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Who reminds an HIV-positive pregnant woman to take her vitamins and the drugs that will protect her baby from infection? 

Who explains to fearful parents that COVID-19 vaccines will protect them and their children from the disease?

Who shows people how to wash their hands properly so they don’t spread germs to themselves and others?

In many countries across the globe it’s community health workers like Margaret Odera of Nairobi, Kenya.

Margaret, herself an HIV-positive mother who has managed to ensure her husband and children remain uninfected, works day and night to keep her community safe, too. Yet she feels undervalued and underpaid.

She’s become an advocate for community health workers like herself – most of whom are women, and many untrained and either underpaid or unpaid.

Listen as Margaret tells One World, One Health host Maggie Fox what she does in her work for the community, and how training and better pay are needed for her and others in her trade to promote health both locally and globally. 

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Vaccines are lifesavers. Childhood vaccines save 4 million lives every year, according to the US Centers for Disease Control and Prevention. And it turns out vaccines don’t just save lives by directly preventing disease. They can save lives by reducing the rise of drug-resistant pathogens (mostly bacteria and viruses). This is because people who are vaccinated are less likely to get sick and to get treated either appropriately or inappropriately with antibiotics and antiviral drugs. And less use of these valuable drugs means less opportunity for germs to develop resistance to them. 

The One Health Trust set out to quantify just how well vaccination could reduce the emergence and spread of antimicrobial resistance or drug-defying germs.  

The latest report from the One Health Trust pulls together a variety of studies showing the impact of vaccines not only on drug resistance but also on economies, especially in low- and middle-income countries.  

Some highlights:  

• A typhoid vaccination campaign for infants could prevent more than 53 million cases of drug-resistant typhoid in low- and middle-income countries over 10 years. 
• A successful rotavirus vaccination program in Africa and Asia could prevent more than 13 million cases of diarrhea that otherwise would be treated with antibiotics – reducing opportunities for bacteria to evolve resistance to those drugs. 
• In Indonesia alone, vaccinating 50% of eligible people with pneumococcal vaccine over five years could save more than US$2 million in costs related to treatment failure.  

 One Health Trust Fellow and Director of Partnerships, Dr. Erta Kalanxhi, led the team that put together the report. Listen as she chats with One World, One Health host Maggie Fox about how vaccines can prevent the rise of drug-resistant bacteria and viruses. 

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Air – it’s our most basic need. It’s far more vital than water, food, or medicine. People can survive just minutes without its most important component: oxygen. 

But in much of the world, people struggling to breathe lack access to medical oxygen, a treatment that makes the difference between life and death. The COVID-19 pandemic highlighted the problem and made it exponentially worse. 

“I will never forget the images,” Leith Greenslade, coordinator of the Every Breath Counts coalition, tells us on the One World, One Health podcast. “Patients suffocating to death as hospitals ran out of oxygen.” 

A team at the University of Washington estimates that 25 million people die every year of both acute and chronic conditions that need treatment with medical oxygen. 

“It’s unclear exactly how many of the estimated seven million COVID-19 deaths could have been prevented with adequate supplies of medical oxygen, but a study of COVID-19 deaths in African intensive care units found that half of patients died without ever receiving it,” Greenslade and the One Health Trust’s Ramanan Laxminarayan wrote in a recent article. “Shamefully, world leaders have turned a blind eye to the lack of access to medical oxygen.” 

Listen as Leith explains the scope of the problem and the possible solutions in this episode of One World, One Health. 

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Bird flu is terrifying. Although avian influenza only rarely infects people, when it does, it kills half or more of them. 

For the past 25 years, the number one avian influenza threat has been highly pathogenic H5N1 avian influenza. Like other influenza A viruses, it gets its name from the two important components of the virus – the hemagglutinin, or H designation, and the neuraminidase, or N.

Less important than the name is what the virus has been doing. Tens of millions of birds around the world have been infected, from poultry to wild migrating birds, and H5N1 is making friends with other viruses.

These virus "friendships" help the germs evolve. And the new versions of H5N1 are popping up in unexpected places. It was recently detected in Antarctica. It’s also infecting new animals, including sea lions, foxes, and otters.

Dr. Vijaykrishna Dhanasekaran, Associate Professor in the School of Public Health at Hong Kong University and head of the university’s Pathogen Evolution Lab, has been studying the startling changes in H5N1.

In this episode of One World, One Health, he chats with host Maggie Fox about his team’s most recent findings and what they mean for global efforts to control H5N1 bird flu.

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Drug-defying superbugs can be found in manure, soil, the ocean, and especially in sewers.  

These places are sources of infection, but they also provide a way to keep an eye on which drug-resistant germs are where – and how much they are changing. The World Health Organization encourages mapping all of the places drug-resistant organisms are popping up, and what kind of organisms there are. “If no action is taken, AMR (antimicrobial resistance) could cost the world’s economy US$ 100 trillion by 2050,” WHO says. 

Windi Muziasari, PhD, became passionate about tracking these deadly germs while doing postdoctoral research at the University of Helsinki in Finland. The Indonesian-born scientist founded her own company to do this mapping for governments, communities, and companies. 

As Founder and CEO of ResistoMap, Muziasari has looked for drug-resistant microbes in agricultural runoff, in hospitals, under city streets, among wildlife, and elsewhere in dozens of countries. The hope is to act as an early warning system so that companies, governments, and others can do something about the problem. 

“Almost everywhere is polluted,” she tells us on the One World, One Health podcast. Listen as Windi Muziasari tells host Maggie Fox about how and why she got started and what she's learned since launching ResistoMap.  

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Sexually transmitted infections (STIs) are very, very common. One million people get infected with an STI every day, according to the World Health Organization. Many are easy to treat with antibiotics, or should be. These include gonorrhea, syphilis, and chlamydia. Like nearly all bacterial infections, they can and have begun to evolve resistance to antibiotics. The threat: these infections may again become untreatable, as they were in the days before antibiotics.

Sex workers have a very high risk of catching these infections.

So if sex workers have a higher risk of sexually transmitted infections, shouldn’t they get specialized treatment? It sounds like a good idea, says Salome Manyau, PhD, a researcher in the Department of Global Health and Development and the Faculty of Public Health and Policy at the London School of Hygiene and Tropical Medicine.

But things haven’t always worked out the way global health nonprofits and medical experts thought they would. Dr. Manyau spent months living among sex workers in Harare, Zimbabwe, and what she discovered may surprise many. It’s not so easy to just tell people to practice safe sex, and focusing treatments on one particular group of people can cause unexpected problems.

Listen as she tells One World, One Health host Maggie Fox what she found out in her research on antibiotic use among some of the most stigmatized people in the world. 

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Malaria is an ancient killer and it’s one that keeps outwitting humanity at every turn. It took centuries for people to figure out it was spread by mosquitoes. It evolved resistance to the drugs used to treat it and we developed new ones. It’s made comebacks thanks to climate change in places that got rid of the disease before by cleaning out mosquitoes. 

And now, the parasites that cause malaria have evolved resistance to the newest treatments – drugs based on artemisinin. 

Worse, that resistance is spreading and has emerged in Africa, the continent with the most malaria cases. 

COVID created a double whammy, not only killing people directly but also raising the death rate from malaria, as people got the symptoms mixed up or simply avoided going to clinics for treatment, says Karen Barnes, a professor of pharmacology and Founding Director of the Collaborating Centre for Optimising Antimalarial Therapy at the University of Cape Town in South Africa.  

Professor Barnes has been working for 20 years to coordinate better treatments for malaria as Director of the Pharmacology Scientific Group for the World Wide Antimalarial Resistance Network (WWARN) and Co-chair of the South African Malaria Elimination Committee. She’s also the coordinator of an EU-funded consortium to help countries in eastern and southern Africa tackle malaria drug resistance called MARC SE-Africa (Mitigating Antimalarial Resistance Consortium for South-East Africa). 

She says it’s vital to improve treatments by combining drugs more effectively to catch the parasite at various stages of its life cycle in the body. And, of course, new and better drugs are needed to fight malaria. 

Listen as Professor Barnes explains the problem and possible solutions to One World, One Health host Maggie Fox.  

 You can hear more about malaria from One World, One Health here.

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When the so-called Spanish Influenza started spreading in 1918, people locked themselves in their homes or even into small towns and tried to ride it out. It seemed to make sense – travelers could bring the virus with them, so wouldn’t keeping them out keep the deadly germ out, too?

It did not work, of course. No one could stay isolated for years on end while the virus and its descendants made its way through the population. People are still getting infected today by a distant descendant of that virus.

Humans are far too interconnected to be able to think that keeping others out will protect them from disease. Yet that attitude remains. So does the stigmatization and exclusion of migrants.

Dr. Alena Kamenshchikova, an assistant professor in the Care and Public Health Research Institute (CAPHRI) at Maastricht University in the Netherlands has been studying this very complicated intersection of language, migration, and disease spread – especially the spread of antimicrobial-resistant organisms, often called superbugs.

She says that all stigma does is force people to try to hide it when they are sick. Or, worse, they may take antibiotics inappropriately to try to treat themselves when they cannot get the proper healthcare they need. This inappropriate use of antibiotics can drive the rise of drug-resistant bacteria.

Listen as Dr. Kamenshchikova tells some startling stories about how keeping migrants of all kinds on the margins can endanger everyone around them.

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Meat is never cheap – not in terms of the cost of raising animals for meat, or in terms of the impact on the environment. And now science has clearly shown that the way people use antibiotics in their flocks and herds can feed the rise of antimicrobial resistance. 

But antibiotics are so very useful, and in many countries, they are just “part of the furniture,” says Clare Chandler, PhD, a medical anthropologist who leads the Anthropology of Antimicrobial Resistance research group at the London School of Hygiene and Tropical Medicine. 

It’s impossible to figure out how to help people stop overusing antibiotics without first understanding all the reasons they are doing it, Chandler says. In this episode of One World, One Health, Chandler describes how some people who were never traditionally farmers are raising meat small scale as a business venture. 

This economic drive to raise livestock is entangled with the idea that eating meat demonstrates wealth and status. Listen as Chandler tells host Maggie Fox how experts can't simply tell people to stop feeding antibiotics to their livestock. 

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Dr. Henry Skinner thought he had a winning new antibiotic – perhaps even more than one – when he was CEO of a small biotech company called SelectX Pharmaceuticals. But like so many other companies working to develop new antimicrobial drugs, it went bust.

Skinner learned a fair bit from that experience. Many people working in antibiotics become “gun-shy,” he says, or simply get burned out. But he’s taken those hard lessons and is using them as CEO of the AMR Action Fund. AMR stands for antimicrobial resistance – the inevitable ability of viruses, bacteria, fungi, and parasites to acquire resistance to antibiotics, antivirals, antifungals, and antiparasitic drugs. AMR Action Fund has one billion US dollars to invest in labs willing to take the gamble and develop new antibiotics.

The organization has also collaborated with the BBC on a documentary, “Race Against Resistance,” to tell the story of antimicrobial resistance and its effects on people.

Listen as Dr. Skinner chats with One World, One Health host Maggie Fox about lessons learned and the value of telling the story of antimicrobial resistance.