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This is my great uncle,

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my father's father's younger brother.

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His name was Joe McKenna.

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He was a young husband
and a semi-pro basketball player

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and a fireman in New York City.

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Family history says
he loved being a fireman,

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and so in 1938, on one of his days off,

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he elected to hang out at the firehouse.

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To make himself useful that day,
he started polishing all the brass,

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the railings on the fire truck,
the fittings on the walls,

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and one of the fire hose nozzles,

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a giant, heavy piece of metal,

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toppled off a shelf and hit him.

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A few days later,
his shoulder started to hurt.

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Two days after that, he spiked a fever.

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The fever climbed and climbed.

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His wife was taking care of him,

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but nothing she did made a difference,
and when they got the local doctor in,

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nothing he did mattered either.

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They flagged down a cab
and took him to the hospital.

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The nurses there recognized right away
that he had an infection,

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what at the time they would
have called "blood poisoning,"

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and though they probably didn't say it,

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they would have known right away

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that there was nothing they could do.

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There was nothing they could do
because the things we use now

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to cure infections didn't exist yet.

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The first test of penicillin,
the first antibiotic,

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was three years in the future.

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People who got infections
either recovered, if they were lucky,

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or they died.

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My great uncle was not lucky.

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He was in the hospital for a week,
shaking with chills,

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dehydrated and delirious,

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sinking into a coma as his organs failed.

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His condition grew so desperate

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that the people from his firehouse
lined up to give him transfusions

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hoping to dilute the infection
surging through his blood.

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Nothing worked. He died.

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He was 30 years old.

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If you look back through history,

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most people died the way
my great uncle died.

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Most people didn't die
of cancer or heart disease,

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the lifestyle diseases that afflict us
in the West today.

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They didn't die of those diseases
because they didn't live long enough

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to develop them.

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They died of injuries --

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being gored by an ox,

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shot on a battlefield,

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crushed in one of the new factories
of the Industrial Revolution --

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and most of the time from infection,

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which finished what those injuries began.

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All of that changed
when antibiotics arrived.

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Suddenly, infections that had
been a death sentence

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became something
you recovered from in days.

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It seemed like a miracle,

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and ever since, we have been living inside
the golden epoch of the miracle drugs.

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And now, we are coming to an end of it.

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My great uncle died in the last days
of the pre-antibiotic era.

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We stand today on the threshold
of the post-antibiotic era,

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in the earliest days of a time
when simple infections

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such as the one Joe had
will kill people once again.

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In fact, they already are.

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People are dying of infections again
because of a phenomenon

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called antibiotic resistance.

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Briefly, it works like this.

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Bacteria compete against each other
for resources, for food,

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by manufacturing lethal compounds
that they direct against each other.

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Other bacteria, to protect themselves,

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evolve defenses against
that chemical attack.

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When we first made antibiotics,

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we took those compounds into the lab
and made our own versions of them,

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and bacteria responded to our attack
the way they always had.

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Here is what happened next:

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Penicillin was distributed in 1943,

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and widespread penicillin resistance
arrived by 1945.

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Vancomycin arrived in 1972,

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vancomycin resistance in 1988.

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Imipenem in 1985,

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and resistance to in 1998.

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Daptomycin, one of
the most recent drugs, in 2003,

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and resistance to it
just a year later in 2004.

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For 70 years, we played
a game of leapfrog --

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our drug and their resistance,

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and then another drug,
and then resistance again --

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and now the game is ending.

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Bacteria develop resistance so quickly
that pharmaceutical companies

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have decided making antibiotics
is not in their best interest,

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so there are infections
moving across the world

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for which, out of the more
than 100 antibiotics

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available on the market,

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two drugs might work with side effects,

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or one drug,

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or none.

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This is what that looks like.

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In 2000, the Centers for Disease
Control and Prevention, the CDC,

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identified a single case

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in a hospital in North Carolina

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of an infection resistant
to all but two drugs.

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Today, that infection, known as KPC,

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has spread to every state but three,

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and to South America, Europe

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and the Middle East.

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In 2008, doctors in Sweden

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diagnosed a man from India
with a different infection

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resistant to all but one drug that time.

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The gene that creates that resistance,

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known as NDM, has now spread
from India into China, Asia, Africa,

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Europe and Canada, and the United States.

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It would be natural to hope

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that these infections
are extraordinary cases,

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but in fact,

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in the United States and Europe,

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50,000 people a year

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die of infections which no drugs can help.

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A project chartered
by the British government

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known as the Review
on Antimicrobial Resistance

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estimates that the worldwide toll
right now is 700,000 deaths a year.

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That is a lot of deaths,

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and yet, the chances are good
that you don't feel at risk,

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that you imagine these people
were hospital patients

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in intensive care units

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or nursing home residents
near the ends of their lives,

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people whose infections
are remote from us,

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in situations we can't identify with.

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What you didn't think about,
none of us do,

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is that antibiotics support
almost all of modern life.

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If we lost antibiotics,

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here's what else we'd lose:

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First, any protection for people
with weakened immune systems --

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cancer patients, AIDS patients,

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transplant recipients, premature babies.

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Next, any treatment that installs
foreign objects in the body:

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stents for stroke, pumps for diabetes,

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dialysis, joint replacements.

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How many athletic baby boomers
need new hips and knees?

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A recent study estimates
that without antibiotics,

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one out of ever six would die.

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Next, we'd probably lose surgery.

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Many operations are preceded

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by prophylactic doses of antibiotics.

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Without that protection,

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we'd lose the ability to open
the hidden spaces of the body.

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So no heart operations,

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no prostate biopsies,

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no Cesarean sections.

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We'd have to learn to fear infections
that now seem minor.

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Strep throat used to cause heart failure.

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Skin infections led to amputations.

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Giving birth killed,
in the cleanest hospitals,

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almost one woman out of every 100.

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Pneumonia took three children
out of every 10.

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More than anything else,

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we'd lose the confident way
we live our everyday lives.

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If you knew that any injury
could kill you,

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would you ride a motorcycle,

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bomb down a ski slope,

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climb a ladder to hang
your Christmas lights,

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let your kid slide into home plate?

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After all, the first person
to receive penicillin,

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a British policeman named
Albert Alexander,

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who was so ravaged by infection
that his scalp oozed pus

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and doctors had to take out an eye,

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was infected by doing
something very simple.

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He walked into his garden
and scratched his face on a thorn.

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That British project I mentioned
which estimates that the worldwide toll

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right now is 700,000 deaths a year

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also predicts that if we can't
get this under control by 2050,

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not long, the worldwide toll
will be 10 million deaths a year.

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How did we get to this point

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where what we have to look forward to

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is those terrifying numbers?

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The difficult answer is,
we did it to ourselves.

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Resistance is an inevitable
biological process,

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but we bear the responsibility
for accelerating it.

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We did this by squandering antibiotics

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with a heedlessness
that now seems shocking.

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Penicillin was sold
over the counter until the 1950s.

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In much of the developing world,
most antibiotics still are.

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In the United States, 50 percent

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of the antibiotics given
in hospitals are unnecessary.

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Forty-five percent of the prescriptions
written in doctor's offices

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are for conditions
that antibiotics cannot help.

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And that's just in healthcare.

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On much of the planet, most meat animals
get antibiotics every day of their lives,

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not to cure illnesses,

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but to fatten them up
and to protect them against

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the factory farm conditions
they are raised in.

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In the United States, possibly 80 percent

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of the antibiotics sold every year
go to farm animals, not to humans,

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creating resistant bacteria
that move off the farm

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in water, in dust,

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in the meat the animals become.

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Aquaculture depends on antibiotics too,

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particularly in Asia,

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and fruit growing relies on antibiotics

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to protect apples, pears,
citrus, against disease.

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And because bacteria can pass
their DNA to each other

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like a traveler handing off
a suitcase at an airport,

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once we have encouraged
that resistance into existence,

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there is no knowing where it will spread.

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This was predictable.

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In fact, it was predicted

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by Alexander Fleming,
the man who discovered penicillin.

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He was given the Nobel Prize
in 1945 in recognition,

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and in an interview shortly after,
this is what he said:

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"The thoughtless person playing
with penicillin treatment

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is morally responsible
for the death of a man

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who succumbs to infection

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with a pencillin-resistant organism."

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He added, "I hope this evil
can be averted."

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Can we avert it?

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There are companies working
on novel antibiotics,

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things the superbugs
have never seen before.

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We need those new drugs badly,

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and we need incentives:

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discovery grants, extended patents,

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prizes, to lure other companies
into making antibiotics again.

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But that probably won't be enough.

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Here's why: Evolution always wins.

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Bacteria birth a new generation
every 20 minutes.

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00:13:04,627 --> 00:13:09,410
It takes pharmaceutical chemistry
10 years to derive a new drug.

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Every time we use an antibiotic,

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we give the bacteria billions of chances

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to crack the codes

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of the defenses we've constructed.

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There has never yet been a drug

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they could not defeat.

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This is asymmetric warfare,

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but we can change the outcome.

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We could build systems to harvest data
to tell us automatically and specifically

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how antibiotics are being used.

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We could build gatekeeping
into drug order systems

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so that every prescription
gets a second look.

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We could require agriculture
to give up antibiotic use.

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We could build surveillance systems

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to tell us where resistance
is emerging next.

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Those are the tech solutions.

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They probably aren't enough either,

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unless we help.

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Antibiotic resistance is a habit.

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We all know how hard it is
to change a habit.

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But as a society,
we've done that in the past.

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People used to toss litter
into the streets,

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00:14:29,972 --> 00:14:31,737
used to not wear seatbelts,

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00:14:31,737 --> 00:14:35,994
used to smoke inside public buildings.

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We don't do those things anymore.

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We don't trash the environment

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or court devastating accidents

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or expose others
to the possibility of cancer,

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because we decided those things
were expensive,

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destructive, not in our best interest.

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We changed social norms.

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We could change social norms
around antibiotic use too.

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I know that the scale
of antibiotic resistance

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seems overwhelming,

257
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but if you've ever bought
a fluorescent lightbulb

258
00:15:13,138 --> 00:15:15,854
because you were concerned
about climate change,

259
00:15:15,854 --> 00:15:18,989
or read the label on a box of crackers

260
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because you think about
the deforestation from palm oil,

261
00:15:23,470 --> 00:15:26,349
you already know what it feels like

262
00:15:26,349 --> 00:15:31,349
to take a tiny step to address
an overwhelming problem.

263
00:15:31,829 --> 00:15:36,310
We could take those kinds of steps
for antibiotic use too.

264
00:15:36,310 --> 00:15:43,947
We could forgo giving an antibiotic
if we're not sure it's the right one.

265
00:15:44,251 --> 00:15:50,564
We could stop insisting on a prescription
for our kid's ear infection

266
00:15:50,564 --> 00:15:52,462
before we're sure what caused it.

267
00:15:53,678 --> 00:15:57,045
We could ask every restaurant,

268
00:15:57,045 --> 00:15:58,856
every supermarket,

269
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where their meat comes from.

270
00:16:00,806 --> 00:16:02,640
We could promise each other

271
00:16:02,640 --> 00:16:06,745
never again to buy chicken
or shrimp or fruit

272
00:16:06,745 --> 00:16:09,629
raised with routine antibiotic use,

273
00:16:09,629 --> 00:16:12,323
and if we did those things,

274
00:16:12,323 --> 00:16:16,815
we could slow down the arrival
of the post-antibiotic world.

275
00:16:17,547 --> 00:16:21,680
But we have to do it soon.

276
00:16:21,680 --> 00:16:26,185
Penicillin began
the antibiotic era in 1943.

277
00:16:26,185 --> 00:16:31,891
In just 70 years, we walked ourselves
up to the edge of disaster.

278
00:16:32,291 --> 00:16:34,613
We won't get 70 years

279
00:16:34,613 --> 00:16:38,339
to find our way back out again.

280
00:16:38,769 --> 00:16:40,279
Thank you very much.

281
00:16:40,789 --> 00:16:46,640
(Applause)