Fighting Back Against Killer Superbugs

our intestines possess special powers. They're developing resistance to antibiotics, in large part because of the overuse of those medicines. The risk of harboring drug evading bowel dwelling bacteria varies from country to country depending on where we travel. We can return from a trip with some unwanted guests. Sometimes the threat is right on our our step. Welcome to Prognosis, a podcast about health and science, medical technology, and the

changes that are underway across the globe. I'm your host, Michelle fay Cortes. This season, we've been focusing on the loss of our infection fighting medications because of antimicrobial resistance, and we've been exploring how we can find new ways to battle the crisis. In this final episode, Bloomberg's Jason Gale takes us to Copenhagen to investigate an unlikely way

researchers are tracking this problem. He looks at what happened when one country found the threat lurked in refrigerators and on countertops and took bold action to stop superbugs at their source. And he hears from Dame Sally Davies, England's top medical advisor, about why she's optimistic that we can

mitigate the global superbug crisis. Here's Jason helpful. Authorities have been warning for years that the world is losing its most precious weapons against bacterial infections because of antibiotic resistance. Around seven hundred thousand people worldwide diannually as a consequence of superbugs. That number is predicted to climb to ten million by and one of the biggest challenges researchers have faced is tracking their spread outside of hospitals, carried around

in the digestive tracks of healthy people. First of all, we have always at this need of doing a global monitoring offensive acropal assistance. It's basically that if you don't know where you are, you have no clue where you're going. That's Frank Austro. He's a professor at the Technical University of Denmark and heads the Reference Laboratory on anti microbial resistance for the European Union, the World Health Organization and

the Food and Agriculture Organization of the United Nations. He's been studying the rise of superbugs for almost twenty five years with his team in Copenhagen. One of Professor Austri's goals is being figuring out how to get around this global tracking problem. The biggest issue, he says, is acquiring samples that are representative of large numbers of people. When he says samples by the way, he means human feces.

To do global monitoring, well, that's requires that you go out and get samples from other countries and that can actually be associated with a lot of time delays and problems logistics. Until recently, researches can only grasp the superbug problem by the infections hospital patients get. But that's an incomplete picture because healthy people also have a multi drug

resistant germs in their digestive tracks. Because when it comes to resistance, it is really a silent epidemics where it is spreading in that the normal god flora is spreading between you know, healthy people, and then it's only occasionally that if you see it's a upping up in the

clinicalized relates in the critical sick people. So if you're only monitoring critically sick people at hospitals, then we are really missing what is actually happening in the population as a whole, where most of the evolution probably is taking place. Said Professor a Strap. Had a two pronged problem. He needed samples from across the world, and samples not just from sick people. So we were a little bit of frustrated to say, okay, how could we in an easy

way obtain samples from all around the world. Then it dawned on him. Airplane waste tanks are repositories of a pulled sample of fickle bacteria, and the specimens can be tested in real time and can't be traced back to their original donors, so there's no need to get permission or ethics approval. It was something of a light bulb moment for Professor Austrap. Oh wow, couldn't just be a way of actually doing monitory So you could be sitting here in Copenhagen and then just let all the samples

come to you. So I simply pick up the phone and give a call to airport and Copenhagen and said, do you know anyone that's taken care of the toilet waist there? And I think that was Friday. Friday morning I called, and Friday afternoon we had a meeting and then they said, okay, well that's that sounds cool. Let's let's go ahead. Professor Alster looked for flights long enough to a mass sufficient testing material, and he settled on studying the raw sewage from eighteen long haul flights arriving

in Copenhagen from nine cities across three regions. The results were pretty consistent among flights from each region. In general, planes arriving from Asia carried more drug resistant bacteria. The biggest surprise was this a vague clear peasant and also that there was more resistance than we had expected. There was a very very clear patent at where we had

most resistance. That was in South Asia, then a little bit less in Northern Asia, and then the lowest occurrence of resistance was actually in flights coming in from North America. The results were published in a scientific journal over four years ago. It was just the start of Professor A. Strops work on this global superbug tracking system. Based on the positive results of the long distance flights and our results there, but then we decided to go out and

collect sewage from from cities around the world. Next, Professor A. Strop sent out a request to collaborators around the world asking for samples of raw sewage. He was delivered sludge from the sewers of seventy cities in sixty countries. Once again, he looked for drug resistance genes carried by bacteria. It gave him an even better idea of how superbugs were

spread out across the planet. We are purified to d in the sequence data and analyze the data and try to look at, okay, what is the patterns of antimicrob resistance around the world, and basically to a large the center, verifying also what we saw and expanding on what we saw in our long distance flights study, we could see that there was a very last difference in occurrence of resistance around the world. Those results were published in March. They showed the globe can be divided into two basic

groups based on their superbugs. There's Africa, South America and Asia that's like one group, and then there's a North America, Europe, and you see Land Australia in another group. And that there was a little bit of a surprise for us that we have this clear separation in the diversity and prevalence of resistance around the world. It was already known that antibiotic use drives drug resistance, but Professor Alsto discovered something else. The main explanation in terms of occurrence of

resistance that is, apparently it's related to sanitation. So how good is your sensation system, your how much do you wasted your sewage system, the health system and how well that is functioning, and then actually also parameters related to education. So we're a little bit surprisedful this because I've really learned that it is all about use of antimcrobial agents, but it seems to be that artifacts was also play a large role here. Professor Alstrop gave researchers a better

idea of how superbugs spread around the world. But once you know where they are and where they're going, what can a country do about it? One answer is in the Netherlands, a little over a decade ago, the Netherlands faxed and intriguing but worrying problem. Famous for its windmills and eat um cheese, the country had a pristine track

record from prescribing antibiotics. Doctors administered them judiciously, hospitals were good at preventing infections from spreading from patient to patient, and yet more and more people were getting sick with a particular type of super bug. Ordinarily, health officials could point to the overuse of antibiotics and humans as the cause, but in the Netherlands, Young client Monts says it was hard to make that connection, and biotic used a humans

traditionally has been very restricted. We have used, but if you look at the European rankings were always at the bottom. Dr Klip Monts is a consultant microbiologist and a professor of epidemiology at the University of Utrecht in the Netherlands. He focuses on healthcare related infections. I was trying to find the source of the drug resistant bacteria in his patients. It was puzzling because they didn't appear to be getting

these jams from traveling to a superbug hotspot. It wasn't a single bacterium that was the problem, but a gene that e coal iron other intestinal bacteria were harboring. That gene provides the recipe for an enzyme that destroys most penicillin based antibiotics. That enzyme is called extended spectrum beta lactoms. Scientists usually referred to it simply as E S b L. It made headlines after an elderly woman died from her infection.

The superbuc E s b l is performed the indoor lusting from Scientists had been given something of a tip off about a possible source. Years earlier, a toddler in the Netherlands tested positive for m R s a mercer or methocillin resistant Staphylococcus aureus. It's a very common superbug that causes deadly infections, except this child's gam was remarkably different. It was resistant to a group of broad spectrum antibiotics

called tetracycling. This was remarkable because tetracycle clean drugs aren't used to treat staph infections in people, but they were used in pigs, and the girl's parents were pig farmers. When scientists look to see if the same unusual variant was in their hogs, they were alarmed to find it was there also and in more people. The reason it was in the pigs was because swine like most farm animals. In the Netherlands, we're getting a lot of antibiotics in animals,

and bioticus has been high. We were among the higher users in Europe. Farmers would give antibiotics to livestock to prevent disease and make the animals gain weight faster, and for a while the Dutch were doling out more than five hundred tons a year of the drugs to animals. Professor Client monstercalls a student visiting his lab who culture

bacteria from meat products. It was meant to be a small experiment, but it turned into a survey of hundred of fresh chicken, beef, pork, and ground meat samples brought from grocery stores in the southern Netherlands. The researchers analyzed the DNA fingerprints of SBL jeans and E. Coli specimens collected from both patients and meat, and they looked to see if there were any genetic similarities. One variant was very often silent in chickens, so we call that the

chicken ees bell. And this variant was found in that false woman who died from head. Of all the meat types tested for E. S. Bills, poultry had the most. In fact, the poultry meat tested harbored these multi drug resistant bacteria. The infections of their cause are usually cured

with the last line antibiotic known as carbon pennum. The main concern with E. S. B Ls is that they drive up the use of carbon penems, and that in turn makes more deadly carbon penem resistant bacteria even more prevalent. In the Netherlands, the presence of E. S. B ls in bacteria in poultry was growing rapidly, and these germs seemed to be spilling over from animals to humans. Thorough

cooking kills bacteria, but microbs spread in other ways. When raw meat comes in contact with chopping boards, cooking utensils, and the hands, things bugs can cross contaminate food, such as salad. The rising presence of E. S. B l s and meat was more bad news for Dutch farmers. Around the same time, thousands of people had become sick from an unprecedented outbreak of a disease from goats called

q fever. Coming after the pig mercer. The public had become increasingly suspicious of the way farm animals were being intensively raised in the Netherlands. The link between antibiodic use and chickens and superbugs in people heightened that concern and that was I think the game changer and had a huge impact, saying that it was clear to the farmers

that they wouldn't get away with this one. The EU banned the use of antibiotics as growth promoters in two thousand and six, but in the Netherlands farmers continued to administer them anyway, saying they were for therapeutic purposes. But the studies implicating antibiotic use on farms in causing hard to treat infections and people change that and pretty swiftly.

Politicians wanted to get farmers to kick their antibiotic habit and do it fast, but Christian Abruska, the Netherlands Chief veterinary Officer for the past decade, says farmers and veterinarians worried how it would affect their incomes and animal welfare.

Action wasn't happening fast enough, and political pressure was increasing, and one day the ministers just declared in the Parliament that we would require from the sector to decrease antibiotics with then the parliament had emotion and they said now is not enough. It should be Dutch farmers realized the game was up. The use of antibiotics had become a crutch that enabled them to deal with animal health problems that would otherwise require changes in animal husbandry. The animal

feed sector stopped adding antibiotics to prepared fodder. Certain critical antibiotics were banned or restricted for veterinary use, and systems were put in place to track the amount of antibiotics used by each industry and by each farm. The number of prescriptions dispensed by veterinarian was counted by an independent authority plus Dr Bruska says legislation was introduced to strengthen the position of veterinarians. The United States, for a comparison,

has implemented restrictions too. As of two thousand and seventeen, drugs that are important to human health aren't allowed to be used for growth promotion or feed efficiency. There are signs it's led to a reduction in antibiotic sales. Still, the latest date to show injectable antibiotics are used on almost nine of US peak farms and of cattle feed lots, and the US lacks the level of oversight and control

that the Netherlands has put in place. For example, a farmer has to have one dedicated veterinarian who works on his farm, and he's not allowed to have somebody else. So a farmer is not allowed to go shopping like if I can't get it with my own veterinarian, I'll go to somebody else. That's not possible anymore. In just a couple of years, the Netherlands managed to reduce by half the volume of antibiotics used on farms. That showed us that a fifty percent reduction didn't have to be

the end. It was like the lower hanging fruit, and the concerns some of the farmers and veterinarian's voiced about the economic and animal health impact also turned out to be unfounded. Antibiotic volumes have fallen by two thirds over the past decade without any discernible impact on farm economics

or animal welfare. But more importantly, the superbugs that were being detected on poultry mate they have declined to So when we started this policy, we hoped that the resistance levels wouldn't further increase, But what we've seen is that over the years consistently every year the resistance levels go down. Surveys have found that about two out of every five samples of raw chicken meat bought from Dutch retailers harbor these espl producing germs. That's down from four out of

five samples ten years ago. Professor Young Klipmant says there is wide variation across brands, but overall, the policy of reducing the use of antibiotics on farms has had a beneficial impact and it's sparing the Dutch government to continue to look for ways to drive down usage. The Netherlands isn't exactly unique or the first to reduce the use

of antibiotics on farms. Nordic countries where pioneers on this front, but still there's a lot of interest from other countries about the Dutch experience and what it can teach them. Dr Bruska says it's just one example of how the drug resistance crisis can be mitigated where there is the political will to reduce antibiotic use. Other country are following. France, Germany, and the UK have implemented measures to curb antibiotic use

on farms. In the United States, a five year action plan for supporting anti microbial stewardship and Animal Health was released twelve months ago, but experts say the country is lagging behind. I asked James Johnson, a professor of medicine at the University of Minnesota and Minneapolis. He's also an infectious disease consultant at the city's Veterans Affairs Medical Center, and he's been working in the field for more than

thirty years. He says there's a dearth of data to indicate what role antibodic use on farms is playing in the spread of superbugs in people. So there isn't the same level of public outcry that led the Netherlands to wean its farmers off antibiotics. An absence of data doesn't mean an absence of a link, perhaps more reticence to

study it. This is a challenge in the US. The producers have been very good about I would say, stone walling and putting out a smoke screen about there's nothing, no problem here, farms have nothing to do with it, Leave us alone. The evidence just isn't there, and they're doing their best to keep anyone from doing the science that would be able to answer the questions that would

lead maybe clarify some of the uncertainty. In the US and most parts of the world, it's impossible to know exactly where superbugs are coming from, whether it's from drug resistance caused by the antibilotics we humans take all the ones we give to farm animals. Locating the source of these bugs and stopping them from spreading at two of the biggest challenges in the fight against anti microbial resistance,

and time is crucial in this fight. Millions more lives are predicted to be lost as a result of superbugs in the coming years. Multi drug resistant bacteria and not only claiming lives through vicious infections, but making treatments such as chemotherapy even riskier. In countries like India, cancer patients are dying from infections as a result of their chemo. These tragic cases could soon become common in more countries.

I have predicted for some years now we would get to the point where doctors would be saying to cancer patients, m I could cure your cancer, but you'll get an infection that might kill you. In some parts of the world, as as you have heard, that is becoming a reality because we all carry bacteria in our guts and some of them may well be resistant to standard treatments, but we can stop that happening. We can get new antibiotics if we only invest in the pipeline. This is Professor

Sally dave Yes. She leads her post as the UK's Chief Medical Officer at the end of September, but she'll continued to tackle the global problem as her government's Special Envoy on anti microbial resistance. Dames Sally says there's also

a financial cost to the rise of superbugs. The global economy is predicted to lose one hundred trillion dollars in economic output by But despite the lives at stake and the devastating effect anti microbial resistance could have on the economy, Dames Sally is optimistic about our ability to beat back superbugs.

A review her government commissioned three years ago found the calamity could be avoided, but it requires spending forty two billion dollars over a decade on new medical and pharmaceutical tools and promoting ways to curb antibiotic use. That's a frak of the amount spent rescuing banks during the global financial crisis. The return on investment is clear. If we

invest now in infection prevention control. If we invest now in better diagnostics, if we invest now in new treatments, it will pay off dramatically, not just in human lives and suffering, but actually in keeping our hospitals open and working so that we can look after patients. A crucial peace of that financing, she says, needs to go toward

developing new antibiotics and other treatments. And when I talked to the experts, it was absolutely clear they could all articulate the problem, but none of them could see a way through that problem. And for them, the amounts of money seemed immense, whereas we know, compared with what was given to banks to bail them out, or what's spent on making a blockbuster film, it is not immense. It

is proportionate, and the life saves could be amazing. So I thought someone needed to take some action, and I decided to push our government to take action. Dames Sally says there's been progress, but we can't afford to lose the momentum. In England, anti bider use on farms as decreased in four years. Internationally, drug resistance is being discussed by world leaders, including at the United Nations General Assembly. Countries are developing national action plans and more money is

being spent on fighting anti microbial resistance. What's more, the crisis is garnering media attention that's raising the alarm that people everywhere are dying from infections once cured with a handful of pills and Dames Sally says, public outrage over the spread of superbugs will motivate governments to do more to tackle this global threat. I believe we can get on top of this, and there are good signs. We know that it's a natural phenomenon for effective organisms to

develop resistance and then they multiply. So what we have to do is use much less of the anti infected the antibiotics for bacteria. Just as superbugs have adapted to our treatments, we have to find new ways to adapt

to their resistance. Maybe it's doing work like Bill Gates, the Microsoft co founder, is investing in waterless toilets to stop spreading bacteria through sewage, or its hospitals like the Austin in Melbourne, where doctors are using simple practices that went out of style as we became more reliant on antibiotics. Now the Austin uses bleached to clean and kill superbugs and isolates patients harboring them. In the age of evolving superbugs, we have to evolve too. And that's it for this

season of Prognosis. Thanks so much for listening. Do you have a story about healthcare in the US or around the world we want to hear from you. Find me on Twitter at p Cortes or email m Cortes at Bloomberg dot net. If you were a fan of this episode, please take a moment to rate and review us. It really helps new listeners find the show, and don't forget to subscribe. This episode was produced by Top Foreheads. Our story editor was Rick Shine. Special thanks to Drew Armstrong.

Our healthcare team leader, Francesca Levi, is head of Bloomberg Podcasts. We'll be back with a new episode soon, but until then, you can see what our health team is up to by going to www dot Bloomberg dot com slash Prognosis. See you soon.