"Have you ever taken an antibiotic?" "And did you really need this miracle medicine?" "Tonight, Panorama investigates the rise of superbugs, organisms that may soon defeat everything modern medicine can throw at them." "This is our worst nightmare really, taking us back to the Stone Age." "Everything we take for granted in medicine would go." "So what happens if the drugs stop working?" "It's terrifying." "Because if I get an infection and the antibiotics don't clear that infection, well, my future's grim." "Some superbugs are now resistant to nearly every antibiotic." "If they all fail, the consequences would be horrendous." "We have to get on top of this or people will lose modern medicine, modern cancer therapy won't be possible." "Antibiotic resistance could be apocalyptic." "Worldwide, that danger is being increased by a lack of controls on antibiotics, some which are the last line of defence for the NHS." "In India we set out to buy these drugs, no questions asked." "Thank you very much." "Simple as that." "Most of us take these pills for granted." "Antibiotics can cure bacterial infections that used to kill millions, but one by one, they are losing their potency." "And replacement antibiotics simply aren't coming through." "The drug pipeline is running dry." "The Government's chief medical advisor says that could have terrifying consequences." "In the first half of the last century, 43% of people died of infection." "That was before we had antibiotics." "We risk going back to that sort of scenario." "Last year, the Prime Minister, told me there was to be an independent review into antibiotic resistance and he issued a stark warning about the dangers posed by superbugs." "I think this is a very serious threat." "We are in danger of going back to the dark ages of medicine." "We have to grip it globally, because this is a problem that's going to affect every country in the world." "The man leading that review is not a scientist or a doctor but former chief economist for the investment bank Goldman Sachs." "Jim O'Neill is now based at London's welcome trust medical charity." "We met before joining him on a fact-finding trip to India to hear his assessment of the cost of a world without antibiotics." "If we don't solve this problem, in 35 years' time, there's going to be ten million people a year dying from this." "The world will have lost $100 trillion of output." "In Europe, superbug infections are already responsible for at least 25,000 deaths a year." "Drug-resistant strains of E-coli, C diff, MRSA, and TB are just some of the threats facing hospitals like the 700-bed Royal Liverpool." "It's radically redesigned some of its wards to limit the spread of infection." "On this unit, patients are nursed in specially segregated rooms." "This was a 26-bed ward." "We've got 13 single rooms, special isolation rooms, usually in doubles with an antechamber." "That needs lots of space." "Everything is designed to prevent the spread of infection - from costly air pressure controls to strict hygiene measures." "You can see, we've got them in individual rooms." "They have got their own toilet and shower." "We put on gowns to protect ourselves, stop us picking up bugs and passing them on to others." "On open wards, these are the patients they need to protect from bugs." "Graham has only just been moved here, after weeks in isolation with a drug-resistant blood infection." "Good afternoon, Graham." "Are you all right?" "Yes, thank you." "The toxins produced by the infection had begun to attack his brain." "I think you were quite confused because you had a really severe infection." "Yeah." "You've had several water infections." "I know." "That causes sepsis syndrome." "That means you were delirious in the old-fashioned sense." "Oh, yes." "I didn't realise I'd had such a bad infection." "You had and you probably don't remember that one of those recurring infections was actually quite a resistant bug and we had to give you special antibiotics." "Without the antibiotics I would have been brown bread." "I just didn't realise I had such a powerful infection." "For his wife, Gill, it's been a worrying time." "It was very upsetting, but I realised it was the infection." "We had to change to another antibiotic because it's not doing its job." "But he was on antibiotics and pain killers." "Obviously, it was a build up and that's why he wasn't quite all there sometimes." "Graham's life was saved by antibiotics." "But if the dwindling number of effective drugs fail, doctors would be left powerless." "This is our worst nightmare really." "It would be taking us back to the Stone Age." "Everything we take for granted in medicine would go." "Treating somebody with blood poisoning, people getting infections after giving birth, most kinds of surgery, hip replacements, cancer treatment of all sorts would all just go by the wayside." "Given that antibiotics are so precious, why have they been so misused?" "I think we were very complacent in the 70s and 80s in particular." "We had lots of antibiotics." "We were more indiscriminate, and I think the general population expected to be treated with an antibiotic every time they saw their doctor." "Antibiotics are vital to prevent infection following surgery." "Transplant patients are especially vulnerable, as their immune system is suppressed to prevent organ rejection." "Kathy has just been given a new kidney." "Hi, Kathy." "Hello there." "I've caught you just before you take your antibiotics." "How important are those for you since you've had your kidney transplant?" "For me, antibiotics are life saving." "I can't afford to catch an infection." "It could cause me to reject the kidney and it's life saving." "So who gave you a kidney?" "My eldest son and I'm very proud of him." "It's saved my life." "I'm quite emotional and still overwhelmed by it all." "So the idea of being plunged back into the pre-antibiotic era for somebody like you..." "It's terrifying, yeah." "Because if I get an infection and the antibiotics don't clear that infection, well, my future's grim." "ARCHIVE:" "A miracle out of mould, this evil looking fungus would still be regarded as a pest, were it not for a brilliant doctor, Professor" "Alexander Fleming of St Mary's Hospital, London, who produced the drug known as penicillin." "The marvellous new cure..." "This is the lab where Fleming discovered penicillin in 1928, a breakthrough that has saved millions of lives and revolutionised medicine." "Fleming himself warned that misusing antibiotics would lead to the rise of dangerous drug-resistant bugs." "Today, antibiotic development is in the hands of pharmaceutical giants like GlaxoSmithKline." "There are now around 200 of these drugs, but the last entirely new class of antibiotics was discovered back in the '80s." "GSK has spent $1 billion over the past decade on antibiotic research but has failed to deliver a single new drug." "We haven't been successful in making a new class of antibiotic." "We were close with one, but fell over, as often happens, quite late in the process." "It fell over, was that because of drug resistance?" "Resistance, I mean, almost immediately it started showing resistance, so the bugs got round it quickly, much to our surprise." "And is that, in a sense, an indication of just how difficult this area is?" "This area is really tough." "I mean bugs exist in hostile chemical environments." "They resist chemicals, they kick them out, they deal with them, they get resistant to them." "Any new antibiotic that is created will be used as sparingly as possible to preserve its potency." "That's not the best recipe for profit and one reason why many big pharma companies have pulled out of antibiotic research." "Take $1 billion to build a drug, 10, 15 years." "If you spend that money, that time, you invest in it, you make an antibiotic that's really important for the world, the world says, I want that on the shelf because I don't want" "resistance immediately, I will keep it on the shelf for ten years." "At that point, maybe a patent's run out, that's not a great business model." "You wouldn't get your return?" "You wouldn't get any return." "You'd sink a lot of cost and there's only a limited number of times any company can do that." "While drug development has stalled, bacteria never stop evolving." "They grow at remarkable speed and every time we take an antibiotic it presents an opportunity for a new resistant strain to emerge." "Bacteria have been around millions and millions and millions of years compared to us." "We shouldn't underestimate them." "There is the phrase:" "they're older than us, they're cleverer than us, and they're wiser than us." "Professor Laura Piddick is one of the UK's leading microbiologists." "She showed us bacteria from patient samples where antibiotics, which used to be effective, have failed due to resistance." "On this plate we've got bacteria growing on the surface and these dots are little filter paper discs with antibiotics in them." "These antibiotics you could treat a patient with." "You can see that where there's this big zone, this clear zone here, that's where the antibiotic is killing the bacteria." "Interestingly there's two dots growing here." "These are bacteriathat are resistant to that antibiotic." "If you look at all these other filter paper discs, the bacteria goes right up to the edge." "That's because they're resistant." "Some of these are our most powerful antibiotics." "None of these will be able to treat a patient." "Those two spots there are antibiotic resistance emerging before our eyes." "Absolutely." "The NHS now relies on just one class of antibiotics to deal with resistant bugs that cause pneumonia and blood infections." "Sold under various names, they're collectively known as carbapenems." "They are our last resort, really strong drugs for really powerful bugs that kill, and the resistance is growing across the world, particularly bad in some countries." "We see health tourism, people coming back from India, with these resistant bugs and people die of them." "The booming global population means the need for antibiotics has never been greater." "India is helping to satisfy that desire, with factories churning out millions of medicine's magic bullets every day." "But the more antibiotics that are consumed and taken inappropriately, the greater the chance drug resistance will emerge." "With a population of 1.25 billion, it's here in India that more antibiotics are now used than anywhere else." "But a combination of poor sanitation and widespread misuse of those drugs make it a perfect setting for the rise of superbugs." "And air travel means those bugs can cross the world in hours, making emerging nations like India crucial to solving the antibiotics crisis, which is why Jim O'Neill has come to the capital," "Delhi, to meet key players here." "There's no point, particularly given my background, me just speaking to medical people." "I've got to get all the finance and economics people on board." "The challenge is how to turn the talk and good intentions into action." "He knows India's economy has enormous potential, but amid the wealth, there is still massive poverty." "Millions live without clean water or sanitation." "This drives the spread of infection." "As do the polluted waters of this tributary of the Ganges, which is teeming with bacterial life." "This stinking river water is contaminated with human waste." "Just one reason why drug-resistant microbes are so entrenched in India." "And that poses a particular threat to the weak and vulnerable, such as newborns." "Around 60,000 newborns are estimated to die in India each year from drug-resistant infections." "Antibiotics that worked just a few years ago are now useless against many bacteria." "This hospital in Ahmedabad, in western India, delivers more than 8,000 babies a year." "If anywhere marks the front-line of the war against superbugs, this is it." "This is a neonatal intensive care unit, where we have these babies who are twins, one is a boy, the other is a girl." "They are born to a 32-year-old mother." "These twins are fighting for life." "Born premature, they're being given carbapenems, those last-ditch antibiotics used the world over for severe infections." "Does it scare you that the drugs that you have are being reduced one by one as the bugs become resistant to more and more antibiotics?" "Yes, it does scare us." "It makes us feel frustrated because, previously, our drugs used to work, now they have stopped working." "I feel they will all die without antibiotics." "At some point, they need it because their defences are low and they are quite vulnerable." "India has seen a dramatic rise in bugs which are resistant to antibiotics." "When an infection takes hold, babies can die within hours." "It's a frightening prospect for parents, like those of baby Mohammed." "He was infected with a superbug that even this hospital had never seen." "There's a long list of antibiotics that Mohammed's bug appears to be resistant to." "How concerning is that?" "Yes, we are really concerned and in fact scared because the bug was showing resistance to all the antibiotics including carbapenems and even colistin." "How unusual is that?" "That's very unusual, for the first time we have seen this kind of report, but..." "First time in this hospital?" "First time in this hospital." "The medical notes show that Mohammed's bug was resistant to nearly 20 antibiotics, including carbapenems." "Fortunately, a combination of drugs saved his life." "The rise in resistant bugs is blamed partly on a lack of controls over access to antibiotics." "India now has laws restricting the sale of powerful antibiotics." "I'm going to see whether it's still possible to buy these drugs without a prescription." "We went to more than half a dozen pharmacies in Delhi, some just across the street from major hospitals." "We set out to buy carbapenems, those last-resort antibiotics." "I'll take those." "These one and the syringes." "And we did it without any prescription." "The drugs were handed over with no questions asked." "Everyone knows that you need to take a full course of antibiotics to be sure to kill an infection." "Thank you very much." "But here we could buy just single doses, a sure-fire way of encouraging drug resistance." "Thank you very much." "It's as simple as that." "Persuading the world to take better care of antibiotics is part of" "Jim O'Neill's brief, so we showed him what we had bought." "We went to a number of pharmacies and I've got loads of these in the bag, I've got a whole sackful of drugs." "Well, I'm not surprised." "Obviously, it's a sad state of affairs and it is part of the challenge and the problem I'm facing in trying to come up with a solution." "This sort of thing has to be stopped." "It's fascinating but distressing to see it that you've found it so easily." "Of course, it's not the only place in the emerging world either where this happens, but it's the sort of thing - if I'm going to be able to contribute to solving this problem, we have got to stop this." "It is not just in humans where antibiotic use is out of control, but in animals, in food production." "In some countries, like the United States, more antibiotics are used in livestock than in human health, partly as growth promoters." "We must get rid of the growth-promoting use of antibiotics because that does drive resistance to the antibiotics, but we have a problem because until the Americans phase it out, the developing world say, "Why should we?"" "It is like the climate change debate." "I'm told that when you eat a farmed salmon in the States, that by the time it reaches our plates, it will have eaten its weight in antibiotics." "But things may be about to change." "The US fast-food giant McDonald's recently announced it will reduce the use of antibiotics in its chicken products." "Given the worldwide failings of past decades, medicine urgently needs the next generation of drugs." "It is nearly 30 years since a new class of antibiotic drug was discovered." "A team of US researchers have gone back to basics using low-tech methods to see whether nature will provide any answers." "We're in a park in Boston, an unlikely setting for a medical breakthrough." "But scientists working on soil samples here have made what many consider to be a game-changing discovery." "Many antibiotics were derived from soil microbes, so could the ground beneath our feet have more to offer?" "Every gram of soil contains about ten billion bacteria." "Ten billion cells?" "Ten billion cells." "Only 1% have been cultivated in the lab." "Only 1% of them have been explored." "Only 1% have been studied academically from the point of view drug discovery." "This simple device, dubbed the iChip, has enabled the team at Northeastern University to investigate a vast untapped resource." "So, instead of bringing the soil to the lab, you are bringing the lab to the soil?" "Exactly." "This kind of microbiology is really cultivation in the field as opposed to in the lab." "And this is how it's done." "A few grains of soil are taken from the bucket and then repeatedly diluted until just one bacterial cell is injected into each chamber." "The iChip is covered with a membrane which allows soil nutrients in." "Over a period of weeks, the bacteria grow and produce chemicals they naturally use to kill other microbes." "Exploiting this simple method, the team have done something astonishing - they've identified 25 potential new antibiotics." "25 antibiotics out of 50,000 microbial strains, each of which started from a single cell grown in the iChip first, or diffusion chamber, and then eventually in the lab." "So, 50,000 cells give you 25 antibiotics." "50,000 cells you can find in probably one milligram of soil." "That is extraordinary." "That would suggest that one person's back garden might provide us with more new antibiotics than we've ever imagined possible." "Not only it would suggest, it does suggest." "One of the soil microbes has resulted in an antibiotic called" "Teixobactin, which has proved highly effective in animal trials." "Teixobactin is a remarkable compound." "But we also tested Teixobactin for toxicity against mammalian cells, against human cells, and found no toxicity, so that told us that we have in our hands something remarkable." "Teixobactin is going to be potentially very useful to treat" "Staph Aureus/MRSA infections - that's one of the superbugs - and then there is, of course, tuberculosis." "Teixobactin has a unique promise of becoming a single therapeutic to treat tuberculosis." "Do you think there could be thousands more antibiotics out there in the soil waiting to be discovered?" "There is no doubt in my mind that that is the case." "That would revolutionise medicine?" "That is indeed our hope." "It would be nice to revolutionise this field." "But it's early days." "Teixobactin still has to undergo human trials and many promising drugs fail at this stage." "More innovation is vital and that will require greater investment from drug companies." "A guaranteed payment for proven new antibiotics safeguarding the profits for big pharma even when the drugs are held in reserve is one proposal." "From his base at the Wellcome Trust, Jim O'Neill also wants the top companies to pay for a $2 billion innovation fund, to support research like that in Boston." "He believes it could deliver 15 new antibiotics in a decade." "I would like the pharmaceutical industry collectively to actually finance an innovation fund." "Do you think there is a moral duty on the pharmaceutical industry to help finance this?" "I don't think I'd like to see it in moral terms." "I'm a business person." "I'd like to see it in their own terms of commerciality." "I would call it enlightened self-interest of which morality is part of because, sooner or later, if it gets really bad, somebody is going to come gunning for these guys, just how people came gunning for finance." "Would you accept that there is a moral duty on the pharmaceutical industry to do more and to invest more in antibiotics?" "If you are a company whose mission is to improve health, you can't ignore the major health problems in the world." "So that's why we are committed to carry on with antibiotics." "I do believe that you look right the way across the patch, whether it is public funding, whether it is investor funding, whether it is company funding, it's been less than it should be, right the way across the patch." "So, society has been asleep on this issue, I agree." "It's time to wake up and do something about it." "Yes, the pharmaceutical industry absolutely should be part of that." "So, does Jim O'Neill think the system can be reset and the antibiotic apocalypse averted?" "I now feel that solving this just requires all the players to do as opposed to talk." "It includes pharma, it includes governments, it includes research bodies, it includes doctors, and it includes you and me, so that we need to be reconditioned to not walk into a doctor's surgery and say, "Give me an antibiotic."" "Bacteria are constantly evolving and spreading across borders." "We cannot win the war against superbugs, but unless we act now, the era of antibiotics could end less than a hundred years after penicillin was discovered." "This is the reality." "People are already dying and it will only get worse." "We've got to look after the antibiotics we've got - good hygiene, careful prescribing - but unless we have an endless stream over the generations of new antibiotics, we will see increasing deaths and return to that dreadful scenario of pre-antibiotics." "We will be betraying our grandchildren." "They will die."