0:00:00.921,0:00:02.918
This is my great uncle,

0:00:02.918,0:00:05.936
my father's father's younger brother.

0:00:05.936,0:00:08.142
His name was Joe McKenna.

0:00:08.142,0:00:10.719
He was a young husband

0:00:10.719,0:00:13.320
and semi-pro basketball player

0:00:13.320,0:00:16.617
and a fireman in New York City.

0:00:16.617,0:00:20.007
Family history says[br]he loved being a fireman,

0:00:20.007,0:00:23.002
and so in 1938, on one of his days off,

0:00:23.002,0:00:27.019
he elected to hang out at the firehouse.

0:00:27.019,0:00:28.598
To make himself useful that day,

0:00:28.598,0:00:31.175
he started polishing all the brass,

0:00:31.175,0:00:34.612
the railings on the fire truck,[br]the fittings on the walls,

0:00:34.612,0:00:36.957
and one of the fire hose nozzles,

0:00:36.957,0:00:39.465
a giant, heavy piece of metal,

0:00:39.465,0:00:43.574
toppled off a shelf and hit him.

0:00:43.574,0:00:47.382
A few days later,[br]his shoulder started to hurt.

0:00:47.382,0:00:50.656
Two days after that, he spiked a fever.

0:00:50.656,0:00:53.141
The fever climbed and climbed.

0:00:53.141,0:00:55.091
His wife was taking care of him,

0:00:55.091,0:00:57.273
but nothing she did made a difference,[br]and when they got the local doctor in,

0:00:57.273,0:01:02.149
nothing he did mattered either.

0:01:02.149,0:01:04.030
They flagged down a cab

0:01:04.030,0:01:05.911
and took him to the hospital.

0:01:05.911,0:01:09.905
The nurses there recognized right away[br]that he had an infection,

0:01:09.905,0:01:14.061
what at the time they would[br]have called "blood poisoning,"

0:01:14.061,0:01:16.174
and though they probably didn't say it,

0:01:16.174,0:01:18.031
they would have known right away

0:01:18.031,0:01:21.770
that there was nothing they could do.

0:01:21.770,0:01:24.788
There was nothing they could do[br]because the things we use now

0:01:24.788,0:01:27.737
to cure infections didn't exist yet.

0:01:27.737,0:01:31.173
The first test of penicillin,[br]the first antibiotic,

0:01:31.173,0:01:33.843
was three years in the future.

0:01:33.843,0:01:37.767
People who got infections[br]either recovered, if they were lucky,

0:01:37.767,0:01:40.322
or they died.

0:01:40.322,0:01:42.411
My great uncle was not lucky:

0:01:42.411,0:01:45.708
he was in the hospital for a week,[br]shaking with chills,

0:01:45.708,0:01:47.566
dehydrated and delirious,

0:01:47.566,0:01:50.468
sinking into a coma as his organs failed.

0:01:50.468,0:01:52.604
His condition grew so desperate

0:01:52.604,0:01:54.624
that the people from his firehouse

0:01:54.624,0:01:57.364
lined up to give him transfusions

0:01:57.364,0:02:01.497
hoping to dilute the infection[br]surging through his blood.

0:02:01.497,0:02:05.143
Nothing worked. He died.

0:02:05.143,0:02:08.115
He was 30 years old.

0:02:08.115,0:02:10.088
If you look back through history,

0:02:10.088,0:02:13.362
most people died the way[br]my great uncle died.

0:02:13.362,0:02:16.032
Most people didn't die[br]of cancer or heart disease,

0:02:16.032,0:02:20.490
the lifestyle diseases that afflict us[br]in the West today.

0:02:20.490,0:02:24.229
They didn't die of those diseases[br]because they didn't live long enough

0:02:24.229,0:02:26.225
to develop them.

0:02:26.225,0:02:28.338
They died of injuries

0:02:28.338,0:02:30.823
-- being gored by an ox,

0:02:30.823,0:02:32.727
shot on a battlefield,

0:02:32.727,0:02:36.465
crushed in one of the new factories[br]of the Industrial Revolution --

0:02:36.465,0:02:39.846
and most of the time from infection,

0:02:39.846,0:02:43.352
which finished what those injuries began.

0:02:43.352,0:02:46.184
All of that changed

0:02:46.184,0:02:48.599
when antibiotics arrived.

0:02:48.599,0:02:52.198
Suddenly, infections that had[br]been a death sentence

0:02:52.198,0:02:55.588
became something[br]you recovered from in days.

0:02:55.588,0:02:58.630
It seemed like a miracle,

0:02:58.630,0:03:05.294
and ever since, we have been living inside[br]the golden epoch of the miracle drugs.

0:03:05.294,0:03:09.241
And now, we are coming to an end of it.

0:03:09.241,0:03:14.303
My great uncle died in the last days[br]of the pre-antibiotic era.

0:03:14.303,0:03:19.457
We stand today on the threshold[br]of the post-antibiotic era,

0:03:19.457,0:03:23.219
in the earliest days of the time[br]when simple infections

0:03:23.219,0:03:25.308
such as the one Joe had

0:03:25.308,0:03:28.884
will kill people once again.

0:03:28.884,0:03:32.785
In fact, they already are.

0:03:32.785,0:03:35.618
People are dying of infections again[br]because of a phenomenon

0:03:35.618,0:03:38.381
called antibiotic resistance.

0:03:38.381,0:03:40.819
Briefly, it works like this.

0:03:40.819,0:03:45.091
Bacteria compete against each other[br]for resources, for food,

0:03:45.091,0:03:49.758
by manufacturing lethal compounds[br]that they direct against each other.

0:03:49.758,0:03:52.103
Other bacteria, to protect themselves,

0:03:52.103,0:03:55.354
evolve defenses against[br]that chemical attack.

0:03:55.354,0:03:57.676
When we first made antibiotics,

0:03:57.676,0:04:01.878
we took those compounds into the lab[br]and made our own versions of them,

0:04:01.878,0:04:04.386
and bacteria responded to our attack

0:04:04.386,0:04:06.894
they way they always have.

0:04:06.894,0:04:10.098
Here is what happened next.

0:04:10.098,0:04:13.488
Penicillin was distributed in 1943,

0:04:13.488,0:04:18.619
and widespread penicillin resistance[br]arrived by 1945.

0:04:18.619,0:04:21.568
Vancomycin arrived in 1972,

0:04:21.568,0:04:25.028
vancomycin resistance in 1988.

0:04:25.028,0:04:27.150
Inipenem in 1985,

0:04:27.150,0:04:30.192
and resistance to in 1998.

0:04:30.192,0:04:33.860
Daptomycin, one of[br]the most recent drugs, in 2003,

0:04:33.860,0:04:38.225
and resistance to it[br]just a year later in 2004.

0:04:38.225,0:04:42.335
For 70 years, we played[br]a game of leapfrog,

0:04:42.335,0:04:45.261
our drug and their resistance,

0:04:45.261,0:04:48.906
and then another drug,[br]and then resistance again,

0:04:48.906,0:04:51.437
and now the game is ending.

0:04:51.437,0:04:55.477
Bacteria develop resistance so quickly[br]that pharmaceutical companies

0:04:55.477,0:04:59.842
have decided making antibiotics[br]is not in their best interest,

0:04:59.842,0:05:02.652
so there are infections[br]moving across the world

0:05:02.652,0:05:06.111
for which, out of the more[br]than 100 antibiotics

0:05:06.111,0:05:08.340
available on the market,

0:05:08.340,0:05:11.754
two drugs might work with side effects,

0:05:11.754,0:05:14.238
or one drug,

0:05:14.238,0:05:16.096
or none.

0:05:16.096,0:05:18.278
This is what that looks like.

0:05:18.278,0:05:22.458
In 2000, the Centers for Disease[br]Control and Prevention, the CDC,

0:05:22.458,0:05:24.501
identified a single case

0:05:24.501,0:05:26.753
in a hospital in North Carolina

0:05:26.753,0:05:30.886
of an infection resistant[br]to all but two drugs.

0:05:30.886,0:05:35.205
Today, that infection, known as KPC,

0:05:35.205,0:05:37.805
has spread to every state but three,

0:05:37.805,0:05:40.150
and to South America, Europe,

0:05:40.150,0:05:42.867
and the Middle East.

0:05:42.867,0:05:45.189
In 2008, doctors in Sweden

0:05:45.189,0:05:47.975
diagnosed a man from India[br]with a different infection

0:05:47.975,0:05:51.690
resistant to all but one drug that time.

0:05:51.690,0:05:53.919
The gene that creates that resistance,

0:05:53.919,0:06:00.444
known as NDM, has now spread[br]from India into China, Asia, Africa,

0:06:00.444,0:06:04.809
Europe, and Canada, and the United States.

0:06:04.809,0:06:07.688
It would be natural to hope

0:06:07.688,0:06:11.287
that these infections[br]are extraordinary cases,

0:06:11.287,0:06:13.145
but in fact,

0:06:13.145,0:06:15.606
in the United States and Europe,

0:06:15.606,0:06:18.322
50,000 people a year

0:06:18.322,0:06:22.966
die of infections which no drugs can help.

0:06:22.966,0:06:26.008
A project chartered[br]by the British government

0:06:26.008,0:06:29.746
known as the Review[br]on Antimicrobial Resistance

0:06:29.746,0:06:31.998
estimates that the worldwide toll

0:06:31.998,0:06:38.291
right now is 700,000 deaths a year.

0:06:38.291,0:06:41.425
That is a lot of deaths,

0:06:41.425,0:06:45.767
and yet, the chances are good[br]that you don't feel at risk,

0:06:45.767,0:06:48.995
that you imagine these people[br]were hospital patients

0:06:48.995,0:06:50.713
in intensive care units

0:06:50.713,0:06:54.660
or nursing home residents[br]near the ends of their lives,

0:06:54.660,0:06:57.841
people whose infections[br]are remote from us,

0:06:57.841,0:07:01.045
in situations we can't identify with.

0:07:01.045,0:07:04.342
What you didn't think about,

0:07:04.342,0:07:05.829
none of us do,

0:07:05.829,0:07:07.918
is that antibiotics support

0:07:07.918,0:07:11.401
almost all of modern life.

0:07:11.401,0:07:13.932
If we lost antibiotics,

0:07:13.932,0:07:15.836
here's what else we'd lose.

0:07:15.836,0:07:20.015
First, any protection for people[br]with weakened immune systems:

0:07:20.015,0:07:23.475
cancer patients, AIDS patients,

0:07:23.475,0:07:27.979
transplant recipients, premature babies.

0:07:27.979,0:07:32.391
Next, any treatment that installs[br]foreign objects in the body:

0:07:32.391,0:07:36.269
stents for stroke, pumps for diabetes,

0:07:36.269,0:07:40.193
dialysis, joint replacements.

0:07:40.193,0:07:43.908
How many athletic baby boomers[br]need new hips and knees?

0:07:43.908,0:07:46.717
A recent study estimates[br]that without antibiotics,

0:07:46.717,0:07:50.664
one out of ever six would die.

0:07:50.664,0:07:53.869
Next, we'd probably lose surgery.

0:07:53.869,0:07:56.191
Many operations are preceded

0:07:56.191,0:07:59.139
by prophylactic doses of antibiotics.

0:07:59.139,0:08:00.811
Without that protection,

0:08:00.811,0:08:05.015
we'd lose the ability to open[br]the hidden spaces of the body.

0:08:05.015,0:08:07.848
So no heart operations,

0:08:07.848,0:08:10.680
no prostate biopsies,

0:08:10.680,0:08:13.792
no Caesarean sections.

0:08:13.792,0:08:18.784
We'd have to learn to fear infections[br]that now seem minor.

0:08:18.784,0:08:22.592
Strep throat used to cause heart failure.

0:08:22.592,0:08:25.819
Skin infections led to amputations.

0:08:25.819,0:08:28.722
Giving birth killed[br]in the cleanest hospitals

0:08:28.722,0:08:31.717
almost one woman out of every hundred.

0:08:31.717,0:08:37.220
Pneumonia took three children[br]out of every 10.

0:08:37.220,0:08:39.333
More than anything else,

0:08:39.333,0:08:41.608
we'd lose the confident way

0:08:41.608,0:08:44.836
we live our everyday lives.

0:08:44.836,0:08:46.159
If you knew

0:08:46.159,0:08:48.643
that any injury could kill you,

0:08:48.643,0:08:52.289
would you ride a motorcycle,

0:08:52.289,0:08:54.820
bomb down a ski slope,

0:08:54.820,0:08:58.976
climb a ladder to hang[br]your Christmas lights,

0:08:58.976,0:09:03.573
let your kid slide into home plate?

0:09:03.573,0:09:06.638
After all, the first person[br]to receive penicillin,

0:09:06.638,0:09:10.516
a British policeman named[br]Albert Alexander,

0:09:10.516,0:09:14.858
who was so ravaged by infection[br]that his scalp oozed pus

0:09:14.858,0:09:17.783
and doctors had to take out an eye,

0:09:17.783,0:09:22.172
was infected by doing[br]something very simple.

0:09:22.172,0:09:24.238
He walked into his garden

0:09:24.238,0:09:27.953
and scratched his face on a thorn.

0:09:29.161,0:09:32.481
That British project I mentioned[br]which estimates that the worldwide toll

0:09:32.481,0:09:36.358
right now is 700,000 deaths a year

0:09:36.358,0:09:42.535
also predicts that if we can't[br]get this under control by 2050,

0:09:42.535,0:09:50.127
not long, the worldwide toll[br]will be 10 million deaths a year.

0:09:50.127,0:09:53.169
How did we get to this point

0:09:53.169,0:09:54.864
where what we have to look forward to

0:09:54.864,0:09:58.347
is those terrifying numbers?

0:09:58.347,0:10:02.875
The difficult answer is,[br]we did it to ourselves.

0:10:02.875,0:10:05.847
Resistance is an inevitable[br]biological process,

0:10:05.847,0:10:10.490
but we bear the responsibility[br]for accelerating it.

0:10:10.490,0:10:14.043
We did this by squandering antibiotics

0:10:14.043,0:10:18.131
with a heedlessness[br]that now seems shocking.

0:10:19.408,0:10:23.494
Penicillin was sold[br]over the counter until the 1950s.

0:10:23.494,0:10:27.209
In much of the developing world,[br]most antibiotics still are.

0:10:27.209,0:10:30.321
In the United States, 50 percent

0:10:30.321,0:10:34.663
of the antibiotics given[br]in hospitals are unnecessary.

0:10:34.663,0:10:38.587
Forty-five percent of the prescriptions[br]written in doctor's offices

0:10:38.587,0:10:40.700
are for conditions

0:10:40.700,0:10:44.577
that antibiotics cannot help.

0:10:44.577,0:10:47.247
And that's just in health care.

0:10:47.247,0:10:52.100
On much of the planet, most meat animals[br]get antibiotics every day of their lives,

0:10:52.100,0:10:54.376
not to cure illnesses,

0:10:54.376,0:10:57.835
but to fatten them up[br]and to protect them against

0:10:57.835,0:11:01.806
the factory farm conditions[br]they are raised in.

0:11:01.806,0:11:04.824
In the United States, possibly 80 percent

0:11:04.824,0:11:07.564
of the antibiotics sold every year

0:11:07.564,0:11:11.697
go to farm animals, not to humans,

0:11:11.697,0:11:15.203
creating resistant bacteria[br]that move off the farm

0:11:15.203,0:11:17.827
in water, in dust,

0:11:17.827,0:11:20.985
in the meat the animals become.

0:11:20.985,0:11:23.910
Aquaculture depends on antibiotics too,

0:11:23.910,0:11:25.559
particularly in Asia,

0:11:25.559,0:11:28.902
and fruit growing relies on antibiotics

0:11:28.902,0:11:33.801
to protect apples, pears,[br]citrus, against disease.

0:11:33.801,0:11:40.117
And because bacteria can pass[br]their DNA to each other

0:11:40.117,0:11:44.552
like a traveler handing off[br]a suitcase at an airport,

0:11:44.552,0:11:48.360
once we have encouraged[br]that resistance into existence,

0:11:48.360,0:11:51.587
there is no knowing where it will spread.

0:11:53.723,0:11:55.674
This was predictable.

0:11:55.674,0:11:58.506
In fact, it was predicted

0:11:58.506,0:12:02.941
by Alexander Fleming,[br]the man who discovered penicillin.

0:12:02.941,0:12:06.935
He was given the Nobel Prize[br]in 1945 in recognition,

0:12:06.935,0:12:11.602
and in an interview shortly after,[br]this is what he said.

0:12:11.602,0:12:15.549
"The thoughtless playing[br]with penicillin treatment

0:12:15.549,0:12:18.823
is morally responsible[br]for the death of a man

0:12:18.823,0:12:21.147
who succumbs to infection

0:12:21.147,0:12:24.050
with a pencillin-resistant organism."

0:12:24.050,0:12:27.175
He added, "I hope this evil[br]can be averted."

0:12:28.986,0:12:31.842
Can we avert it?

0:12:31.842,0:12:35.510
There are companies working[br]on novel antibiotics,

0:12:35.510,0:12:39.086
things the superbugs[br]have never seen before.

0:12:39.086,0:12:41.803
We need those new drugs badly,

0:12:41.803,0:12:44.055
and we need incentives:

0:12:44.055,0:12:46.586
discovery grants, extended patents,

0:12:46.586,0:12:53.343
prizes, to lure other companies[br]into making antibiotics again.

0:12:53.343,0:12:56.059
But that probably won't be enough.

0:12:56.059,0:13:00.703
Here's why: evolution always wins.

0:13:00.703,0:13:04.627
Bacteria birth a new generation[br]every 20 minutes.

0:13:04.627,0:13:09.410
It takes pharmaceutical chemistry[br]10 years to derive a new drug.

0:13:09.410,0:13:12.266
Every time we use an antibiotic,

0:13:12.266,0:13:15.540
we give the bacteria billions of chances

0:13:15.540,0:13:17.281
to crack the codes

0:13:17.281,0:13:20.486
of the defenses we've constructed.

0:13:20.486,0:13:22.877
There has never yet been a drug

0:13:22.877,0:13:25.431
they could not defeat.

0:13:25.431,0:13:28.961
This is asymmetric warfare,

0:13:28.961,0:13:33.929
but we can change the outcome.

0:13:33.929,0:13:37.714
We could build systems to harvest data

0:13:37.714,0:13:40.524
to tell us automatically and specifically

0:13:40.524,0:13:43.263
how antibiotics are being used.

0:13:43.263,0:13:46.096
We could use gatekeeping[br]into drug order systems

0:13:46.096,0:13:49.811
so that every prescription[br]gets a second look.

0:13:49.811,0:13:53.480
We could require agriculture

0:13:53.480,0:13:56.243
to give up antibiotic use.

0:13:56.243,0:13:59.275
We could build surveillance systems

0:13:59.275,0:14:03.501
to tell us where resistance[br]is emerging next.

0:14:03.501,0:14:06.264
Those are the tech solutions.

0:14:06.264,0:14:08.888
They probably aren't enough either,

0:14:08.888,0:14:12.117
unless we help.

0:14:15.785,0:14:18.479
Antibiotic resistance is a habit.

0:14:18.479,0:14:21.567
We all know how hard it is[br]to change a habit.

0:14:21.567,0:14:26.397
But as a society,[br]we've done that in the past.

0:14:26.397,0:14:29.972
People used to toss litter[br]into the streets,

0:14:29.972,0:14:31.737
used to not wear seatbelts,

0:14:31.737,0:14:36.404
used to smoke inside public buildings.

0:14:36.404,0:14:39.144
We don't do those things anymore.

0:14:39.144,0:14:41.466
We don't trash the environment

0:14:41.466,0:14:44.623
or court devastating accidents

0:14:44.623,0:14:47.595
or expose others[br]to the possibility of cancer,

0:14:47.595,0:14:51.102
because we decided those things[br]were expensive,

0:14:51.102,0:14:55.815
destructive, not in our best interest.

0:14:55.815,0:14:59.135
We changed social norms.

0:14:59.135,0:15:03.279
We could change social norms[br]around antibiotic use too.

0:15:05.499,0:15:07.774
I know that the scale[br]of antibiotic resistance

0:15:07.774,0:15:09.678
seems overwhelming,

0:15:09.678,0:15:13.138
but if you've ever bought[br]a fluorescent light bulb

0:15:13.138,0:15:15.854
because you were concerned[br]about climate change,

0:15:15.854,0:15:18.989
or read the label on a box of crackers

0:15:18.989,0:15:23.470
because you think about[br]the deforestation from palm oil,

0:15:23.470,0:15:26.349
you already know what it feels like

0:15:26.349,0:15:31.829
to take a tiny step to address[br]an overwhelming problem.

0:15:31.829,0:15:36.310
We could take those kinds of steps[br]for antibiotic use too.

0:15:36.310,0:15:38.237
We could forego

0:15:38.237,0:15:40.815
giving an antibiotic

0:15:40.815,0:15:44.251
if we're not sure it's the right one.

0:15:44.251,0:15:47.664
We could stop insisting on a prescription

0:15:47.664,0:15:50.520
for our kid's ear infection

0:15:50.520,0:15:52.772
before we're sure what caused it.

0:15:53.678,0:15:57.045
We could ask every restaurant,

0:15:57.045,0:15:58.856
every supermarket,

0:15:58.856,0:16:00.806
where their meat comes from.

0:16:00.806,0:16:02.640
We could promise each other

0:16:02.640,0:16:04.475
never again to buy chicken

0:16:04.475,0:16:06.657
or shrimp or fruit

0:16:06.657,0:16:09.629
raised with routine antibiotic use,

0:16:09.629,0:16:12.323
and if we did those things,

0:16:12.323,0:16:14.645
we could slow down the arrival

0:16:14.645,0:16:17.547
of the post-antibiotic world.

0:16:17.547,0:16:21.680
But we have to do it soon.

0:16:21.680,0:16:26.185
Penicillin began[br]the antibiotic era in 1943.

0:16:26.185,0:16:32.291
In just 70 years, we walked ourselves[br]up to the edge of disaster.

0:16:32.291,0:16:34.613
We won't get 70 years

0:16:34.613,0:16:38.769
to find our way back out again.

0:16:38.769,0:16:40.789
Thank you very much.

0:16:40.789,0:16:46.640
(Applause)