One World, One Health

Vaccines save lives. There’s no doubt about this: childhood vaccination saves four million lives every year, the US Centers for Disease Control and Prevention says. Children worldwide get a long list of vaccines, but what about adults?A study by the Office of Health Economics (OHE), an independent research organization, took a look at the cost-effectiveness of four commonly given adult vaccines: the influenza vaccine, pneumococcal vaccines that protect against a batch of respiratory infections, the herpes zoster vaccine that protects against shingles, and the RSV vaccine that prevents respiratory syncytial virus. To get a good idea of the value across different types of economies and cultures, they looked at 10 countries: Australia, Brazil, France, Germany, Italy, Japan, Poland, South Africa, Thailand, and the United States. On average, the report found, these 4 adult vaccines gave a 19-fold return, meaning that the benefits equaled 19 times the costs of vaccination. On average, it worked out to US$4,637 per person vaccinated. Some of the savings are direct – people didn’t rack up hospital costs or miss work if they were vaccinated and evaded serious illness. Some savings were indirect. For instance, “receiving the influenza vaccine reduces the risk of having a stroke and subsequent hospitalization in older adults by 16 percent,” the report reads. “Cancer patients vaccinated with the influenza vaccine also had statistically significantly better survival outcomes, including longer progression-free survival rates and overall survival compared to unvaccinated patients.” One study cited in the report found that Italian adults vaccinated against flu were 13 percent less likely to die of any cause – not just flu, but any cause – over the 2018-2019 winter flu season than unvaccinated adults. In this episode of One World, One Health, Dr. Lotte Steuten, Deputy CEO of OHE and co-author of the report, chats about how her team came up with their findings.

Bird flu – aka avian influenza – is doing what it does best yet again – surprising scientists, public health officials, farmers, and wildlife experts. It’s been spreading among dairy cattle in the United States, something that startles even long-term observers of the virus.The H5N1 strain of avian influenza was first noticed in the late 1990s and it immediately worried experts, who saw its potential to cause a pandemic. It infects many wild birds without causing them too much trouble, but they can spread it to domestic poultry, which often die en masse. It has occasionally spread to people – just under 900 since 2003 – according to the World Health Organization. But it’s deadly when it does, killing half of these people. It's a perfect One Health issue – a disease that circulates among animals, spreads from one species to another, and then makes the jump to people. Farming practices, climate change, and the environment all play a role. Now it’s shown up in Antarctica, and at least one person on a dairy farm has been infected. That surprised Dr. Richard Webby, Director of the World Health Organization Collaborating Centre for Studies on the Ecology of Influenza in Animals and Birds at St. Jude Children’s Research Hospital in Memphis, Tennessee. He says H5N1, like so many flu viruses, is constantly changing and evolving. That’s why it’s so important to keep an eye on it. “If there is one virus I don’t want to catch, this is it,” he says. Listen as Dr. Webby tells One World, One Health about what experts are working to find out about H5N1’s latest moves.

Coral reefs are literally the foundation for much of the life on Earth. These living cities are made up of animals –coral – which exist in symbiosis with algae.They are home to thousands of species of fish, as well as important to the lives of as many as a billion people who rely on their production of food, their protection of coastal areas, and their attraction for tourists. They’re ancient, too, and have survived for millions of years. But now coral reefs are under threat, from pollution, changing temperatures, and disease.  Alizée Zimmermann, executive director of the Turks & Caicos Reef Fund, says she was startled to see one particular disease, stony coral tissue loss disease, kill off 500-year-old corals in the span of a few weeks.Her organization has started to preserve coral species, maintaining them in a lab to save them for when they might safely be returned to the sea. It’s a complicated project and they are racing against time to save species before they go extinct. It’s too late for some. The United Nations Environment Program estimates that 14 percent of the world’s corals died between 2009 and 2018. To stop stony coral tissue disease from killing off selected colonies in the ocean, Alizée's team has even had to apply a specially formulated antibiotic to save these creatures and the ecosystem they comprise. In this episode of One World, One Health, Alizée explains why corals are so important to everyone, and she talks about some of the creative ways she and her colleagues are working to save these animals that are so important to so many.

From the moment people discovered how to use penicillin, the first antibiotic, resistance has been a problem. Bacteria may be small, but they are not simple organisms and they have been fighting for survival for billions of years. Many bacteria have developed the tools they need to evade the effects of antibiotic treatments, and they can trade these weapons with other bacteria as they swap genetic material.Bacterial infections aren’t new to humanity, and for more than two decades world health leaders have urgently warned about the threat of antibiotic resistance. Dr. Otto Cars is one of them. He is a senior professor of infectious diseases at Uppsala University in Sweden and the founder and senior adviser to ReAct – Action on Antibiotic Resistance.In this episode of One World, One Health, Dr. Cars says he has hope for turning around the impending dystopia of a world without antibiotics.Listen as Dr. Cars outlines the history of the fight against antibiotic resistance, and what he hopes its future might be.Learn more about the struggle to control drug-resistant bacteria, viruses, and fungi in some of our other episodes. We’ve spoken with experts about how vaccines can help prevent the spread of drug-resistant germs, about tracking superbugs in sewage, and the surprising rise of drug-resistant fungi. Experts in drug design have talked to us about the search for new and better antibiotics and how these little organisms are winning an arms race against us. Filmmakers have told us about how storytelling can help people understand the threat while global health specialists explained that good stewardship can keep the antibiotics we have working as they should. We’ve even investigated superbug mysteries, like the case of the killer eyedrops.

It’s hotter and wetter than usual in Brazil, and climate conditions are driving an early blast of a killer virus – dengue. The mosquito-borne virus is spreading earlier than ever before and affecting far more parts of the country than usual – and all at once.Dengue’s a nasty virus. It causes pain so severe that it’s sometimes called breakbone fever. Patients often feel nauseated, develop rashes, and vomit blood. The most severe cases can cause internal bleeding. There’s no specific treatment – just fluids and rest, and watching out for signs of shock, which can kill patients within hours.Dengue is unusual because there are four different types, known as serotypes. The first infection is often mild, but people are not immune to the other three serotypes after that first time. The second time someone gets infected, they are more likely to become seriously ill – a phenomenon called antibody-dependent enhancement. Sometimes a vaccine can cause this effect.Brazilian authorities are keeping this in mind as they rush to roll out vaccines to fight this unusually early and widespread epidemic of dengue, says Dr. André Siqueira, principal investigator at the National Institute of Infectious Diseases Evandro Chagas at Fundação Oswaldo Cruz, also known as FioCruz, in Rio de Janeiro.There are nowhere near enough vaccines yet – only six million doses this year, enough to protect just three million people with the two-dose regimen. Brazil’s population is more than 200 million.Researchers at Brazil’s Butantan Institute are working to develop a new vaccine that should protect people with just one dose and, they hope, will protect against all four serotypes of dengue.Dr. Siqueira is part of the team working on that new vaccine. Listen as he explains to One World, One Health host Maggie Fox why dengue is so bad in Brazil this year and what he and colleagues are doing to control it.

Peggy Lillis wasn’t expecting trouble when her dentist prescribed antibiotics after she had a root canal in 2010. It was a standard, just-in-case treatment to prevent infections after the procedure.She also wasn’t worried when she developed diarrhea soon afterward. The kindergarten teacher assumed she’d caught a bug from one of her young students.But within just a few days, the previously healthy 56-year-old was dead – a victim of Clostridioides difficile or C. diff. These bacteria are common but can grow out of control when antibiotics or other factors deplete the healthy microbes living in the intestines – the microbiome.Patients can suffer severe diarrhea, a distortion of the colon known as megacolon, and sepsis as the infection spreads to the bloodstream. It’s painful and can be hard to treat.About one out of every six patients who get C. diff will get it again in the following two months, the U.S. Centers for Disease Control and Prevention says. Such infections kill 1 out of 11 people over the age of 65 who develop a C. diff infection in the hospital.It’s a One Health problem, as the bacteria spread globally.Antibiotics are not always effective in treating C. diff. because these bacteria thrive when the natural population of microbes is killed off. Instead, many doctors are turning to treatments that can replace the healthy microbiome. These can include fecal microbiota transplants (FMTs), also known as poop transplants, or therapies that more directly replace the “good” microbes.Peggy Lillis’ sons, Christian and Liam, didn’t want her death to have been in vain, so they founded the Peggy Lillis Foundation to advocate for awareness of C. diff, public policy to fight it, and for better treatments.Christian Lillis says he will never get over losing his mother to C. diff.  “It remains the worst thing that has ever happened to me,” he tells One World, One Health host Maggie Fox. In this episode, Lillis tells us about this dangerous repercussion of the misuse and overuse of antibiotics, the need for new treatments, and what survivors and family members can do to take action against C. diff.

There’s a virus that infects just about every adult. It’s passed by skin-to-skin contact – most often during sexual intercourse. It’s the human papillomavirus (HPV for short). It often doesn't show any symptoms, and at times the infection resolves on its own.  It can cause warts, but more ominously, HPV is the single biggest cause of cervical cancer. It's also a factor in common cancers of the head and neck, as well as cancers of the anus and penis. It's the main reason most adult women must undergo regular Pap smears, which work well to catch the changes that can lead to cancer while still treatable. But there’s no Pap smear for the mouth and throat, and none for the anus or penis either.  So the invention of a vaccine that prevents cancers caused by HPV should have people running to get it. It has been proven very safe and effective. According to the US Centers for Disease Control and Prevention, infections with the strains of HPV that cause cancers and genital warts have dropped 88 percent in vaccinated teen girls, and 81 percent among vaccinated young women.While vaccination has focused on girls, boys and men suffer from and spread this infection. A study in the Lancet Global Health found nearly a third of men and boys over the age of 15 are infected with at least one genital strain of HPV and one in five have a cancer-causing type.Studies show that the earlier teens get the vaccine against HPV, the better it protects them. But people are resisting it. Dr. Grace Ryan, assistant professor of population & quantitative health sciences at the University of Massachusetts Chan Medical School, is looking at why people are hesitant to use this life-saving vaccine, and at how to get people to better understand its benefits.In this episode of One World, One Health, Dr. Ryan chats with host Maggie Fox about what she’s found about HPV vaccine hesitancy.

The world acted as if the COVID-19 pandemic was a big surprise. However, just months before, the Global Preparedness Monitoring Board (GPMB) had warned that the world was vulnerable to a pandemic of respiratory illness and needed to act quickly.  Kolinda Grabar-Kitarović, the former president of Croatia, says she felt frustrated and helpless when the pandemic took hold in early 2020. She had just left office and felt powerless as she watched global failure after global failure from lockdown.Now Grabar-Kitarović is co-chair of the GPMB and is urging world leaders and institutions to act on what’s been learned from COVID-19 failures. “Today, we find that despite some improvement, preparedness remains perilously fragile,” the GPMB says in its latest report. “We know in theory how to stop a pandemic in its tracks, but in practice, the gaps in preparedness leave us dangerously exposed to a future threat.”What’s needed is much better planning, preparation, and, above all, trust, Grabar-Kitarović tells us in this episode of One World, One Health.  And the first step to growing trust is to build equity.Listen as Grabar-Kitarović explains how short attention spans work against us, and what the Three Little Pigs can teach everyone about preparing for the next pandemic.

Drug-resistant infections are a problem for everyone, but especially for newborns. They don’t have fully developed immune systems, and their bodies are less equipped to fight infections.The risk is highest for infants born sick or prematurely.  Bloodborne infections – sepsis – are one major threat to newborns. Sepsis can move quickly, overpowering the body and causing severe illness and even death within hours. Doctors don’t have time to test babies to see what’s infecting them and have to treat them based on what Dr. Mike Sharland calls a best guess. These infections are often resistant to the drugs that are available to treat them, too. National and international guidelines can help doctors make difficult and life-altering decisions about treatment, but there’s not much guidance for health professionals treating newborns. That’s in part because there is so little research on which antibiotics work in newborns. Sharland, a pediatric infectious disease specialist at St George's University of London, is helping lead a group running the clinical trials needed to form the basis of guidelines.In this episode, Dr. Sharland tells us about the terrifying growth of drug-resistant infections in newborns and the need for better antibiotics for these vulnerable babies. 

Air pollution is a big killer, a culprit in 6.7 million deaths a year. It’s also depressing to live in a polluted area, and not simply for aesthetic reasons. Many people don't even know they are being exposed to some types of invisible air pollution.A team of researchers in California recently linked air pollution to depression during and after pregnancy. That’s dangerous to both mothers and their babies, explains Dr. Jun Wu, the team's principal investigator and a Professor of Environmental and Occupational Health at the University of California Irvine.Mothers with postpartum depression have a higher risk of suicide and of harming their babies. Babies of mothers with postpartum depression themselves risk emotional and cognitive damage.The UC Irvine team found that air pollution shows up in some surprising places as well. Listen as Dr. Wu chats with One World, One Health host Maggie Fox about what her team found and what it means for our health.

While innovative and effective ideas to help solve major global health problems are hard to come by, finding and attaining funding to put them into action can be even more difficult. The research grant review process takes time and can be bogged down in red tape. Decisions on who and what kind of research gets funded can pass over novel ideas in favor of familiar project plans.The Trinity Challenge aims to shake things up a bit by rewarding creative and practical ideas that take research down to the community level. While the first round was dedicated to addressing COVID-19, the latest prize will go to ideas to fight the emergence and spread of drug-resistant infections, otherwise known as antimicrobial resistance (AMR). In this episode of One World, One Health, Dr. Marc Mendelson, Professor of Infectious Diseases and Head of the Division of Infectious Diseases & HIV Medicine at Groote Schuur Hospital at the University of Cape Town and director of the Trinity Challenge tells us how the Trinity Challenge aims to support researchers with ideas to fight the present and growing problem of drug resistance in new and inclusive ways. 

In Gaza, thousands have been killed, tens of thousands injured, and hundreds of thousands more are without shelter, clean water, or medical care.“You have these horrible, horrible scenes playing out in many places,” says Avril Benoit, executive director of Medecins Sans Frontieres-USA, also known as MSF or Doctors Without Borders in English.Humanitarian groups such as Doctors Without Borders have called for an immediate ceasefire between Israel and Hamas so they can help innocent and helpless civilians caught in the conflict in Gaza.People in Gaza are suffering horrific injuries, and without antibiotics and even the most basic of medical supplies, they are likely to develop deadly infections. The filthy and crowded conditions are helping the spread of diarrhea and respiratory disease. People are also developing skin infections such as scabies, and they’ve had to abandon treatment for day-to-day conditions from diabetes and high blood pressure to cancer chemotherapy.MSF is struggling to help the people of Gaza, Benoit tells One World, One Health host Maggie Fox in this episode. While Gaza is, understandably, grabbing the headlines, more than six million Sudanese people are displaced and fighting malaria and malnutrition, while avoiding violence and slaughter. Rohingya refugees from Myanmar are living in unbearable conditions in the world’s largest refugee camp in Bangladesh. Refugees are fleeing conflict in Ukraine and Syria as well. “We are really stretched very thin,” Benoit says. “Syria has fallen off our radar.”Listen as Benoit talks about the horrors that conflict rain on populations, and the enduring effects that persist long after the bombs and shooting stop.

It’s heartbreaking when a drought or flood causes crops in a region to fail, and children to go hungry. Kids can starve to death or endure social, economic, and health problems well into adulthood due to malnutrition. But what if there was a way to predict when these weather disasters are likely to happen, so governments, aid organizations, and residents could prepare? A team at the University of Chicago says people could already do this, using one of the best-known weather patterns: the El Niño Southern Oscillation or ENSO. “ENSO has destabilizing effects on agriculture, economic production, and social stability throughout areas of the global tropics that are teleconnected to it. It has been linked to human health outcomes directly through its effects on vector- and water-borne infectious diseases, as well as indirectly by decreasing agricultural yields and increasing food insecurity and the likelihood of conflict,” they write in a Nature Communications article. It's possible to predict this Pacific Ocean-based pattern, says Dr. Amir Jina, an Assistant Professor at the University of Chicago’s Harris School of Public Policy and a Senior Fellow at the Energy Policy Institute of Chicago. In this episode of One World, One Health, listen as Dr. Jina explains how people could use predictions about El Niño years to get ahead of some of the forces that make children go hungry.

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. 

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. 

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. 

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.

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.  

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. 

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.