my father's father's younger brother.
He was a young husband and a semi-pro basketball player
and a fireman in New York City.
Family history says he loved being a fireman,
and so in 1938, on one of his days off,
he elected to hang out at the firehouse.
To make himself useful that day, he started polishing all the brass,
the railings on the fire truck, the fittings on the walls,
and one of the fire hose nozzles,
a giant, heavy piece of metal,
toppled off a shelf and hit him.
A few days later, his shoulder started to hurt.
Two days after that, he spiked a fever.
The fever climbed and climbed.
His wife was taking care of him,
but nothing she did made a difference, and when they got the local doctor in,
nothing he did mattered either.
They flagged down a cab and took him to the hospital.
The nurses there recognized right away that he had an infection,
what at the time they would have called "blood poisoning,"
and though they probably didn't say it,
they would have known right away
that there was nothing they could do.
There was nothing they could do because the things we use now
to cure infections didn't exist yet.
The first test of penicillin, the first antibiotic,
was three years in the future.
People who got infections either recovered, if they were lucky,
He was in the hospital for a week, shaking with chills,
sinking into a coma as his organs failed.
His condition grew so desperate
that the people from his firehouse lined up to give him transfusions
hoping to dilute the infection surging through his blood.
If you look back through history,
most people died the way my great uncle died.
Most people didn't die of cancer or heart disease,
the lifestyle diseases that afflict us in the West today.
They didn't die of those diseases because they didn't live long enough
crushed in one of the new factories of the Industrial Revolution --
and most of the time from infection,
which finished what those injuries began.
All of that changed when antibiotics arrived.
Suddenly, infections that had been a death sentence
became something you recovered from in days.
and ever since, we have been living inside the golden epoch of the miracle drugs.
And now, we are coming to an end of it.
My great uncle died in the last days of the pre-antibiotic era.
We stand today on the threshold of the post-antibiotic era,
in the earliest days of a time when simple infections
such as the one Joe had will kill people once again.
People are dying of infections again because of a phenomenon
Bacteria compete against each other for resources, for food,
by manufacturing lethal compounds that they direct against each other.
Other bacteria, to protect themselves,
evolve defenses against that chemical attack.
When we first made antibiotics,
we took those compounds into the lab and made our own versions of them,
and bacteria responded to our attack the way they always had.
Penicillin was distributed in 1943,
and widespread penicillin resistance arrived by 1945.
Vancomycin arrived in 1972,
vancomycin resistance in 1988.
and resistance to in 1998.
Daptomycin, one of the most recent drugs, in 2003,
and resistance to it just a year later in 2004.
For 70 years, we played a game of leapfrog --
our drug and their resistance,
and then another drug, and then resistance again --
Bacteria develop resistance so quickly that pharmaceutical companies
have decided making antibiotics is not in their best interest,
so there are infections moving across the world
for which, out of the more than 100 antibiotics
two drugs might work with side effects,
In 2000, the Centers for Disease Control and Prevention, the CDC,
in a hospital in North Carolina
of an infection resistant to all but two drugs.
Today, that infection, known as KPC,
has spread to every state but three,
diagnosed a man from India with a different infection
resistant to all but one drug that time.
The gene that creates that resistance,
known as NDM, has now spread from India into China, Asia, Africa,
Europe and Canada, and the United States.
that these infections are extraordinary cases,
in the United States and Europe,
die of infections which no drugs can help.
A project chartered by the British government
known as the Review on Antimicrobial Resistance
estimates that the worldwide toll right now is 700,000 deaths a year.
and yet, the chances are good that you don't feel at risk,
that you imagine these people were hospital patients
or nursing home residents near the ends of their lives,
people whose infections are remote from us,
in situations we can't identify with.
What you didn't think about, none of us do,
is that antibiotics support almost all of modern life.
First, any protection for people with weakened immune systems --
cancer patients, AIDS patients,
transplant recipients, premature babies.
Next, any treatment that installs foreign objects in the body:
stents for stroke, pumps for diabetes,
How many athletic baby boomers need new hips and knees?
A recent study estimates that without antibiotics,
one out of ever six would die.
Next, we'd probably lose surgery.
by prophylactic doses of antibiotics.
we'd lose the ability to open the hidden spaces of the body.
We'd have to learn to fear infections that now seem minor.
Strep throat used to cause heart failure.
Skin infections led to amputations.
Giving birth killed, in the cleanest hospitals,
almost one woman out of every 100.
Pneumonia took three children out of every 10.
we'd lose the confident way we live our everyday lives.
If you knew that any injury could kill you,
climb a ladder to hang your Christmas lights,
let your kid slide into home plate?
After all, the first person to receive penicillin,
a British policeman named Albert Alexander,
who was so ravaged by infection that his scalp oozed pus
and doctors had to take out an eye,
was infected by doing something very simple.
He walked into his garden and scratched his face on a thorn.
That British project I mentioned which estimates that the worldwide toll
right now is 700,000 deaths a year
also predicts that if we can't get this under control by 2050,
not long, the worldwide toll will be 10 million deaths a year.
where what we have to look forward to
The difficult answer is, we did it to ourselves.
Resistance is an inevitable biological process,
but we bear the responsibility for accelerating it.
We did this by squandering antibiotics
with a heedlessness that now seems shocking.
Penicillin was sold over the counter until the 1950s.
In much of the developing world, most antibiotics still are.
In the United States, 50 percent
of the antibiotics given in hospitals are unnecessary.
Forty-five percent of the prescriptions written in doctor's offices
are for conditions that antibiotics cannot help.
And that's just in healthcare.
On much of the planet, most meat animals get antibiotics every day of their lives,
but to fatten them up and to protect them against
the factory farm conditions they are raised in.
In the United States, possibly 80 percent
of the antibiotics sold every year go to farm animals, not to humans,
creating resistant bacteria that move off the farm
in the meat the animals become.
Aquaculture depends on antibiotics too,
and fruit growing relies on antibiotics
to protect apples, pears, citrus, against disease.
And because bacteria can pass their DNA to each other
like a traveler handing off a suitcase at an airport,
once we have encouraged that resistance into existence,
there is no knowing where it will spread.
by Alexander Fleming, the man who discovered penicillin.
He was given the Nobel Prize in 1945 in recognition,
and in an interview shortly after, this is what he said:
"The thoughtless person playing with penicillin treatment
is morally responsible for the death of a man
with a pencillin-resistant organism."
He added, "I hope this evil can be averted."
There are companies working on novel antibiotics,
things the superbugs have never seen before.
We need those new drugs badly,
discovery grants, extended patents,
prizes, to lure other companies into making antibiotics again.
But that probably won't be enough.
Here's why: Evolution always wins.
Bacteria birth a new generation every 20 minutes.
It takes pharmaceutical chemistry 10 years to derive a new drug.
Every time we use an antibiotic,
we give the bacteria billions of chances
of the defenses we've constructed.
There has never yet been a drug
but we can change the outcome.
We could build systems to harvest data to tell us automatically and specifically
how antibiotics are being used.
We could build gatekeeping into drug order systems
so that every prescription gets a second look.
We could require agriculture to give up antibiotic use.
We could build surveillance systems
to tell us where resistance is emerging next.
They probably aren't enough either,
Antibiotic resistance is a habit.
We all know how hard it is to change a habit.
But as a society, we've done that in the past.
People used to toss litter into the streets,
used to smoke inside public buildings.
We don't do those things anymore.
We don't trash the environment
or court devastating accidents
or expose others to the possibility of cancer,
because we decided those things were expensive,
destructive, not in our best interest.
We could change social norms around antibiotic use too.
I know that the scale of antibiotic resistance
but if you've ever bought a fluorescent lightbulb
because you were concerned about climate change,
or read the label on a box of crackers
because you think about the deforestation from palm oil,
you already know what it feels like
to take a tiny step to address an overwhelming problem.
We could take those kinds of steps for antibiotic use too.
We could forgo giving an antibiotic if we're not sure it's the right one.
We could stop insisting on a prescription for our kid's ear infection
before we're sure what caused it.
We could ask every restaurant,
never again to buy chicken or shrimp or fruit
raised with routine antibiotic use,
we could slow down the arrival of the post-antibiotic world.
Penicillin began the antibiotic era in 1943.
In just 70 years, we walked ourselves up to the edge of disaster.
to find our way back out again.
(Applause)