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From the moment people discovered how to use penicillin, the first antibiotic, resistance has been a problem. Bacteria may be small, but they are not simple organisms and they have been fighting for survival for billions of years. Many bacteria have developed the tools they need to evade the effects of antibiotic treatments, and they can trade these weapons with other bacteria as they swap genetic material.

Bacterial infections aren’t new to humanity, and for more than two decades world health leaders have urgently warned about the threat of antibiotic resistance. Dr. Otto Cars is one of them. He is a senior professor of infectious diseases at Uppsala University in Sweden and the founder and senior adviser to ReAct – Action on Antibiotic Resistance.

In this episode of One World, One Health, Dr. Cars says he has hope for turning around the impending dystopia of a world without antibiotics.

Listen as Dr. Cars outlines the history of the fight against antibiotic resistance, and what he hopes its future might be.

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.

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It’s hotter and wetter than usual in Brazil, and climate conditions are driving an early blast of a killer virus – dengue. The mosquito-borne virus is spreading earlier than ever before and affecting far more parts of the country than usual – and all at once.

Dengue’s a nasty virus. It causes pain so severe that it’s sometimes called breakbone fever. Patients often feel nauseated, develop rashes, and vomit blood. The most severe cases can cause internal bleeding. There’s no specific treatment – just fluids and rest, and watching out for signs of shock, which can kill patients within hours.

Dengue is unusual because there are four different types, known as serotypes. The first infection is often mild, but people are not immune to the other three serotypes after that first time. The second time someone gets infected, they are more likely to become seriously ill – a phenomenon called antibody-dependent enhancement. Sometimes a vaccine can cause this effect.

Brazilian authorities are keeping this in mind as they rush to roll out vaccines to fight this unusually early and widespread epidemic of dengue, says Dr. André Siqueira, principal investigator at the National Institute of Infectious Diseases Evandro Chagas at Fundação Oswaldo Cruz, also known as FioCruz, in Rio de Janeiro.

There are nowhere near enough vaccines yet – only six million doses this year, enough to protect just three million people with the two-dose regimen. Brazil’s population is more than 200 million.

Researchers at Brazil’s Butantan Institute are working to develop a new vaccine that should protect people with just one dose and, they hope, will protect against all four serotypes of dengue.

Dr. Siqueira is part of the team working on that new vaccine. Listen as he explains to One World, One Health host Maggie Fox why dengue is so bad in Brazil this year and what he and colleagues are doing to control it.

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Peggy Lillis wasn’t expecting trouble when her dentist prescribed antibiotics after she had a root canal in 2010. It was a standard, just-in-case treatment to prevent infections after the procedure.

She also wasn’t worried when she developed diarrhea soon afterward. The kindergarten teacher assumed she’d caught a bug from one of her young students.

But within just a few days, the previously healthy 56-year-old was dead – a victim of Clostridioides difficile or C. diff. These bacteria are common but can grow out of control when antibiotics or other factors deplete the healthy microbes living in the intestines – the microbiome.

Patients can suffer severe diarrhea, a distortion of the colon known as megacolon, and sepsis as the infection spreads to the bloodstream. It’s painful and can be hard to treat.

About one out of every six patients who get C. diff will get it again in the following two months, the U.S. Centers for Disease Control and Prevention says. Such infections kill 1 out of 11 people over the age of 65 who develop a C. diff infection in the hospital.

It’s a One Health problem, as the bacteria spread globally.

Antibiotics are not always effective in treating C. diff. because these bacteria thrive when the natural population of microbes is killed off. Instead, many doctors are turning to treatments that can replace the healthy microbiome. These can include fecal microbiota transplants (FMTs), also known as poop transplants, or therapies that more directly replace the “good” microbes.

Peggy Lillis’ sons, Christian and Liam, didn’t want her death to have been in vain, so they founded the Peggy Lillis Foundation to advocate for awareness of C. diff, public policy to fight it, and for better treatments.

Christian Lillis says he will never get over losing his mother to C. diff.  “It remains the worst thing that has ever happened to me,” he tells One World, One Health host Maggie Fox. In this episode, Lillis tells us about this dangerous repercussion of the misuse and overuse of antibiotics, the need for new treatments, and what survivors and family members can do to take action against C. diff.

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There’s a virus that infects just about every adult. It’s passed by skin-to-skin contact – most often during sexual intercourse. 

It’s the human papillomavirus (HPV for short). It often doesn't show any symptoms, and at times the infection resolves on its own.  It can cause warts, but more ominously, HPV is the single biggest cause of cervical cancer. It's also a factor in common cancers of the head and neck, as well as cancers of the anus and penis. 

It's the main reason most adult women must undergo regular Pap smears, which work well to catch the changes that can lead to cancer while still treatable. But there’s no Pap smear for the mouth and throat, and none for the anus or penis either.  So the invention of a vaccine that prevents cancers caused by HPV should have people running to get it. It has been proven very safe and effective. According to the US Centers for Disease Control and Prevention, infections with the strains of HPV that cause cancers and genital warts have dropped 88 percent in vaccinated teen girls, and 81 percent among vaccinated young women.

While vaccination has focused on girls, boys and men suffer from and spread this infection. A study in the Lancet Global Health found nearly a third of men and boys over the age of 15 are infected with at least one genital strain of HPV and one in five have a cancer-causing type.

Studies show that the earlier teens get the vaccine against HPV, the better it protects them. But people are resisting it. Dr. Grace Ryan, assistant professor of population & quantitative health sciences at the University of Massachusetts Chan Medical School, is looking at why people are hesitant to use this life-saving vaccine, and at how to get people to better understand its benefits.

In this episode of One World, One Health, Dr. Ryan chats with host Maggie Fox about what she’s found about HPV vaccine hesitancy.

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The world acted as if the COVID-19 pandemic was a big surprise. However, just months before, the Global Preparedness Monitoring Board (GPMB) had warned that the world was vulnerable to a pandemic of respiratory illness and needed to act quickly.  Kolinda Grabar-Kitarović, the former president of Croatia, says she felt frustrated and helpless when the pandemic took hold in early 2020. She had just left office and felt powerless as she watched global failure after global failure from lockdown.

Now Grabar-Kitarović is co-chair of the GPMB and is urging world leaders and institutions to act on what’s been learned from COVID-19 failures. “Today, we find that despite some improvement, preparedness remains perilously fragile,” the GPMB says in its latest report. “We know in theory how to stop a pandemic in its tracks, but in practice, the gaps in preparedness leave us dangerously exposed to a future threat.”

What’s needed is much better planning, preparation, and, above all, trust, Grabar-Kitarović tells us in this episode of One World, One Health.  And the first step to growing trust is to build equity.

Listen as Grabar-Kitarović explains how short attention spans work against us, and what the Three Little Pigs can teach everyone about preparing for the next pandemic.

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Drug-resistant infections are a problem for everyone, but especially for newborns. They don’t have fully developed immune systems, and their bodies are less equipped to fight infections.

The risk is highest for infants born sick or prematurely.  Bloodborne infections – sepsis – are one major threat to newborns. Sepsis can move quickly, overpowering the body and causing severe illness and even death within hours. Doctors don’t have time to test babies to see what’s infecting them and have to treat them based on what Dr. Mike Sharland calls a best guess. These infections are often resistant to the drugs that are available to treat them, too. 

National and international guidelines can help doctors make difficult and life-altering decisions about treatment, but there’s not much guidance for health professionals treating newborns. That’s in part because there is so little research on which antibiotics work in newborns. Sharland, a pediatric infectious disease specialist at St George's University of London, is helping lead a group running the clinical trials needed to form the basis of guidelines.

In this episode, Dr. Sharland tells us about the terrifying growth of drug-resistant infections in newborns and the need for better antibiotics for these vulnerable babies. 

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Air pollution is a big killer, a culprit in 6.7 million deaths a year. It’s also depressing to live in a polluted area, and not simply for aesthetic reasons. Many people don't even know they are being exposed to some types of invisible air pollution.

A team of researchers in California recently linked air pollution to depression during and after pregnancy. That’s dangerous to both mothers and their babies, explains Dr. Jun Wu, the team's principal investigator and a Professor of Environmental and Occupational Health at the University of California Irvine.

Mothers with postpartum depression have a higher risk of suicide and of harming their babies. Babies of mothers with postpartum depression themselves risk emotional and cognitive damage.

The UC Irvine team found that air pollution shows up in some surprising places as well. Listen as Dr. Wu chats with One World, One Health host Maggie Fox about what her team found and what it means for our health.

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While innovative and effective ideas to help solve major global health problems are hard to come by, finding and attaining funding to put them into action can be even more difficult. The research grant review process takes time and can be bogged down in red tape. Decisions on who and what kind of research gets funded can pass over novel ideas in favor of familiar project plans.

The Trinity Challenge aims to shake things up a bit by rewarding creative and practical ideas that take research down to the community level. While the first round was dedicated to addressing COVID-19, the latest prize will go to ideas to fight the emergence and spread of drug-resistant infections, otherwise known as antimicrobial resistance (AMR). 

In this episode of One World, One Health, Dr. Marc Mendelson, Professor of Infectious Diseases and Head of the Division of Infectious Diseases & HIV Medicine at Groote Schuur Hospital at the University of Cape Town and director of the Trinity Challenge tells us how the Trinity Challenge aims to support researchers with ideas to fight the present and growing problem of drug resistance in new and inclusive ways. 

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In Gaza, thousands have been killed, tens of thousands injured, and hundreds of thousands more are without shelter, clean water, or medical care.

“You have these horrible, horrible scenes playing out in many places,” says Avril Benoit, executive director of Medecins Sans Frontieres-USA, also known as MSF or Doctors Without Borders in English.

Humanitarian groups such as Doctors Without Borders have called for an immediate ceasefire between Israel and Hamas so they can help innocent and helpless civilians caught in the conflict in Gaza.

People in Gaza are suffering horrific injuries, and without antibiotics and even the most basic of medical supplies, they are likely to develop deadly infections. The filthy and crowded conditions are helping the spread of diarrhea and respiratory disease. People are also developing skin infections such as scabies, and they’ve had to abandon treatment for day-to-day conditions from diabetes and high blood pressure to cancer chemotherapy.

MSF is struggling to help the people of Gaza, Benoit tells One World, One Health host Maggie Fox in this episode. While Gaza is, understandably, grabbing the headlines, more than six million Sudanese people are displaced and fighting malaria and malnutrition, while avoiding violence and slaughter. Rohingya refugees from Myanmar are living in unbearable conditions in the world’s largest refugee camp in Bangladesh. Refugees are fleeing conflict in Ukraine and Syria as well. “We are really stretched very thin,” Benoit says. “Syria has fallen off our radar.”

Listen as Benoit talks about the horrors that conflict rain on populations, and the enduring effects that persist long after the bombs and shooting stop.

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It’s heartbreaking when a drought or flood causes crops in a region to fail, and children to go hungry. Kids can starve to death or endure social, economic, and health problems well into adulthood due to malnutrition. 

But what if there was a way to predict when these weather disasters are likely to happen, so governments, aid organizations, and residents could prepare?

A team at the University of Chicago says people could already do this, using one of the best-known weather patterns: the El Niño Southern Oscillation or ENSO.

“ENSO has destabilizing effects on agriculture, economic production, and social stability throughout areas of the global tropics that are teleconnected to it. It has been linked to human health outcomes directly through its effects on vector- and water-borne infectious diseases, as well as indirectly by decreasing agricultural yields and increasing food insecurity and the likelihood of conflict,” they write in a Nature Communications article.

It's possible to predict this Pacific Ocean-based pattern, says Dr. Amir Jina, an Assistant Professor at the University of Chicago’s Harris School of Public Policy and a Senior Fellow at the Energy Policy Institute of Chicago. In this episode of One World, One Health, listen as Dr. Jina explains how people could use predictions about El Niño years to get ahead of some of the forces that make children go hungry.