.279 needed samples from across the world, and samples not just 0:04:26.520 --> 0:04:28.360 from sick people. So we were a little bit of 0:04:28.480 --> 0:04:30.960 frustrated to say, okay, how could we in an easy 0:04:31.000 --> 0:04:35.359 way obtain samples from all around the world. Then it 0:04:35.600 --> 0:04:39.599 dawned on him. Airplane waste tanks are repositories of a 0:04:39.760 --> 0:04:43.880 pulled sample of fickle bacteria, and the specimens can be 0:04:43.960 --> 0:04:47.159 tested in real time and can't be traced back to 0:04:47.200 --> 0:04:50.520 their original donors, so there's no need to get permission 0:04:50.640 --> 0:04:53.960 or ethics approval. It was something of a light bulb 0:04:54.080 --> 0:04:57.760 moment for Professor Austrap. Oh wow, couldn't just be a 0:04:57.760 --> 0:05:01.760 way of actually doing monitory So you could be sitting 0:05:01.760 --> 0:05:05.000 here in Copenhagen and then just let all the samples 0:05:05.600 --> 0:05:11.440 come to you. So I simply pick up the phone 0:05:11.440 --> 0:05:14.279 and give a call to airport and Copenhagen and said, 0:05:14.320 --> 0:05:16.599 do you know anyone that's taken care of the toilet 0:05:16.640 --> 0:05:20.840 waist there? And I think that was Friday. Friday morning 0:05:20.880 --> 0:05:23.800 I called, and Friday afternoon we had a meeting and 0:05:23.839 --> 0:05:26.560 then they said, okay, well that's that sounds cool. Let's 0:05:26.600 --> 0:05:31.839 let's go ahead. Professor Alster looked for flights long enough 0:05:31.880 --> 0:05:35.680 to a mass sufficient testing material, and he settled on 0:05:35.880 --> 0:05:39.960 studying the raw sewage from eighteen long haul flights arriving 0:05:39.960 --> 0:05:44.560 in Copenhagen from nine cities across three regions. The results 0:05:44.600 --> 0:05:48.719 were pretty consistent among flights from each region. In general, 0:05:49.160 --> 0:05:53.440 planes arriving from Asia carried more drug resistant bacteria. The 0:05:53.480 --> 0:05:57.000 biggest surprise was this a vague clear peasant and also 0:05:57.080 --> 0:06:00.600 that there was more resistance than we had expected. There 0:06:00.640 --> 0:06:02.680 was a very very clear patent at where we had 0:06:03.040 --> 0:06:07.080 most resistance. That was in South Asia, then a little 0:06:07.080 --> 0:06:10.120 bit less in Northern Asia, and then the lowest occurrence 0:06:10.160 --> 0:06:13.960 of resistance was actually in flights coming in from North America. 0:06:14.600 --> 0:06:17.760 The results were published in a scientific journal over four 0:06:17.880 --> 0:06:21.320 years ago. It was just the start of Professor A. 0:06:21.440 --> 0:06:25.560 Strops work on this global superbug tracking system. Based on 0:06:25.600 --> 0:06:28.400 the positive results of the long distance flights and our 0:06:28.560 --> 0:06:31.280 results there, but then we decided to go out and 0:06:31.520 --> 0:06:36.520 collect sewage from from cities around the world. Next, Professor A. 0:06:36.600 --> 0:06:39.400 Strop sent out a request to collaborators around the world 0:06:39.520 --> 0:06:44.000 asking for samples of raw sewage. He was delivered sludge 0:06:44.040 --> 0:06:49.200 from the sewers of seventy cities in sixty countries. Once again, 0:06:49.640 --> 0:06:53.640 he looked for drug resistance genes carried by bacteria. It 0:06:53.760 --> 0:06:56.880 gave him an even better idea of how superbugs were 0:06:56.920 --> 0:06:59.840 spread out across the planet. We are purified to d 0:07:00.000 --> 0:07:03.320 in the sequence data and analyze the data and try 0:07:03.400 --> 0:07:05.680 to look at, okay, what is the patterns of antimicrob 0:07:05.800 --> 0:07:09.560 resistance around the world, and basically to a large the center, 0:07:09.800 --> 0:07:12.960 verifying also what we saw and expanding on what we 0:07:13.000 --> 0:07:16.200 saw in our long distance flights study, we could see 0:07:16.440 --> 0:07:18.760 that there was a very last difference in occurrence of 0:07:18.840 --> 0:07:22.200 resistance around the world. Those results were published in March. 0:07:22.880 --> 0:07:25.960 They showed the globe can be divided into two basic 0:07:26.080 --> 0:07:31.080 groups based on their superbugs. There's Africa, South America and 0:07:31.200 --> 0:07:35.440 Asia that's like one group, and then there's a North America, Europe, 0:07:35.560 --> 0:07:39.400 and you see Land Australia in another group. And that 0:07:39.520 --> 0:07:41.000 there was a little bit of a surprise for us 0:07:41.000 --> 0:07:43.840 that we have this clear separation in the diversity and 0:07:44.800 --> 0:07:48.640 prevalence of resistance around the world. It was already known 0:07:48.680 --> 0:07:53.880 that antibiotic use drives drug resistance, but Professor Alsto discovered 0:07:53.920 --> 0:07:57.920 something else. The main explanation in terms of occurrence of 0:07:58.000 --> 0:08:02.440 resistance that is, apparently it's related to sanitation. So how 0:08:02.480 --> 0:08:05.880 good is your sensation system, your how much do you 0:08:06.000 --> 0:08:09.360 wasted your sewage system, the health system and how well 0:08:09.400 --> 0:08:13.520 that is functioning, and then actually also parameters related to education. 0:08:14.080 --> 0:08:16.160 So we're a little bit surprisedful this because I've really 0:08:16.240 --> 0:08:19.400 learned that it is all about use of antimcrobial agents, 0:08:19.400 --> 0:08:22.440 but it seems to be that artifacts was also play 0:08:22.520 --> 0:08:26.960 a large role here. Professor Alstrop gave researchers a better 0:08:27.000 --> 0:08:30.720 idea of how superbugs spread around the world. But once 0:08:30.840 --> 0:08:34.320 you know where they are and where they're going, what 0:08:34.400 --> 0:08:38.120 can a country do about it? One answer is in 0:08:38.160 --> 0:08:46.079 the Netherlands, a little over a decade ago, the Netherlands 0:08:46.080 --> 0:08:51.319 faxed and intriguing but worrying problem. Famous for its windmills 0:08:51.320 --> 0:08:54.560 and eat um cheese, the country had a pristine track 0:08:54.679 --> 0:09:01.000 record from prescribing antibiotics. Doctors administered them judiciously, hospitals were 0:09:01.160 --> 0:09:04.600 good at preventing infections from spreading from patient to patient, 0:09:05.280 --> 0:09:08.360 and yet more and more people were getting sick with 0:09:08.440 --> 0:09:13.120 a particular type of super bug. Ordinarily, health officials could 0:09:13.240 --> 0:09:16.600 point to the overuse of antibiotics and humans as the cause, 0:09:17.480 --> 0:09:21.120 but in the Netherlands, Young client Monts says it was 0:09:21.520 --> 0:09:25.840 hard to make that connection, and biotic used a humans 0:09:25.960 --> 0:09:31.800 traditionally has been very restricted. We have used, but if 0:09:31.800 --> 0:09:35.960 you look at the European rankings were always at the bottom. 0:09:36.120 --> 0:09:40.280 Dr Klip Monts is a consultant microbiologist and a professor 0:09:40.320 --> 0:09:43.439 of epidemiology at the University of Utrecht in the Netherlands. 0:09:44.000 --> 0:09:48.240 He focuses on healthcare related infections. I was trying to 0:09:48.280 --> 0:09:51.800 find the source of the drug resistant bacteria in his patients. 0:09:52.520 --> 0:09:55.560 It was puzzling because they didn't appear to be getting 0:09:55.559 --> 0:09:59.600 these jams from traveling to a superbug hotspot. It wasn't 0:09:59.600 --> 0:10:02.960 a single bacterium that was the problem, but a gene 0:10:03.000 --> 0:10:07.640 that e coal iron other intestinal bacteria were harboring. That 0:10:07.720 --> 0:10:11.640 gene provides the recipe for an enzyme that destroys most 0:10:11.720 --> 0:10:18.280 penicillin based antibiotics. That enzyme is called extended spectrum beta lactoms. 0:10:18.600 --> 0:10:21.679 Scientists usually referred to it simply as E S b L. 0:10:22.320 --> 0:10:26.080 It made headlines after an elderly woman died from her infection. 0:10:26.440 --> 0:10:29.480 The superbuc E s b l is performed the indoor 0:10:29.600 --> 0:10:32.880 lusting from Scientists had been given something of a tip 0:10:32.880 --> 0:10:37.200 off about a possible source. Years earlier, a toddler in 0:10:37.200 --> 0:10:40.440 the Netherlands tested positive for m R s a mercer 0:10:40.640 --> 0:10:46.040 or methocillin resistant Staphylococcus aureus. It's a very common superbug 0:10:46.040 --> 0:10:51.600 that causes deadly infections, except this child's gam was remarkably different. 0:10:52.160 --> 0:10:55.400 It was resistant to a group of broad spectrum antibiotics 0:10:55.440 --> 0:11:00.840 called tetracycling. This was remarkable because tetracycle clean drugs aren't 0:11:00.920 --> 0:11:04.520 used to treat staph infections in people, but they were 0:11:04.640 --> 0:11:08.520 used in pigs, and the girl's parents were pig farmers. 0:11:09.240 --> 0:11:12.800 When scientists look to see if the same unusual variant 0:11:12.920 --> 0:11:15.600 was in their hogs, they were alarmed to find it 0:11:15.640 --> 0:11:20.000 was there also and in more people. The reason it 0:11:20.080 --> 0:11:23.960 was in the pigs was because swine like most farm animals. 0:11:23.960 --> 0:11:28.920 In the Netherlands, we're getting a lot of antibiotics in animals, 0:11:29.240 --> 0:11:34.040 and bioticus has been high. We were among the higher 0:11:34.160 --> 0:11:38.280 users in Europe. Farmers would give antibiotics to livestock to 0:11:38.440 --> 0:11:42.040 prevent disease and make the animals gain weight faster, and 0:11:42.120 --> 0:11:45.080 for a while the Dutch were doling out more than 0:11:45.240 --> 0:11:48.360 five hundred tons a year of the drugs to animals. 0:11:49.040 --> 0:11:52.520 Professor Client monstercalls a student visiting his lab who culture 0:11:52.559 --> 0:11:55.920 bacteria from meat products. It was meant to be a 0:11:56.000 --> 0:11:59.920 small experiment, but it turned into a survey of hundred 0:12:00.040 --> 0:12:03.960 of fresh chicken, beef, pork, and ground meat samples brought 0:12:04.000 --> 0:12:07.880 from grocery stores in the southern Netherlands. The researchers analyzed 0:12:07.960 --> 0:12:12.080 the DNA fingerprints of SBL jeans and E. Coli specimens 0:12:12.080 --> 0:12:15.400 collected from both patients and meat, and they looked to 0:12:15.400 --> 0:12:19.520 see if there were any genetic similarities. One variant was 0:12:19.679 --> 0:12:22.040 very often silent in chickens, so we call that the 0:12:22.200 --> 0:12:26.959 chicken ees bell. And this variant was found in that 0:12:27.400 --> 0:12:30.480 false woman who died from head. Of all the meat 0:12:30.520 --> 0:12:34.280 types tested for E. S. Bills, poultry had the most. 0:12:34.880 --> 0:12:39.400 In fact, the poultry meat tested harbored these multi drug 0:12:39.480 --> 0:12:43.640 resistant bacteria. The infections of their cause are usually cured 0:12:43.679 --> 0:12:47.520 with the last line antibiotic known as carbon pennum. The 0:12:47.600 --> 0:12:50.480 main concern with E. S. B Ls is that they 0:12:50.640 --> 0:12:53.160 drive up the use of carbon penems, and that in 0:12:53.200 --> 0:12:58.160 turn makes more deadly carbon penem resistant bacteria even more prevalent. 0:12:58.920 --> 0:13:01.520 In the Netherlands, the presence of E. S. B ls 0:13:01.520 --> 0:13:06.520 in bacteria in poultry was growing rapidly, and these germs 0:13:06.960 --> 0:13:20.280 seemed to be spilling over from animals to humans. Thorough 0:13:20.280 --> 0:13:24.800 cooking kills bacteria, but microbs spread in other ways. When 0:13:25.000 --> 0:13:29.079 raw meat comes in contact with chopping boards, cooking utensils, 0:13:29.120 --> 0:13:33.000 and the hands, things bugs can cross contaminate food, such 0:13:33.040 --> 0:13:36.640 as salad. The rising presence of E. S. B l 0:13:36.720 --> 0:13:39.680 s and meat was more bad news for Dutch farmers. 0:13:40.400 --> 0:13:44.480 Around the same time, thousands of people had become sick 0:13:44.600 --> 0:13:48.400 from an unprecedented outbreak of a disease from goats called 0:13:48.559 --> 0:13:52.679 q fever. Coming after the pig mercer. The public had 0:13:52.720 --> 0:13:56.439 become increasingly suspicious of the way farm animals were being 0:13:56.440 --> 0:14:01.079 intensively raised in the Netherlands. The link between antibiodic use 0:14:01.120 --> 0:14:07.480 and chickens and superbugs in people heightened that concern and 0:14:07.559 --> 0:14:10.680 that was I think the game changer and had a 0:14:10.760 --> 0:14:15.200 huge impact, saying that it was clear to the farmers 0:14:15.200 --> 0:14:19.920 that they wouldn't get away with this one. The EU 0:14:20.040 --> 0:14:23.240 banned the use of antibiotics as growth promoters in two 0:14:23.320 --> 0:14:27.520 thousand and six, but in the Netherlands farmers continued to 0:14:27.560 --> 0:14:32.080 administer them anyway, saying they were for therapeutic purposes. But 0:14:32.160 --> 0:14:36.280 the studies implicating antibiotic use on farms in causing hard 0:14:36.360 --> 0:14:40.520 to treat infections and people change that and pretty swiftly. 0:14:41.080 --> 0:14:45.040 Politicians wanted to get farmers to kick their antibiotic habit 0:14:45.520 --> 0:14:49.760 and do it fast, but Christian Abruska, the Netherlands Chief 0:14:49.840 --> 0:14:53.760 veterinary Officer for the past decade, says farmers and veterinarians 0:14:53.880 --> 0:14:57.080 worried how it would affect their incomes and animal welfare. 0:14:57.680 --> 0:15:02.400 Action wasn't happening fast enough, and political pressure was increasing, 0:15:02.880 --> 0:15:07.400 and one day the ministers just declared in the Parliament 0:15:07.560 --> 0:15:13.520 that we would require from the sector to decrease antibiotics 0:15:13.600 --> 0:15:22.440 with then the parliament had emotion and they said now 0:15:23.080 --> 0:15:26.960 is not enough. It should be Dutch farmers realized the 0:15:27.080 --> 0:15:31.120 game was up. The use of antibiotics had become a 0:15:31.200 --> 0:15:35.200 crutch that enabled them to deal with animal health problems 0:15:35.240 --> 0:15:39.720 that would otherwise require changes in animal husbandry. The animal 0:15:39.800 --> 0:15:44.800 feed sector stopped adding antibiotics to prepared fodder. Certain critical 0:15:44.840 --> 0:15:49.640 antibiotics were banned or restricted for veterinary use, and systems 0:15:49.680 --> 0:15:52.840 were put in place to track the amount of antibiotics 0:15:52.960 --> 0:15:57.320 used by each industry and by each farm. The number 0:15:57.360 --> 0:16:02.000 of prescriptions dispensed by veterinarian was counted by an independent 0:16:02.040 --> 0:16:07.280 authority plus Dr Bruska says legislation was introduced to strengthen 0:16:07.320 --> 0:16:11.000 the position of veterinarians. The United States, for a comparison, 0:16:11.520 --> 0:16:16.000 has implemented restrictions too. As of two thousand and seventeen, 0:16:16.520 --> 0:16:19.920 drugs that are important to human health aren't allowed to 0:16:19.960 --> 0:16:24.040 be used for growth promotion or feed efficiency. There are 0:16:24.080 --> 0:16:28.600 signs it's led to a reduction in antibiotic sales. Still, 0:16:28.840 --> 0:16:33.080 the latest date to show injectable antibiotics are used on 0:16:33.160 --> 0:16:38.800 almost nine of US peak farms and of cattle feed lots, 0:16:39.120 --> 0:16:42.360 and the US lacks the level of oversight and control 0:16:42.440 --> 0:16:45.920 that the Netherlands has put in place. For example, a 0:16:45.960 --> 0:16:51.400 farmer has to have one dedicated veterinarian who works on 0:16:51.520 --> 0:16:54.640 his farm, and he's not allowed to have somebody else. 0:16:54.680 --> 0:16:58.720 So a farmer is not allowed to go shopping like 0:16:58.960 --> 0:17:01.880 if I can't get it with my own veterinarian, I'll 0:17:01.920 --> 0:17:05.399 go to somebody else. That's not possible anymore. In just 0:17:05.520 --> 0:17:09.240 a couple of years, the Netherlands managed to reduce by 0:17:09.320 --> 0:17:13.480 half the volume of antibiotics used on farms. That showed 0:17:13.560 --> 0:17:18.679 us that a fifty percent reduction didn't have to be 0:17:18.720 --> 0:17:22.520 the end. It was like the lower hanging fruit, and 0:17:22.560 --> 0:17:25.680 the concerns some of the farmers and veterinarian's voiced about 0:17:25.760 --> 0:17:29.399 the economic and animal health impact also turned out to 0:17:29.440 --> 0:17:34.200 be unfounded. Antibiotic volumes have fallen by two thirds over 0:17:34.240 --> 0:17:38.720 the past decade without any discernible impact on farm economics 0:17:38.800 --> 0:17:43.080 or animal welfare. But more importantly, the superbugs that were 0:17:43.080 --> 0:17:46.880 being detected on poultry mate they have declined to So 0:17:47.040 --> 0:17:51.639 when we started this policy, we hoped that the resistance 0:17:51.720 --> 0:17:55.960 levels wouldn't further increase, But what we've seen is that 0:17:56.600 --> 0:18:01.840 over the years consistently every year the resistance levels go down. 0:18:02.240 --> 0:18:05.399 Surveys have found that about two out of every five 0:18:05.480 --> 0:18:09.479 samples of raw chicken meat bought from Dutch retailers harbor 0:18:09.560 --> 0:18:13.919 these espl producing germs. That's down from four out of 0:18:13.960 --> 0:18:18.800 five samples ten years ago. Professor Young Klipmant says there 0:18:18.960 --> 0:18:23.639 is wide variation across brands, but overall, the policy of 0:18:23.720 --> 0:18:26.720 reducing the use of antibiotics on farms has had a 0:18:26.720 --> 0:18:30.840 beneficial impact and it's sparing the Dutch government to continue 0:18:30.840 --> 0:18:34.280 to look for ways to drive down usage. The Netherlands 0:18:34.480 --> 0:18:37.760 isn't exactly unique or the first to reduce the use 0:18:37.800 --> 0:18:42.119 of antibiotics on farms. Nordic countries where pioneers on this front, 0:18:42.480 --> 0:18:45.400 but still there's a lot of interest from other countries 0:18:45.440 --> 0:18:48.480 about the Dutch experience and what it can teach them. 0:18:49.080 --> 0:18:52.159 Dr Bruska says it's just one example of how the 0:18:52.240 --> 0:18:56.040 drug resistance crisis can be mitigated where there is the 0:18:56.080 --> 0:19:09.439 political will to reduce antibiotic use. Other country are following. France, Germany, 0:19:09.480 --> 0:19:13.640 and the UK have implemented measures to curb antibiotic use 0:19:13.720 --> 0:19:17.439 on farms. In the United States, a five year action 0:19:17.480 --> 0:19:21.520 plan for supporting anti microbial stewardship and Animal Health was 0:19:21.560 --> 0:19:25.639 released twelve months ago, but experts say the country is 0:19:25.720 --> 0:19:30.080 lagging behind. I asked James Johnson, a professor of medicine 0:19:30.080 --> 0:19:33.760 at the University of Minnesota and Minneapolis. He's also an 0:19:33.760 --> 0:19:37.840 infectious disease consultant at the city's Veterans Affairs Medical Center, 0:19:38.200 --> 0:19:40.560 and he's been working in the field for more than 0:19:40.640 --> 0:19:44.280 thirty years. He says there's a dearth of data to 0:19:44.400 --> 0:19:48.680 indicate what role antibodic use on farms is playing in 0:19:48.720 --> 0:19:52.480 the spread of superbugs in people. So there isn't the 0:19:52.600 --> 0:19:56.119 same level of public outcry that led the Netherlands to 0:19:56.240 --> 0:20:01.480 wean its farmers off antibiotics. An absence of data doesn't 0:20:01.480 --> 0:20:05.080 mean an absence of a link, perhaps more reticence to 0:20:05.160 --> 0:20:08.399 study it. This is a challenge in the US. The 0:20:08.520 --> 0:20:12.479 producers have been very good about I would say, stone 0:20:12.480 --> 0:20:15.000 walling and putting out a smoke screen about there's nothing, 0:20:15.040 --> 0:20:17.560 no problem here, farms have nothing to do with it, 0:20:17.640 --> 0:20:20.640 Leave us alone. The evidence just isn't there, and they're 0:20:20.680 --> 0:20:23.120 doing their best to keep anyone from doing the science 0:20:23.359 --> 0:20:26.280 that would be able to answer the questions that would 0:20:26.480 --> 0:20:30.560 lead maybe clarify some of the uncertainty. In the US 0:20:30.640 --> 0:20:33.680 and most parts of the world, it's impossible to know 0:20:33.960 --> 0:20:37.920 exactly where superbugs are coming from, whether it's from drug 0:20:37.960 --> 0:20:41.600 resistance caused by the antibilotics we humans take all the 0:20:41.600 --> 0:20:45.080 ones we give to farm animals. Locating the source of 0:20:45.119 --> 0:20:48.840 these bugs and stopping them from spreading at two of 0:20:48.840 --> 0:20:52.480 the biggest challenges in the fight against anti microbial resistance, 0:20:53.119 --> 0:20:56.800 and time is crucial in this fight. Millions more lives 0:20:57.040 --> 0:21:00.159 are predicted to be lost as a result of superbugs 0:21:00.200 --> 0:21:05.000 in the coming years. Multi drug resistant bacteria and not 0:21:05.119 --> 0:21:09.400 only claiming lives through vicious infections, but making treatments such 0:21:09.440 --> 0:21:15.919 as chemotherapy even riskier. In countries like India, cancer patients 0:21:15.960 --> 0:21:18.840 are dying from infections as a result of their chemo. 0:21:19.880 --> 0:21:24.600 These tragic cases could soon become common in more countries. 0:21:25.600 --> 0:21:29.680 I have predicted for some years now we would get 0:21:29.720 --> 0:21:32.800 to the point where doctors would be saying to cancer patients, 0:21:33.320 --> 0:21:35.879 m I could cure your cancer, but you'll get an 0:21:35.960 --> 0:21:39.439 infection that might kill you. In some parts of the world, 0:21:39.480 --> 0:21:43.440 as as you have heard, that is becoming a reality 0:21:43.880 --> 0:21:46.760 because we all carry bacteria in our guts and some 0:21:46.920 --> 0:21:51.560 of them may well be resistant to standard treatments, but 0:21:51.680 --> 0:21:55.800 we can stop that happening. We can get new antibiotics 0:21:55.920 --> 0:21:59.320 if we only invest in the pipeline. This is Professor 0:21:59.320 --> 0:22:02.760 Sally dave Yes. She leads her post as the UK's 0:22:02.800 --> 0:22:06.160 Chief Medical Officer at the end of September, but she'll 0:22:06.240 --> 0:22:09.960 continued to tackle the global problem as her government's Special 0:22:10.119 --> 0:22:15.040 Envoy on anti microbial resistance. Dames Sally says there's also 0:22:15.119 --> 0:22:18.720 a financial cost to the rise of superbugs. The global 0:22:18.760 --> 0:22:23.280 economy is predicted to lose one hundred trillion dollars in 0:22:23.440 --> 0:22:28.560 economic output by But despite the lives at stake and 0:22:28.600 --> 0:22:34.000 the devastating effect anti microbial resistance could have on the economy, 0:22:34.240 --> 0:22:38.320 Dames Sally is optimistic about our ability to beat back superbugs. 0:22:43.600 --> 0:22:47.119 A review her government commissioned three years ago found the 0:22:47.200 --> 0:22:51.880 calamity could be avoided, but it requires spending forty two 0:22:51.880 --> 0:22:55.000 billion dollars over a decade on new medical and pharmaceutical 0:22:55.040 --> 0:22:59.560 tools and promoting ways to curb antibiotic use. That's a 0:22:59.600 --> 0:23:02.600 frak of the amount spent rescuing banks during the global 0:23:02.680 --> 0:23:06.600 financial crisis. The return on investment is clear. If we 0:23:06.680 --> 0:23:10.480 invest now in infection prevention control. If we invest now 0:23:10.520 --> 0:23:14.760 in better diagnostics, if we invest now in new treatments, 0:23:14.880 --> 0:23:18.600 it will pay off dramatically, not just in human lives 0:23:18.600 --> 0:23:22.960 and suffering, but actually in keeping our hospitals open and 0:23:23.160 --> 0:23:26.760 working so that we can look after patients. A crucial 0:23:26.840 --> 0:23:30.600 peace of that financing, she says, needs to go toward 0:23:30.720 --> 0:23:35.200 developing new antibiotics and other treatments. And when I talked 0:23:35.280 --> 0:23:38.480 to the experts, it was absolutely clear they could all 0:23:38.640 --> 0:23:42.320 articulate the problem, but none of them could see a 0:23:42.400 --> 0:23:45.560 way through that problem. And for them, the amounts of 0:23:45.600 --> 0:23:49.960 money seemed immense, whereas we know, compared with what was 0:23:50.040 --> 0:23:53.280 given to banks to bail them out, or what's spent 0:23:53.600 --> 0:23:59.520 on making a blockbuster film, it is not immense. It 0:23:59.720 --> 0:24:03.840 is proportionate, and the life saves could be amazing. So 0:24:03.880 --> 0:24:06.560 I thought someone needed to take some action, and I 0:24:06.720 --> 0:24:12.320 decided to push our government to take action. Dames Sally 0:24:12.440 --> 0:24:15.400 says there's been progress, but we can't afford to lose 0:24:15.440 --> 0:24:19.600 the momentum. In England, anti bider use on farms as 0:24:19.800 --> 0:24:26.320 decreased in four years. Internationally, drug resistance is being discussed 0:24:26.320 --> 0:24:29.800 by world leaders, including at the United Nations General Assembly. 0:24:30.520 --> 0:24:34.960 Countries are developing national action plans and more money is 0:24:35.000 --> 0:24:39.720 being spent on fighting anti microbial resistance. What's more, the 0:24:39.840 --> 0:24:44.679 crisis is garnering media attention that's raising the alarm that 0:24:44.800 --> 0:24:49.159 people everywhere are dying from infections once cured with a 0:24:49.200 --> 0:24:54.000 handful of pills and Dames Sally says, public outrage over 0:24:54.040 --> 0:24:57.920 the spread of superbugs will motivate governments to do more 0:24:58.000 --> 0:25:01.479 to tackle this global threat. I believe we can get 0:25:01.640 --> 0:25:05.080 on top of this, and there are good signs. We 0:25:05.240 --> 0:25:09.760 know that it's a natural phenomenon for effective organisms to 0:25:09.960 --> 0:25:13.840 develop resistance and then they multiply. So what we have 0:25:14.000 --> 0:25:19.160 to do is use much less of the anti infected 0:25:19.359 --> 0:25:33.480 the antibiotics for bacteria. Just as superbugs have adapted to 0:25:33.720 --> 0:25:37.400 our treatments, we have to find new ways to adapt 0:25:37.400 --> 0:25:41.400 to their resistance. Maybe it's doing work like Bill Gates, 0:25:41.960 --> 0:25:46.080 the Microsoft co founder, is investing in waterless toilets to 0:25:46.200 --> 0:25:50.679 stop spreading bacteria through sewage, or its hospitals like the 0:25:50.720 --> 0:25:54.439 Austin in Melbourne, where doctors are using simple practices that 0:25:54.480 --> 0:25:57.840 went out of style as we became more reliant on antibiotics. 0:25:58.760 --> 0:26:01.920 Now the Austin uses bleached to clean and kill superbugs 0:26:02.400 --> 0:26:07.320 and isolates patients harboring them. In the age of evolving superbugs, 0:26:07.800 --> 0:26:46.480 we have to evolve too. And that's it for this 0:26:46.520 --> 0:26:49.879 season of Prognosis. Thanks so much for listening. Do you 0:26:49.880 --> 0:26:51.840 have a story about healthcare in the US or around 0:26:51.840 --> 0:26:54.359 the world we want to hear from you. Find me 0:26:54.400 --> 0:26:57.840 on Twitter at p Cortes or email m Cortes at 0:26:57.840 --> 0:27:00.720 Bloomberg dot net. If you were a fan of this episode, 0:27:00.960 --> 0:27:03.360 please take a moment to rate and review us. It 0:27:03.400 --> 0:27:06.560 really helps new listeners find the show, and don't forget 0:27:06.600 --> 0:27:11.119 to subscribe. This episode was produced by Top Foreheads. Our 0:27:11.160 --> 0:27:14.480 story editor was Rick Shine. Special thanks to Drew Armstrong. 0:27:14.680 --> 0:27:18.800 Our healthcare team leader, Francesca Levi, is head of Bloomberg Podcasts. 0:27:19.400 --> 0:27:22.080 We'll be back with a new episode soon, but until then, 0:27:22.320 --> 0:27:23.760 you can see what our health team is up to 0:27:24.000 --> 0:27:28.680 by going to www dot Bloomberg dot com slash Prognosis. 0:27:29.280 --> 0:27:29.840 See you soon.