One World, One Health

Rosemary Bartel had no idea her life was going to take a turn when she went to a hospital near her home in Chilton, Wisconsin in the United States for standard knee replacement surgery – her second such operation. She was ready to work hard to recover and return to her busy job at her Roman Catholic diocese. But Rosie developed an all-too-common infection known as MRSA—methicillin-resistant Staphylococcus aureus. It’s one of the best-known examples of antimicrobial-resistant microbes, often called superbugs. The United Nations is devoting a high-level meeting to the problem in September 2024 in the hopes of getting nations to do more to fight antimicrobial resistance, also known as  AMR.

Now, 15 years later, Rosie has had her leg and hip amputated because the infection got into her bones. She has suffered numerous other infections, been in comas, experienced sepsis, lost her job, lost her health insurance, and lost most of the life she had loved.

“I will probably be paying hospital bills for the rest of my life,” Rosie tells One World, One Health. Rosie is one of the luckier victims of AMR. She’s still alive. Five million people a year die from complications caused by these drug-resistant germs. Today, Rosie shares her story as widely as she can as part of the Patient Family Partners Network, a group of patient advocates working to improve healthcare in the United States, and the Leapfrog Group, a nonprofit patient safety advocacy organization. She’s also written a book, “Rosie’s Story,” about her experience with this devastating and unending infection. 

Listen as Rosie describes what happened to her and what she hopes to do to help stop it from happening to others.

Dr. Nour Shamas knows about antimicrobial resistance. As a clinical pharmacist, she was trained in how to dispense drugs to treat infections, and her graduate studies in global health policy made her aware of the threat of antimicrobial resistance, or AMR. 

Antimicrobial resistance develops when bacteria, viruses, fungi, or parasites evolve the ability to shake off the effects of drugs developed to fight them. It’s one of the biggest threats to humanity – such a serious threat that the United Nations General Assembly is holding a meeting devoted to the subject. Shamas helps lead the Antimicrobial Stewardship Program at the Ministry of National Guard Health Affairs in Jeddah and Riyadh, Saudi Arabia. She knows about the need to preserve the drugs that still work against the many infections that threaten human life. 

But the issue of AMR got personal for her when her mother developed a urinary tract infection after surgery and a hospital stay. Shamas found herself working with her mother’s doctors, and battling to explain to her mother how she could have developed such an infection in the first place. She also found herself fighting to get the right treatment for her mother, who lives in Lebanon, a country struggling with economic challenges, conflict, and a fragile, underfunded, and overloaded healthcare system. 

Now, as a member of the World Health Organization’s AMR Survivors Task Force, she tells the story of how her mother still fights recurrent infections. Listen as she shares some of her story with One World, One Health. 

Urinary tract infections (UTIs) are common, uncomfortable, and embarrassing. They can also be deadly. These infections of the kidneys, bladder, or urethra affect about 1 in 10 men in their lifetimes and more than half of women. Untreated UTIs can cause a body-wide infection known as sepsis. An estimated 236,000 people globally die every year from UTIs.  

Most UTIs are fairly easy to treat with antibiotics. However, a quarter to a third of urinary tract infections (UTIs) are caused by drug-resistant bacteria. That makes them much more difficult to treat. 

There’s no easy test to tell medical professionals whether an infection will be easy to treat with readily available antibiotics, so they often have to make their best guess. Using the wrong antibiotic to treat any infection can delay recovery and help germs evolve drug resistance. 

Sweden-based Sysmex Astrego developed a test that works in 45 minutes to help determine what type of germ is causing a UTI and which antibiotic should be used to treat it.  

Challenge Works, which awards prizes to encourage solutions to hard problems in global health, climate, technology, and other areas, has awarded Sysmex Astrego the Longitude Prize to help the company develop and commercialize the test. 

“The winning test will be transformational for infection diagnosis and treatment, providing accurate antibiotic susceptibility results in 45 minutes – compared to the 2-3 day wait patients currently face,” Challenge Works says. 

In this episode of One World, One Health, Jasmin Major of Challenge Works explains why diagnostic innovations like this are so important. 

Read more about the One Health Trust’s work on antimicrobial resistance here. 

No one wants to be exposed to air pollution. No one wants to raise their kids breathing in polluted air in their own neighborhoods.

But in Austin, Texas, people of color are disproportionately forced to do both.

Dr. Sarah Chambliss, a research associate in the Department of Population Health at Dell Medical School at the University of Texas at Austin, led a team that ran a study of who is being affected by air pollution in Austin, neighborhood by neighborhood.

They found that while Austin has relatively little of the heavy industry traditionally linked with air pollution, it’s got plenty of polluted air. And the people living in the worst affected neighborhoods were far more likely to be Black or Latino(a) than White, they report in the American Journal of Respiratory and Critical Care Medicine.

It’s not just unpleasant. People living in polluted areas are much more likely to end up in emergency rooms for asthma attacks. That’s expensive for everyone because in the United States hospitals must treat people coming to emergency rooms in distress and those costs are passed along to taxpayers as well as to health insurers – who pass along those expenses to customers.

Aside from hurting people of color more than others, air pollution is costing everyone –in this case, residents of Austin– a lot of money, Chambliss tells One World, One Health host Maggie Fox. Listen as Chambliss explains what else she and her team found, and what can be done to address the problem.

People don’t want to see any more pandemics, notes Nita Madhav, Senior Director of Epidemiology & Modeling at Ginkgo Biosecurity, the biosecurity and public health unit of Ginkgo Bioworks.  

The world is collectively traumatized by the horrors of the COVID-19 pandemic, Madhav says in this episode of One World, One Health. 

But just because we don’t want to see another pandemic doesn’t mean we won’t get one. The world isn’t doing enough to keep an eye out for the next one, says Madhav. 

“Covid was a trial run for something that could be a lot worse. It was really a wakeup call that we need to have better systems in place,” she says.

In any given year, she estimates, there’s a two to three percent chance of a pandemic. But human behavior is raising those odds. More frequent travel is one factor; so is climate change. 

What’s she watching most closely right now? H5N1 bird flu. “The more it spreads within mammals that gives it more chances to mutate. As it mutates, as it changes, there is a greater chance it can infect humans. If it gains the ability to spread efficiently from person to person, then it would be hard to stop.” 

Listen as Madhav tells One World, One Health about how she measures these risks and what the world needs to be doing to watch for and to reduce these risks. 

Drug-resistant bacteria are major killers, playing a role in killing five million people a year. Antibiotics were miracle drugs when they were invented 100 years ago, but they are losing their power against always adapting and evolving bacteria. 

At the same time, the market for new antimicrobial drugs has collapsed. Hardly anyone wants to make new antibiotics, and even fewer companies want to make new diagnostic tests or vaccines for drug-resistant infections. 

While the profit motive works well for most diseases – cancer therapies rake in about $200 billion a year – the market for antibiotics was just $8 billion in 2021. 

“We have to accept that there is no money in antibiotics,” says Dr. Ursula Theuretzbacher, who founded the Center of Anti-Infective Agents in Vienna, Austria. 

Only 12 new antibiotics have been launched since 2017, almost all of them variations of existing drugs. 

“What we really need are completely new approaches,” Theuretzbacher says in this episode of One World, One Health. 

She helped write one of a series of papers in the Lancet medical journal looking at the problem, and aiming to set the tone for a high-level United Nations' meeting on antimicrobial resistance (AMR) in 2024. 

“The increasing number of bacterial infections that are no longer responding to any available antibiotics indicate an urgent need to invest in—and ensure global access to—new antibiotics, vaccines, and diagnostic tests,” Theuretzbacher and her team write. 

Listen as Theuretzbacher tells One World, One Health about some new approaches that may work to bring badly needed new drugs, vaccines, and diagnostic tests to the world. 

Check out our other podcasts about the problem of antimicrobial resistance, or AMR, and the Lancet series, including this one with Dr. Iruka Okeke and this one with Aislinn Cook.  

An estimated 7.7 million people die from bacterial infections a year around the world. A growing number of these deaths are caused by bacteria that have developed antibiotic resistance – the ability to thrive in the face of antibiotics. This ability of germs to defy the effects of drugs is called antimicrobial resistance, or AMR. 

But why wait to treat these infections after they’ve happened? It’s far better to prevent them from happening in the first place. 

Dr. Joseph Lewnard, an associate professor of Epidemiology at the School of Public Health at the University of California Berkeley, is studying ways to prevent infections. Vaccines, better hygiene and sanitation, clean water, and proper and careful use of antibiotics and antivirals can all play a role. 

Many governments have done far too little to protect their citizens from infections, Lewnard says. “This has not necessarily been a shining success story,” he says in this episode of One World, One Health. 

He helped write one of a series of papers in the Lancet medical journal looking at the problem of drug-resistant superbugs. The numbers are significant. 

“Improving infection prevention and control in healthcare facilities including better hand hygiene and more regular cleaning and sterilization of equipment, could save up to 337,000 lives a year,” they write. 

They estimated that clean water and sanitation could save another quarter million lives each year.

“Access to improved sanitation facilities (defined as toilets that are not shared with other households and are connected to piped sewer systems or septic tanks) reduces diarrhea incidence by 47 percent,” they point out. 

Listen as Dr. Lewnard explains some of the other findings to One World, One Health host Maggie Fox. 

Learn more about the struggle to control drug-resistant bacteria, viruses, and fungi in some of our other episodes. We’ve spoken with experts about how vaccines can help prevent the spread of drug-resistant germs, about tracking superbugs in sewage, and the surprising rise of drug-resistant fungi. Experts in drug design have talked to us about the search for new and better antibiotics and how these little organisms are winning an arms race against us. Filmmakers have told us about how storytelling can help people understand the threat while global health specialists explained that good stewardship can keep the antibiotics we have working as they should. We’ve even investigated superbug mysteries, like the case of the killer eyedrops. 

The problem of antimicrobial resistance – AMR for short – is clear. More and more of these germs resistant to existing treatments are emerging everywhere, and there’s little disagreement that governments, nonprofits, doctors, patients, and politicians all need to help tackle the problem.

But people need to agree on what to do, and they need to agree on how to measure progress.

That’s where targets come in.

Aislinn Cook, a senior research fellow in infectious disease epidemiology on the antimicrobial resistance team in the Centre for Neonatal and Pediatric Infection of St. George’s University in London, is helping set some of those targets. Cook, who’s also affiliated with the Health Economics Research Centre at the University of Oxford, has helped write a series of papers in the Lancet medical journal bringing attention to the problem of antimicrobial resistance. AMR is a big topic of international discussion in 2024, due in part to it being one of the topics of the United Nations High-Level Meeting, and the Lancet series was put together to help focus that discussion.

Cook’s paper proposes some clear targets to reach by 2030: a 10 percent reduction in mortality from drug-resistant infections; a 20 percent reduction in inappropriate human antibiotic use; and a 30 percent reduction in inappropriate animal antibiotic use.

These goals should be achievable, Cook says. Listen as she tells One World, One Health about some concrete ways the world can work together to control the spread of drug-resistant germs.

Learn more about the struggle to control drug-resistant bacteria, viruses, and fungi in some of our other episodes. We’ve spoken with experts about how vaccines can help prevent the spread of drug-resistant germs, about tracking superbugs in sewage, and the surprising rise of drug-resistant fungi. Experts in drug design have talked to us about the search for new and better antibiotics and how these little organisms are winning an arms race against us. Filmmakers have told us about how storytelling can help people understand the threat while global health specialists explained that good stewardship can keep the antibiotics we have working as they should. We’ve even investigated superbug mysteries, like the case of the killer eyedrops.

What kills more people than HIV or malaria? What threatens anybody on the planet – and not just people, but animals, too?

It’s antimicrobial resistance (AMR), the formal name for drug-resistant superbugs. These include bacteria that defy the effects of antibiotics, viruses that thrive in the face of antiviral drugs, and fungi that are immune to antifungal treatments.

Each year, an estimated 7.7 million deaths are caused by bacterial infections, and nearly 5 million of these deaths are associated with drug-resistant bacteria. These infections include newborn babies, the elderly, and cancer patients, but also people who were young, fit, and healthy before they got infected.

AMR is a major topic of discussion this year (2024) for the World Health Organization and it will take top billing at the United Nations General Assembly. To set the tone for all the discussion, the Lancet has published a series of four papers reviewing the problem and laying out some of the solutions. For the series, the One Health Trust's Dr. Ramanan Laxminarayan brought together experts from around the world to address the issue. 

Dr. Iruka Okeke of the Department of Pharmaceutical Microbiology at the University of Ibadan in Nigeria helped write the first of these papers. Dr. Okeke, a bacterial geneticist, points out that antimicrobial-resistant infections can happen anywhere – in hospital patients, in people leading their everyday lives, in farm animals, and in nature among wildlife.

It’s important to use antibiotics and other antimicrobial drugs properly, but also to make sure that people who need them can get the right antibiotics at the right time. It’s especially important to keep an eye out for these drug-resistant superbugs, she said. Surveillance helps doctors know whether patients coming in can be treated with everyday antibiotics, or if they need special, usually more expensive, drugs.

Skipping surveillance, she says in this episode of One World, One Health, is like playing tennis without keeping score. “If you play tennis and you are not keeping score, you are just practicing.”

Listen as Dr. Okeke explains why we all need to do a better job watching out for these killer germs.

Read more about the One Health Trust’s work on antimicrobial resistance here.

The second wave of the COVID-19 pandemic was especially bad in India. Patients filled hospitals as the Delta variant swept the country in April of 2021. As many as 2,000 people died every day.

Many died literally gasping for air. Although India is a major producer of medical oxygen, supplies ran out amid the unprecedented demand. And while some areas of the vast country had access to medical oxygen, there was no good system for transferring them to places with more need.

It was a horrifying disaster as people who might otherwise have survived succumbed to COVID-19 or other conditions for lack of medical oxygen.

India wasn't the only country with this type of crisis. Oxygen became a black market item in Peru, Supplies were rationed in the UK and patients lined up to fill empty oxygen cylinders in countries around the world, including Brazil, Somalia, and Indonesia. 

It should never happen again, says Varun Manhas, Associate Director of Public Health Programs for the One Health Trust. Varun is working to build a national oxygen grid for India and then share the blueprints with the world.

The National Medical Oxygen Grid isn't what would come to mind for many. It's a cellphone-based app to help hospitals and health officials keep track of where medical oxygen is needed and where supplies are plentiful. The app could be used to make sure no one runs out of oxygen in future crises.

You can hear more about the Global need for medical oxygen in this earlier episode of One World, One Health.