Transcript: Battle Against Bacteria | Jun 09, 2021

(soft music plays)

Against a black screen, the TVF International logo appears.

(wings flapping)

A Female Narrator says EVIL SPIRITS WERE
ONCE BLAMED FOR MEDIEVAL
PLAGUES.
BUT SCIENCE HAS REVEALED OUR
TRUE ENEMY: MICROSCOPIC
BACTERIA.

A close-up shot shows bacteria reproducing.

She continues TODAY, THESE UNSEEN ORGANISMS
KILL A PERSON EVERY 22 SECONDS.
WE FIGHT THEM WITH ANTIBIOTICS,
BUT THEY'RE NOT MIRACLE DRUGS.
BACTERIA SUPERBUGS HAVE ADAPTED
TO RESIST OUR BEST WEAPONS.
WILL DISEASE HUNTERS BE ABLE TO
STOP THE NEXT BACTERIA
PANDEMIC?

Fast clips show an insect, a bat and scientists examining Petri dishes.

Against a red abstract background, a title reads "Disease Hunters. Episode 2: Battle Against Bacteria."

(birds chirping)
Swaine jogs in a park. He is in his thirties, clean-shaven and bald. He wears a beige T-shirt.

Swaine says BACTERIA ARE
SOME OF THE MOST UBIQUITOUS
LIFEFORMS ON EARTH, AND SOME OF
THE OLDEST LIFEFORMS ON EARTH.
THEY'VE EXPLORED EVERY FRONTIER.
ESSENTIALLY, EVERY PLACE ON
EARTH IS COLONIZED BY BACTERIA.

The Narrator says INCLUDING HUMANS.

Swaine says LIFE DOES DEPEND ON
BACTERIA.
CARBON CYCLES, NITROGEN CYCLES,
THE OXYGENATION OF THE AIR,
THOSE ALL DEPEND ON BACTERIA.

The Narrator says RESEARCH SCIENTIST SWAINE
CHEN HAS A LIFE-LONG
FASCINATION WITH BACTERIA.

A caption reads "Associate Professor Swaine Chen. Genome Institute of Singapore."

Swaine says WE'RE IN THE EVOLUTION GARDEN
HERE AT THE BOTANIC GARDENS, AND
IT'S ABOUT HOW PLANTS EVOLVED
AND CHANGED THE LANDSCAPE OF THE
EARTH.
BUT PLANTS WEREN'T AROUND FOR
THE FIRST FEW BILLION YEARS OF
EARTH'S HISTORY, AND THAT'S
BECAUSE WE WERE WAITING FOR
BACTERIA TO CREATE THE OXYGEN
THAT WOULD SUPPORT THEM.
EVEN DOWN TO YOUR IMMUNE SYSTEM,
YOUR ABILITY TO RESIST CERTAIN
PATHOGENS, OR YOUR ABILITY TO
PROCESS NUTRIENTS, THOSE ALL
RELY ON BACTERIA AS WELL.
IT'S TRUE THAT WE DON'T EXIST
WITHOUT THEM.

The Narrator says BUT WHAT HAPPENS WHEN
BACTERIA WORK AGAINST US?
JULY 13, 2015.
50-YEAR-OLD TAN WHEE BOON IS
RUSHED TO KHOO TECK PUAT
HOSPITAL IN SINGAPORE,
AFTER A NIGHT OF VOMITING,
DIARRHEA AND BOUTS OF FEVER.

(monitor beeping)
A man lies in a hospital bed.

The Narrator says IN AND OUT OF CONSCIOUSNESS,
TAN HAS NO IDEA THAT HE HAS
BECOME A VICTIM OF ONE OF THE
BIGGEST BACTERIA OUTBREAKS IN
SINGAPORE, WHICH CLAIMS 238
VICTIMS.
160 WERE HOSPITALIZED WITH
SEVERE FOOD POISONING, WHILE
OTHERS WERE ADMITTED WITH
VARIOUS INFECTIONS.

The caption changes to "Doctor Timothy Barkham. Tan Tock Seng Hospital." Timothy is in his mid-fifties, clean-shaven with a shaved head. He wears a white shirt.

Next to a computer screen, Timothy says SEPTIC
ARTHRITIS, MENINGITIS.
SO, ARTHRITIS MEANS SWOLLEN
JOINTS, PAINFUL JOINTS, INFECTED
JOINTS.
MENINGITIS IS A DISEASE AND
INFECTION AROUND THE BRAIN.
SO, THESE ARE INVASIVE,
IMPORTANT INFECTIONS.
SERIOUS INFECTIONS IN HEALTHY
PEOPLE?
NO WAY IS THAT ALLOWED.
YOU KNOW, ONE OR TWO, OKAY.
BUT A SERIES?
SOMETHING'S GOING ON.

Female Reporter 1 says A NEW STRAIN OF BACTERIAL
INFECTION MAY HAVE SURFACED IN
SINGAPORE.

The Narrator says THESE PATIENTS
WERE INFECTED WITH GROUP B
STREPTOCOCCUS.

Timothy says GROUP B STREP IS IN
ALL OF OUR GUTS.
AND ALSO IN FEMALES, IT'S IN THE
VAGINA.
GROUP B STREP SIMPLY SHOULD NOT
BE.
IT DOES NOT DESERVE TO BE.
IT'S NOT ALLOWED TO CAUSE
DISEASE, INVASIVE DISEASE IN
HEALTHY ADULTS.
THAT'S NOT WHAT IT NORMALLY
DOES.

The Narrator says INTRIGUED BY THE UNUSUAL
NATURE OF THIS OUTBREAK,
BARKHAM, A VETERAN MEDICAL
MICROBIOLOGIST WHO IS ALWAYS ON
THE LOOKOUT FOR POSSIBLE NEW
DISEASES, TURNED TO HIS VAULT,
A FREEZER FULL OF BACTERIA
COLLECTED THROUGHOUT HIS TENURE
AT THE HOSPITAL.

Wearing blue gloves, Timothy takes a frozen sample out of a freezer.

Timothy says THOSE ARE GBS FROM 2014.

Pointing to a line graph on the computer, he continues I WENT BACK TO 2005 AND PLOTTED
THE NUMBER OF INVASIVE
INFECTIONS.
THAT'S BACTERAEMIA, AND IF YOU
LOOK, IT'S ALMOST JUST UP AND
DOWN FOR YEARS.
AND THEN SUDDENLY IN THE LAST
YEAR OR SO, IT'S GONE UP.

(computer keys clacking)

The Narrator says BARKHAM WANTED MORE DATA
FROM HIS COLLEAGUES IN OTHER
HOSPITALS TO VALIDATE HIS
SUSPICIONS.

Timothy says THERE WAS ENOUGH OF A SIGNAL
TO SAY, "SEND ME YOUR BACTERIA,
GUYS.
IF YOU'RE HAPPY SENDING ME YOUR
BACTERIA, I'LL DO ALL THE
LABORATORY WORK ON THEM."

The Narrator says BARKHAM'S CHIEF MEDICAL
TECHNOLOGIST, TANG WEN YING,
STARTED EXTRACTING DNA FROM THE
BACTERIA TO DETERMINE IF THEY
WERE FROM THE SAME STRAIN.

Timothy says THESE LITTLE GROUP B
STREPS, THEY HAVE A LITTLE
CAPSULE WHICH IS LIKE A LITTLE
COAT, AND THEY CAN BE
DIFFERENTIATED ACCORDING TO THE
DIFFERENT KINDS OF COATS, AS IN
LABEL ONE, TWO, THREE, FOUR,
FIVE, SIX.

The Narrator says MEANWHILE, IN THE HOSPITAL,
TAN IS FIGHTING FOR HIS LIFE.
HIS BODY IS GOING INTO SEPTIC
SHOCK.
THE GBS BACTERIA HAS ENTERED
HIS BLOODSTREAM.
THESE HOSTILE MICROBES ARE
GETTING A FREE RIDE TO HIS
MAJOR ORGANS.
HIS IMMUNE SYSTEM GOES INTO
OVERDRIVE, RELEASING ANTIBODIES
TO FIGHT THE INFECTION.

An animation shows the process explained.

She continues BUT THIS OVER-VIGOROUS IMMUNE
RESPONSE IS ACTUALLY TURNING ON
ITS HOST, CAUSING INFLAMMATION
AND SWELLING.
TAN'S BLOOD PRESSURE STARTS
FALLING FAST, DANGEROUSLY
RESTRICTING OXYGEN SUPPLY TO
HIS VITAL ORGANS.

Timothy walks into a lab.

Timothy says HI, WEN YING.

In her thirties with short black hair and wearing a face mask, Wen says HI, DR. BARKHAM.

Timothy says WHAT HAVE YOU GOT?

Wen says YEAH.
THERE'S LOTS OF TYPE 3.

They look at a computer screen.

Timothy says YEAH?

Wen says FROM DIFFERENT HOSPITALS.

Timothy says ONE, TWO, THREE, FOUR, FIVE,
SIX, SEVEN.
ABOUT HALF OF THEM.

Wen says YES.

Timothy says SEVEN OUT OF 15 ARE ALL TYPE
3.

Wen says YES.

Timothy says WHAT WE FOUND: A LOT OF THE
BACTERIA WERE SEROTYPE 3.
AND IF WE COMPARE THE DATA FROM
2014 WITH 2015, LOOK HERE.
IT SAY SEROTYPE 3 EARLY IN 2015
ALREADY HAD AN INCREASE OF 16 percent,
WHEREAS ALL THE OTHER SEROTYPES
HAD NOTHING LIKE IT.
SO, WE KNEW SEROTYPE 3 WAS THE
CULPRIT.

Wen says AND THE SECOND
COMES OUR TTSH.

Timothy says THAT WHOLE THING?

Wen says YEAH.

The Narrator says THE VEIL HAD BEEN LIFTED.
THE VICTIMS WERE INFECTED BY
THE SAME STRAIN OF GROUP B
STREPTOCOCCUS, SEROTYPE 3
SEQUENCE TYPE 283, OR ST283 GBS
FOR SHORT.

Timothy says SO, WHEN WE REALIZED THAT WE
REALLY DID HAVE AN OUTBREAK
GOING ON, NOT JUST A SUSPICION,
THEN THE OBVIOUS QUESTION IS,
WELL, WHAT CAN WE DO TO STOP IT.
WE KNOW THIS ORGANISM IS NOT
GOING TO BE SPREAD BY THE
RESPIRATORY ROUTE.
WE KNOW PEOPLE AREN'T GOING TO
PICK IT UP FROM THE ENVIRONMENT.
IT HAD TO BE FOODBORNE.
BACTERIA ARE KILLED BY HEAT, SO
IT HAD TO BE SOMETHING THAT IS
NOT COOKED.
SO, THE NEXT STEP, OF COURSE,
WAS TO ASK.
PEOPLE STARTED ASKING THEIR
PATIENTS, AND ANECDOTALLY, ALL
THE PATIENTS WERE SAYING, "YEAH,
I HAVE RAW FISH IN MY PORRIDGE."

The Narrator says WITHIN DAYS OF DISCOVERY,
THE MINISTRY OF HEALTH
PUBLISHED A PUBLIC ADVISORY TO
WARN PEOPLE AGAINST EATING RAW
FRESHWATER FISH.

Female Reporter 2 says ALL RAW FISH DISHES
CONTAINING FRESHWATER FISH IS
OFF THE MENU WITH IMMEDIATE
EFFECT.
THE JOINT ANNOUNCEMENT BY THE
HEALTH MINISTRY, NATIONAL
ENVIRONMENT...

The Narrator says BACK AT THE
HOSPITAL, TAN LIES UNCONSCIOUS.
HE IS PUT ON A POTENT DOSE OF
ANTIBIOTICS, AND MEDICATION TO
DIRECT HIS BLOODSTREAM TO WHERE
IT'S NEEDED MOST, HIS MAJOR
ORGANS, TO WARD THEM OFF THE
BACTERIA.

Tan is in his fifties, clean-shaven with black hair. He wears a blue shirt.

Tan says WHEN I WOKE UP FROM THE COMA,
IT HAD ALREADY BEEN TWO WEEKS.
I WAS TOO WEAK TO SIT UP.
I COULD ONLY GLANCE AROUND WITH MY EYES.
AND I SAW MY HANDS AND FEET HAD TURNED BLACK.

The Narrator says WITH LIMITED BLOOD FLOW AND
OXYGEN, TISSUES IN HIS HANDS
AND FEET START DYING.

Tan says ONCE, AN INTERN DOCTOR
WAS MAKING HIS WARD ROUNDS.
SO, I ASKED HIM WHEN MY
LIMBS WOULD RECOVER.
AND HE TOLD ME, THEY WON'T GET BETTER.
THEY HAD TO BE AMPUTATED.
I WAS STUNNED WHEN I HEARD THAT.
IT WAS LIKE I HAD BEEN GIVEN THE
DEATH SENTENCE.
I WAS SIMPLY WAITING FOR THE TIME
TO HAVE MY LIMBS CHOPPED OFF.
IT WAS LIKE DEAD MAN WALKING.

The Narrator says TAN'S LIFE WAS SAVED, BUT NOT
HIS LIMBS.

Tan says TODAY IS THE ANNIVERSARY
OF MY HAND AMPUTATION.
FIVE YEARS AGO, ON AUGUST 21ST.

Tan types in a computer using a prosthesis.

The Narrator says ST283 GBS CASES LIKE THIS ARE
UNHEARD OF IN SINGAPORE, SO
BARKHAM STARTED TO DIG DEEPER.

Timothy says THERE WERE LESS THAN FOUR
REPORTS OF THIS IN THE WHOLE
WORLD LITERATURE.
AMONGST HUMANS, THERE WERE TWO
REPORTS: ONE FROM HONG KONG
SEVERAL YEARS AGO, AND A REPORT
FROM FRANCE WHERE THEY HAD TWO
CASES.
IN ADDITION TO THAT, THERE WAS A
REPORT OF TWO FISH, ONE FROM
THAILAND, AND ONE FROM VIETNAM.
AND THAT CONSTITUTED ALL THE
PUBLICATIONS IN THE WORLD
LITERATURE ON SEQUENCE TYPE 283.
WE HAVE SINGAPORE DOWN HERE WITH
OUR HUMAN OUTBREAK REPRESENTED
BY THE SMILEY.
WE HAD THE REPORT FROM HONG KONG
THAT WAS IN HUMANS, AND WE HAD
TWO FISH.
WELL, TO ME, THIS MEANT IT'S A
REGIONAL OUTBREAK.

The Narrator says THERE WERE FURTHER QUESTIONS.
ARE THE DIFFERENT STRAINS OF
ST283 GBS FROM DIFFERENT PLACES
RELATED?
ARE THE ONES FOUND IN FISH THE
SAME ONES THAT INFECTED PEOPLE?
THESE WERE CRUCIAL QUESTIONS
WHICH COULD ONLY BE ANSWERED BY
MAPPING OUT THE BACTERIA'S
ENTIRE DNA SEQUENCE.

Swaine works in a lab.

Swaine says WHEN YOU'VE GOT A
FINGERPRINT AT THE SCENE OF THE
CRIME, YOU CAN IDENTIFY THE
EXACT INDIVIDUAL THAT WAS THERE.
WE CAN DO THE SAME KIND OF
IDENTIFICATION USING WHOLE
GENOME SEQUENCING.
SO, WHAT WE CAN DO WAS TAKE A
GENOMIC FINGERPRINT OF BACTERIA
PRESENT ON FISH, AND ALSO A
GENOMIC FINGERPRINT OF BACTERIA
ISOLATED FROM THE BLOODSTREAM OF
HUMANS.
AND WE FOUND THAT THOSE WERE A
PERFECT MATCH IN THAT CASE.

The Narrator says ALTHOUGH ST283 GBS IS
COMMONLY FOUND IN FRESHWATER
FISH, THERE HADN'T BEEN ANY
DOCUMENTED CASES OF
TRANSMISSION TO HUMANS, AND IT
WAS NOT THOUGHT TO BE A
FOODBORNE DISEASE AT THAT TIME.

Swaine says IF WE KNOW THAT GROUP B
STREPTOCOCCUS IS CAUSING
INFECTION IN HUMANS AND IS
COMING THROUGH THE FISH, THEN
HAVING A VACCINE FOR THE FISH
WOULD BE ONE WAY THAT WE COULD
ENSURE THAT THE FOOD SUPPLY IS
SAFE.

The Narrator says AFTER THE 2015 OUTBREAK, THE
GENOME INSTITUTE OF SINGAPORE
DESIGNED A TEST TO DETECT ST283
GBS, HELPING DOCTORS TO
IDENTIFY AND TREAT INFECTIONS
MORE EFFICIENTLY.
A SEPARATE TEST FOR THE FISH IS
ALSO IN THE WORKS.

Swaine says BACTERIA ARE INCREDIBLY
DIVERSE.
TWO RANDOM E. COLIS MIGHT BE
DIFFERENT BY 2 PERCENT TO 3 PERCENT
IN THEIR
DNA, OKAY?
AND JUST TO GIVE YOU A POINT OF
CONTEXT, HUMANS AND CHIMPANZEES
ARE ABOUT 1 percent DIFFERENCE.
IF WE UNDERSTAND HOW IT IS THAT
BACTERIA ARE ABLE TO CAUSE
DISEASE-- FOR EXAMPLE, WITH
GROUP B STREPTOCOCCUS, WHICH
SEEMS TO RECENTLY HAVE GAINED
THE ABILITY TO BECOME FOODBORNE.
IF WE UNDERSTAND HOW THAT CHANGE
HAPPENED, MAYBE WE COULD
ANTICIPATE THAT CHANGE OR LOOK
FOR THAT CHANGE IN OTHER
BACTERIA, SO THAT WHEN IT
HAPPENS, WE CAN ALSO CATCH THAT
AS EARLY AS POSSIBLE.

The Narrator says THERE ARE MORE BACTERIA IN
THE WORLD THAN STARS IN THE
UNIVERSE, BY ABOUT
ONE-BILLION-FOLD.
AND THERE IS NO TELLING WHERE
THE NEXT INFECTION WILL COME
FROM.

The caption changes to "New Delhi, India. Ramakrishna mission free TB clinic."

Pawan sits in Sahlini's office looking at an X-ray. He is in his early thirties, with short black hair. He wears blue jeans, a dark shirt and a face mask. Sahlini is in her forties, with long black hair. She wears a white doctor apron, gloves and a face mask.

Sahlini says LOOK HERE, THIS IS WATER,
AND THIS IS THE STAIN IN YOUR LUNGS.
YOU CAME TO ME BECAUSE OF THE WATER
BUT THEN I SAW THE STAINS, WHICH IS
WHY I HAD YOUR SPUTUM TESTED AND
THE RESULT SHOWS THAT THERE ARE BACTERIA.
THIS IS CONTAGIOUS TB.

The Narrator says PAWAN HAS JUST RECEIVED NEWS
THAT HE HAS TUBERCULOSIS.

Sahlini says IF YOU COUGH, SNEEZE OR TALK,
GERMS COME OUT AND THEY REMAIN IN THE AIR.
THE GERMS THEN INFECT ANY HEALTHY
PERSON WHO INHALES THEM.
IF ANYONE FALLS SICK AT HOME,
MAKE SURE THEY GET TESTED WITHIN A WEEK.
AND TELL ME. OK?

The caption changes to "Doctor Sahlini Puri. National TB Elimination Programme."

Sahlini says A TB PATIENT CAN SPREAD
INFECTION TO 10 TO 15 PERSONS IN A YEAR.
OUR COUNTRY IS THICKLY POPULATED. AND THE
CONDITIONS ARE HUMID, IT'S VERY DIFFICULT TO
CONTROL THE ENVIRONMENT AS WELL AS INFECTION.

The Narrator says INDIA CURRENTLY SEES THE
HIGHEST NUMBER OF TB CASES IN
THE WORLD.
BUT THE DISEASE DOES NOT
DISCRIMINATE.
IT NEVER HAS.
ONCE A QUARANTINE STATION IN
THE LATE 19TH CENTURY,
ST. JOHN'S ISLAND, SIX AND A
HALF KILOMETRES SOUTH OF
MAINLAND SINGAPORE, IS TODAY A
DESTINATION FOR OUTDOOR
ENTHUSIASTS.

Wilfried and a man kayak in a calm river.

In off, a man says IT'S A REALLY NICE DAY
TO BE OUT.

The Narrator says THE CONCEPT OF QUARANTINE
TRACES BACK TO BIBLICAL TIMES;
EVIDENCE OF HUMAN STRUGGLE
AGAINST PATHOGENS SINCE THE
BEGINNING OF HISTORY, INCLUDING
TUBERCULOSIS OR TB.
(waves lapping)
MICROBIOLOGIST WILFRIED MOREIRA
FIRST CAME TO SINGAPORE TO LEAD
DRUG DISCOVERY PROJECTS
TARGETING TB.
HE DEVELOPED AN INTEREST IN TB
WHILE HE WAS WORKING ON HIS PHD
DISSERTATION ON NEGLECTED
DISEASES.

The caption changes to "Doctor Wilfried Moreira. Nus Yong Loo Lin School of Medicine." Wilfried is in his mid-thirties, a beard with curly blond hair. He wears a light T-shirt and shorts.

Sitting on a beach, Wilfried says TUBERCULOSIS CAN BE
DATED BACK FOR AS FAR AS TENS OF
THOUSANDS OF YEARS.
SO, TUBERCULOSIS REMAINS ONE OF
THE GREATEST BACTERIAL KILLERS
THROUGHOUT OUR HUMAN HISTORY.
BY THE 1900S, TB HAD KILLED ONE
IN SEVEN PEOPLE THAT HAVE EVER
LIVED ON THE PLANET.
IT WAS NAMED THE WHITE PLAGUE
OR THE GREAT CONSUMPTION
BECAUSE PEOPLE LOST A TREMENDOUS
AMOUNT OF WEIGHT AND THEY HAD
THESE PALE FIGURES.

The Narrator says BECAUSE OF ITS EPIDEMIC
PROPORTIONS, TB WAS COINED
"CAPTAIN OF ALL THESE MEN OF
DEATH" BY ENGLISH WRITER JOHN
BUNYAN, EVOKING THE DESPAIR AND
HORROR OF THE DISEASE.

Wilfried says THERE WERE NO CURE
FOR TUBERCULOSIS FOR THE LONGEST
TIME.
THE ONLY TREATMENT OPTIONS WERE
FRESH AIR IN SANATORIUM.

A black and white portrait of a man with round glasses and a beard appears.

The Narrator says IT'S NOT TILL 1882 WHEN
ROBERT KOCH, A GERMAN
PHYSICIAN, DISCOVERED THE
CAUSE: THE BACTERIA KNOWN AS
MYCOBACTERIUM TUBERCULOSIS
SPREAD THROUGH THE AIR.

Wilfried says WHEN PEOPLE GET EXPOSED TO
DROPLETS THAT CONTAIN THE
BACTERIA, THEN THERE IS POSSIBLY
TWO WAYS.
YOUR IMMUNE SYSTEM DOES NOT
CONTROL IT.
THE BACTERIA REPLICATES, AND YOU
GO INTO ACTIVE TB AND YOU ARE
SICK.
OR IT CONTROLS IT AND IT
ERADICATES THE BACTERIA.
OR IT CONTROLS IT BUT THE
BACTERIA REMAINS THERE, DORMANT.
AND THAT'S WHAT WE CALL LATENT
TB.
AS A MATTER OF FACT, WE CONSIDER
THAT ONE-THIRD OF THE WORLD
POPULATION HAVE BEEN EXPOSED AND
SOMEWHAT INFECTED BY
TUBERCULOSIS.

The Narrator says HARD TO TREAT AND HARD TO
DETECT, MYCOBACTERIUM
TUBERCULOSIS ARE TRICKY
ORGANISMS.
NOT ONLY ARE THEY PROTECTED
WITH A WAXY COATING OF FATS,
MAKING THEM HARD TO BE KILLED;
THEY ALSO HAVE AN INGENIOUS WAY
OF HIDING IN OUR BODIES, BY
ALLOWING THEMSELVES TO BE EATEN
BY WHITE BLOOD CELLS, THE VERY
CELLS THAT WOULD NORMALLY KILL
THEM.
THERE, THEY STAY DORMANT, AND
DEVELOP INTO LATENT TB.
WHEN THE CARRIER'S IMMUNE
SYSTEM WEAKENS, THE BACTERIA
SPRING TO LIFE, REPLICATING
WITH A VENGEANCE.
TODAY, THIS MILLENNIA-OLD
DISEASE IS STILL KILLING 1.5
MILLION PEOPLE WORLDWIDE EVERY
YEAR.

The caption changes to "Pawan Kumar. Diagnosed with tuberculosis."

Pawan says MA'AM WITH THESE MEDICINES,
WHEN WILL I RECOVER?
I'VE BEEN DEPRESSED FOR THE
LAST THREE OR FOUR DAYS.

Sahlini says WHY DEPRESSED?
YOU HAVE A DISEASE THAT HAS A CURE.
NOW ALL YOU HAVE TO DO IS MAKE SURE
YOU TAKE YOUR MEDICATIONS.
STOP SMOKING AND DRINKING, EAT HEALTHY FOOD.
BE CAREFUL, NOT JUST FOR YOURSELF,
BUT FOR OTHERS AS WELL.
GRADUALLY YOU'LL FEEL BETTER.
WE WON'T LEAVE YOU UNTIL YOU RECOVER.

The caption changes to "Manish Parashar. Ramakrishna Mission Free TB Clinic."

In his forties with a face mask, Manish says YOU HAVE TO TAKE THIS
MEDICINE CONTINUOUSLY FOR SIX MONTHS,
YOU CAN'T MISS IT, EVEN FOR JUST ONE DAY.

The Narrator says UNLIKE TB PATIENTS A CENTURY
AGO, PAWAN AND OTHER PATIENTS
TODAY CAN LOOK FORWARD TO A
FULL RECOVERY, THANKS TO THE
DISCOVERY AND DEVELOPMENT OF
ANTIBIOTICS.
SUMMER 1928.
SCOTTISH BACTERIOLOGIST
ALEXANDER FLEMING COMES BACK
FROM A VACATION, AND DISCOVERS
THAT A GREEN MOULD CALLED
PENICILLIUM NOTATUM HAS
CONTAMINATED PETRI DISHES OF
BACTERIA THAT HE'S GROWING IN
HIS LAB, AND IT'S KILLING THEM.
THIS MARKED THE BEGINNING OF
THE ANTIBIOTICS REVOLUTION.

(piano music plays)
The caption changes to "Associate Professor Hsu Li Yang. NUS Saw Swee Hock School of Public Health." Hsu is in his late forties, clean-shaven with receding brown hair. He wears glasses and a white shirt.

Hsu says WHEN PENICILLIN WAS FIRST
MASS-PRODUCED IN THE 1940S
DURING WORLD WAR II, IT SAVED
MORE LIVES THAN ANYTHING ELSE.
AND CURRENTLY, THE SURGERIES
THAT WE DO, THE CHEMOTHERAPY
THAT WE GIVE FOR CANCER, NONE OF
THIS WOULD BE POSSIBLE WITHOUT
ANTIBIOTICS.
SO, ANTIBIOTICS INDEED IS ONE OF
THE MILESTONES OF MODERN
MEDICINE.

The Narrator says THESE MIRACLE DRUGS COME IN
TWO MAJOR CATEGORIES:
BACTERICIDAL AND
BACTERIOSTATIC.
BACTERICIDAL ANTIBIOTICS LIKE
PENICILLIN ATTACK BACTERIA'S
PROTECTIVE CELL WALLS.
WITHOUT AN OUTER MEMBRANE, THE
BACTERIUM IS DEFENCELESS, AND
WITH ITS DNA AND RNA LEAKING
OUT, IT CAN NO LONGER SURVIVE.
BACTERIOSTATIC ANTIBIOTICS LIKE
TETRACYCLINE, ON THE OTHER
HAND, INTERFERE WITH THE
BACTERIA'S PROTEIN PRODUCTION,
DNA REPLICATION AND ENZYME
ACTIVITY.
ALL THESE STOP THE BACTERIA
FROM GROWING, GIVING THE BODY'S
IMMUNE SYSTEM A FIGHTING CHANCE
AGAINST THE BACTERIA.
SOME ANTIBIOTICS ADOPT BOTH
ACTIONS AT THE SAME TIME.

Old footage shows workers selecting pills in a factory.

Hsu says THE GOLDEN AGE OF
ANTIBIOTICS WAS IN THE 1950S AND
1960S, WHERE WE DEVELOPED A LOT
OF NEW AND DIFFERENT ANTIBIOTIC
COMPOUNDS.
AND IT SEEMED TO BE A TRUE
MIRACLE AT THE TIME, BECAUSE WE
WERE CURING ALL KINDS OF
DIFFERENT INFECTIONS AND
DISEASES.

The Narrator says BESIDES BEING A PHYSICIAN,
HSU IS ALSO A CHESS
INTERNATIONAL MASTER AND HAD
REPRESENTED SINGAPORE IN CHESS
OLYMPIADS.
HE SEES SOME PARALLEL IN THE
GAME AND HOW ANTIBIOTICS COMBAT
BACTERIA.

Hsu says WE GAVE ANTIBIOTICS FOR
PEOPLE WITH COUGH AND COLD,
WHERE THEY DID NOT HAVE ANY
BACTERIAL INFECTIONS.

The Narrator says JUST LIKE A CHESS PLAYER'S
OVERCONFIDENCE COULD LEAD TO
RASH MOVES, THE WIDESPREAD
AVAILABILITY OF ANTIBIOTICS LED
TO CARELESS AND EXCESSIVE USE.

Hsu says WE FOUND THAT LOW DOSES OF
ANTIBIOTICS COULD MAKE ANIMALS
LIKE PIGS AND CHICKENS GROW MUCH
FASTER AND FATTIER AND
HEALTHIER, AND SO WE STARTED TO
GIVE IT AS A GROWTH PROMOTER.

The Narrator says IT'S ESTIMATED THAT ABOUT
THREE-QUARTERS OF ALL
ANTIBIOTICS DISPENSED IN THE
WORLD ARE USED IN LIVESTOCK AND
AGRICULTURE.

The caption changes to "Thai Nguyen, Vietnam."

Pham and a farmer chat in chicken farm. Pam is in his forties, clean-shaven with short black hair.
They wear blue overalls.

Male Farmer says STRONG CHICKENS.

Pham says IT IS DRY HERE.

Male Farmer says HERE YOU SEE,
CHICKENS ARE VERY STRONG,
THEY MAKE LOUD CALLS.

The Narrator says HEALTHY AND LARGER ANIMALS
TRANSLATE INTO PROFIT AND
LIVELIHOOD FOR POULTRY FARMERS.

Female Farmer says I AM MAKING MEDICINE
FOR THE BABY CHICKS TO DRINK.

The Narrator says DRIVEN BY ECONOMIC REASONS,
ADDING ANTIBIOTICS IN ANIMAL
FEED IS A COMMON PRACTICE.

In her thirties with black hair and a blue overall, Female Farmer says THIS IS THE ANTIBIOTIC
COLISTIN MIXED WITH AMOXICILLIN TO
TREAT ECOLI FOR THE CHICKS.
I THINK THESE ANTIBIOTICS HELP
STRENGTHEN THE CHICKENS' IMMUNITY.
AND HEALTHY CHICKENS CAN
ABSORB NUTRIENTS BETTER.

The Narrator says DR. PHAM-DUC PHUC FROM HANOI
UNIVERSITY OF PUBLIC HEALTH HAS
BEEN CONDUCTING RESEARCH ALL
ACROSS VIETNAM TO UNDERSTAND
HOW EXTENSIVE ANTIBIOTICS USAGE
IN ANIMAL FARMS LIKE THIS IS.

(squawking)

Pam says WE ARE TAKING SAMPLE
OF THE CHICKEN'S EXCREMENT
TO CHECK WHETHER THERE IS STILL
PRESENCE OF ANTIBIOTICS IN IT.

The Narrator says ANTIBIOTICS HAVE HELPED
DECREASE INFECTION AND
MORTALITY RATES AMONGST
LIVESTOCK, MAKING ANIMAL
PROTEINS AFFORDABLE TO THE
MASSES.
A GOOD ECONOMIC AND SOCIAL MOVE
IN THE EYES OF MANY, BUT
PROBLEMS ARE ARISING.

The caption changes to "Doctor Pham-Duc Phuc. Vietnam One Health University Network."

Pham says IF NOT USED PROPERLY
IT WILL CAUSE THE BACTERIA TO
MUTATE AND LEAD TO DRUG RESISTANCE.
THE BACTERIA KEEP MULTIPLYING AND
THE ANIMAL CAN GET SICK AND MIGHT NOT BE CURED.
MOREOVER, THE BACTERIA CARRYING
THE RESISTANCE GENES
MIGHT BE RELEASED INTO THE
ENVIRONMENT OUTSIDE THE FARM.
AND HUMAN CAN UNKNOWINGLY BE
INFECTED WITH THOSE DRUG
RESISTANT BACTERIA.

Hsu says SO, THE EQUATION IS QUITE A
SIMPLE ONE.
THE MORE ANTIBIOTICS WE USE, THE
GREATER THE PRESSURE ON THE
BACTERIA TO BECOME RESISTANT TO
IT, BECAUSE THEY ALSO WANT TO
SURVIVE AND FLOURISH.

The Narrator says IN THE FIGHT AGAINST
BACTERIA, OUR AGGRESSION HAS
MADE OUR FOE STRONGER.
THE TABLES HAVE TURNED, AND
HUMANITY NOW FACES AN UPHILL
BATTLE.

Hsu says IT BECOMES A KIND OF
EVOLUTIONARY RACE, RIGHT?
LIKE AN ARMS RACE.
WE HUMANS SO FAR ARE LOSING THIS
EVOLUTIONARY RACE.
AND WHEN ANTIBIOTIC RESISTANCE
REACHES A LEVEL WHERE COMMON
INFECTIONS CAN NO LONGER BE SO
EASILY TREATED, MEDICAL
PROCEDURES LIKE TRANSPLANTS,
SURGERIES AND CHEMOTHERAPY WILL
BE AT A MUCH HIGHER RISK.

(siren wailing)

The Narrator says IF NOTHING CHANGES, BY 2050,
10 MILLION PEOPLE COULD DIE OF
ANTIMICROBIAL-RESISTANT
INFECTIONS EVERY YEAR.

The caption changes to "New Delhi, India."

Boys run through a narrow passage.

A boy says YEAH.

Taniya hangs clothes on a clothesline. She is in her twenties, with a black ponytail. She wears a white and blue patterned shirt.

Taniya says MY NEIGHBORHOOD
IS CROWDED AND CONGESTED.
THERE IS POOR VENTILATION,
AND THERE'S NOT ENOUGH SUNLIGHT TOO.

The Narrator says DIAGNOSED WITH
MULTI-DRUG-RESISTANT
TUBERCULOSIS ALMOST FOUR YEARS
AGO, TANIYA IS STILL FIGHTING
THE DISEASE AFTER NUMEROUS
ROUNDS OF TREATMENT.

Taniya says I WAS DIAGNOSED
FOR THE FIRST TIME IN 2017.
IT HAS BEEN THREE YEARS SINCE I STARTED
THE COURSE OF TREATMENT.

The caption changes to "Taniya Digwal. Diagnosed with Mdr-Tb."

Now, Taniya sits in Sahlini's office.

Sahlini says SHE IS A CHALLENGING PATIENT.
WHEN SHE CAME TO US, SHE WAS 17
YEARS OLD AND WE STARTED HER ON MDR TB REGIMENT.
SHE WAS DOING VERY WELL. SHE WAS TAKING
THE DRUGS. AND ALL HER SPUTUM
CAME NEGATIVE.
BUT THE LAST CULTURE WHICH WE SENT TO THE LAB
THAT CAME POSITIVE AND SHE WAS
RESISTANT TO FEW DRUGS.
YOU HAVE TO KEEP DOING THIS FROM NOW ON.
YOUR ECG AND ALL IS FINE. YOUR MEDICATION IS
WORKING WELL. DO YOU HAVE ANY OTHER ISSUE?
THE PROBLEM IS THE BACTERIA KEEPS ON MULTIPLYING
AND IT MUTATES ALSO. SO WHEN HER CULTURE AND
SPUTUM CAME BACK NEGATIVE THEN MAYBE THE
BACTERIA WAS NOT MUTATING AND IT WAS REGRESSING,
BUT MAYBE FEW BACTERIAS WERE LEFT THERE AND
WHEN THE DRUGS WERE STOPPED THEY KEPT ON
MULTIPLYING AND THEY MUTATED ALSO.

The Narrator says EVERY BACTERIUM'S SOLE LIFE
MISSION IS TO BECOME TWO,
NO MATTER WHAT IT TAKES.
ALL BACTERIA ADAPT AND MUTATE
TO SURVIVE AND REPLICATE.
SO DOES MYCOBACTERIUM
TUBERCULOSIS,
SPREADING TO EVERY CORNER OF
THE EARTH.
SINGAPORE, FEBRUARY 2012.
A YOUNG MAN WAS DIAGNOSED WITH
MULTI-DRUG-RESISTANT TB, OR MDR
TB.
FOUR OTHERS IN A GAMING CENTRE
THAT HE FREQUENTED WERE ALSO
INFECTED.

Hsu says WE HAD A CLUSTER OF
MULTI-DRUG-RESISTANT TB CASES
AMONG LOCALS, WHICH IS VERY
UNUSUAL, AND THESE ARE IN YOUNG
MEN WHO WERE OTHERWISE HEALTHY,
WHICH IS ALSO UNUSUAL.
BUT THE ONE THING THEY SHARE IN
COMMON, THEY STAYED FOR HOURS IN
AN AIR-CONDITIONED ROOM, WHICH
IS IDEAL FOR THE SPREAD OF
TUBERCULOSIS.

Young men play videogames in a room.

The Narrator says AT THIS TIME, THE YOUNG MAN
ALSO INFECTED HIS FLATMATE IN
THE SUBURB OF ANG MO KIO.
(coughing)
TWO YEARS LATER, IN 2014, A
NEIGHBOUR LIVING TWO APARTMENTS
AWAY CAME DOWN WITH
MULTI-DRUG-RESISTANT TB.
THEN IN 2015, HIS FLATMATE'S
MOTHER WAS FOUND TO BE
INFECTED, AND SO WAS A RESIDENT
WHO STAYED IN A FLAT THREE
FLOORS DIRECTLY ABOVE THEM.
A YEAR LATER, IN MAY 2016,
ANOTHER CASE WAS DETECTED IN
THE SAME APARTMENT BLOCK.
MULTI-DRUG-RESISTANT TB CASES
ARE RARE IN MODERN SINGAPORE,
SO IT'S HIGHLY UNUSUAL TO HAVE
SIX CASES DETECTED WITHIN THE
SAME BUILDING.
TB WAS ONCE A MAJOR PUBLIC
HEALTH RISK IN SINGAPORE IN THE
EARLY TO MID-20TH CENTURY, WHEN
LIVING CONDITIONS WERE
UNSANITARY AND CONGESTED.
WITH ROBUST URBAN RENEWAL AND
PUBLIC HEALTH PROGRAMS, THE
DISEASE WAS BROUGHT UNDER
CONTROL.
BEGINNING IN THE MID-1950S,
EVERY CHILD BORN IN SINGAPORE
IS GIVEN A TB VACCINE, BACILLUS
CALMETTE-GUÉRIN OR BCG.
THE VACCINE IS PRIMARILY
EFFECTIVE IN PROTECTING
CHILDREN AGAINST THE MORE
SEVERE TYPE OF TB THAT CAUSES
MENINGITIS.

A series of black and white pictures showing people getting vaccinated flash by. Next, old clips show a crowded street market and families going to the doctor.

The caption changes to "Patient taking best x-ray, 1950. Singapore anti-tuberculosis association (SATA), 1952. Bacillus Calmette-Guérin (BCG). BCG injection Bukit Timah Clinic, 1951. BCG VACCINATION, 1958. Mandalay Road Hospital, 1959. SATA mobile x-ray unit, 1964. Parliamentary Secretary to Ministry of Education Rahim Ishrak has a chest x-ray taken, 1965."

Hsu says SO, FROM 1958 TO THE
LATE 1990S, THE TB RATES
DECLINED TREMENDOUSLY, AND THEN
THEY WENT DOWN AGAIN AFTER THE
ESTABLISHMENT OF THE SINGAPORE
TUBERCULOSIS ELIMINATION
PROGRAMME.
BUT FROM THE YEAR 2008 ON, THE
RATES OF TB HAVE STAGNATED.
SO, THERE ARE ROUGHLY ABOUT
2,000 NEW TB CASES EVERY YEAR IN
SINGAPORE.

The Narrator says THIS IS 10 TIMES HIGHER THAN
THAT OF THE UNITED STATES OR
AUSTRALIA.
COMPOUNDED WITH GROWING
ANTIBIOTICS RESISTANCE, RISING
TB CASES WILL BE ESPECIALLY
CONCERNING.
HOUSED IN THIS EUROPEAN-STYLED
BUNGALOW IS THE TB CONTROL UNIT
THAT HAS BEEN SEEING PATIENTS
FOR MORE THAN HALF A CENTURY.

Shera is in her twenties, with long straight brown hair and bangs. She wears glasses and a purple shirt.

Looking at a computer screen, Shera says DO YOU HAVE ANY SYMPTOMS AT
ALL?
FOR EXAMPLE, SAY, A COUGH?

Young Female Patient says I HAVE A MILD COUGH,
BUT I ALWAYS THOUGHT THAT WAS
DUE TO STRESS BECAUSE I WAS
STAYING UP ALL NIGHT.

Shera says OKAY.
AND HOW LONG HAS THIS BEEN FOR?

Patient says MAYBE, LIKE, A MONTH OR TWO.

Shera says OKAY.

Patient says IT ONLY OCCURS AT NIGHT,
THOUGH.

Shera says SO, YOU SEE THE UPPER PARTS
OF YOUR LUNGS HAVE SOME WHITE
SHADOWS.
THIS MEANS THAT SOME PARTS OF
YOUR LUNGS HAVE BEEN AFFECTED BY
AN INFECTION.
SO, IF YOU SEE THIS AREA HERE,
CAN YOU TELL THAT IT IS WHITER
THAN THE OTHER PART OF THE
LUNGS?

Patient says YEAH.

Shera says THIS IS VERY TYPICAL FOR TB.
TB IS A GERM THAT USUALLY
AFFECTS THE UPPER PART OF YOUR
LUNGS.

Patient says I HAVE TB?

Shera says YES, YOU DO.

Patient says I THOUGHT THAT WAS ERADICATED
IN SINGAPORE.

The caption changes to "Doctor Shera Tan. Tan Tock Seng Hospital."

Shera says A LOT OF THE INITIAL REACTION
IS USUALLY SHOCK.
YOU KNOW, LIKE, THEY WOULD
USUALLY ASK US, "DOCTOR, HOW IS
IT POSSIBLE I HAVE TB?
ARE YOU SURE THERE'S TB IN
SINGAPORE?"
BECAUSE THEY WOULD THINK THAT
TB IS A DISEASE OF THE PAST.
THE NURSES WILL BE COLLECTING
SOME SPUTUM SPECIMENS FROM YOU
IN ORDER FOR US TO DO TESTING TO
SEE HOW MUCH TB GERMS THAT YOU
MAY HAVE, AS WELL AS TO FIND OUT
WHETHER YOUR GERMS ARE SENSITIVE
TO THE MEDICATIONS THAT WE ARE
CURRENTLY GOING TO GIVE YOU.
IF YOU WILL JUST FOLLOW ME...

Patient says SURE.

Shera says THE MOLECULAR TEST
GIVES US A VERY RAPID DIAGNOSIS
WITHIN TWO HOURS ON WHETHER A
PATIENT IS DRUG-RESISTANT.

Female Nurse says YOU TAKE ANOTHER DEEP
BREATHING, AND COUGH UP.
UNTIL YOU HAVE SOME PHLEGM COME
INTO YOUR MOUTH.

Patient says MM-HMM.

Shera says WE NEED TO FIND OUT,
YOU KNOW, HOW MUCH GERMS THE
PATIENT HAS.
WHEN WE LOOK UNDER THE
MICROSCOPE TO LOOK AT THE NUMBER
OF TB GERMS THAT WE'RE ABLE TO
SEE COMPARED WITH SOMEONE IN
WHOM WE ARE UNABLE TO SEE ANY
GERMS, WE CAN SAY THAT, "LOOK.
YOU ARE PROBABLY MORE INFECTIOUS
THAN THE OTHER PERSON."
INFECTIOUSNESS IS IMPORTANT
BECAUSE IT HELPS US TO DETERMINE
THE DURATION OF TREATMENT AS
WELL, AND TO SEE HOW FAR WE WANT
TO EXTEND OUR CONTACT TRACING.

The caption changes to "Chai Yun Bing. Tan Tock Seng Hospital."

Chai is in her late twenties, with brown hair in a ponytail and bangs. She wears glasses and a white doctor apron.

Chai says YOUR PRIVACY IS IMPORTANT TO
US.
WE WILL NOT REVEAL YOUR IDENTITY
IF THEY COME HERE FOR SCREENING.

Patient says OKAY.

Chai says SO, COULD YOU LET ME KNOW WHO
YOU HAVE IN CONTACT OR PROLONGED
CONTACT WITH IN THE PAST FEW
MONTHS BEFORE YOU STARTED WITH
YOUR TB TREATMENT?

Shera says UNLIKE OTHER INFECTIOUS
DISEASES, SAY, LIKE COVID, YOU
KNOW, WHERE PATIENTS WOULD BE
REQUIRED TO BE QUARANTINED IN
ORDER TO STOP THE SPREAD OF
GERMS, IN TB, TAKING THE
MEDICATIONS FAITHFULLY,
REGULARLY, KEEPS THE GERMS AT A
VERY LOW LEVEL, SO THAT OUR
PATIENTS ARE ALLOWED TO
GO OUTSIDE, TO LIVE THEIR LIFE
AS PER NORMAL.

Chai says IN SINGAPORE, OUR
PATIENTS TAKE THESE MEDICATIONS
UNDER DIRECTLY OBSERVED THERAPY,
WHICH MEANS THAT YOU WILL NEED
TO GO TO THE NEAREST POLYCLINIC
OR TBCU EVERY DAY TO TAKE THE
MEDICATIONS UNDER THE
SUPERVISION OF A NURSE.

The Narrator says BY MAY 2016, THE SIX
MULTI-DRUG-RESISTANT TB CASES
IN ANG MO KIO HAD AUTHORITIES
CONCERNED.
SINGAPORE'S MINISTRY OF HEALTH
STARTED EXTENSIVE CONTACT
TRACING AND INVESTIGATIONS TO
PIECE TOGETHER THE PUZZLE.

Hsu says THE INVESTIGATIONS ALSO
INCLUDED LOOKING AT THE LIFTS,
HOW WAS THE AIR EXCHANGE IN THE
LIFTS, BECAUSE THAT SEEMS TO BE
THE MOST COMMON POINT WHERE
PEOPLE MIGHT ENCOUNTER EACH
OTHER.

The Narrator says DESPITE THESE EFFORTS, NO
CLEAR TRANSMISSION LINKS COULD
BE ESTABLISHED BETWEEN THE
YOUNG MAN AND HIS FLATMATES AND
THE OTHER CASES.
BUT ONE THING IS CLEAR.
AFTER DEVELOPING SYMPTOMS, THE
YOUNG MAN DIDN'T SEEK TREATMENT
TILL FOUR MONTHS LATER.

Hsu says I THINK A LOT OF TIMES
WE ARE IN DENIAL.
HE WAS STILL QUITE WELL WHEN HE
WAS DIAGNOSED.
AND PERHAPS HE FELT WELL ENOUGH
THAT HE DIDN'T THINK HE NEEDED
TO SEE A DOCTOR.
HIS SPUTUM TEST AT THAT TIME
SHOWED THAT THERE WAS A LOT OF
TB BACTERIA THAT COULD BE SEEN
EVEN UNDER THE MICROSCOPE.

The Narrator says DURING THIS PERIOD OF HIGH
INFECTIOUSNESS, HE HAD BEEN
STAYING AT THE FLAT, EXPOSING
HIS NEIGHBOURS TO HIGH RISK.

Hsu says THAT'S PART OF THE
PROBLEM OF TUBERCULOSIS, WHICH
IS THIS LONG LATENT PERIOD.
OVER FOUR YEARS, WE HAVE SIX
CASES.
BUT THAT MEANS THAT THERE ARE
MANY MORE WHO HAVE BEEN
INFECTED, AND WHOM WE HAVE NOT
FOUND IF WE DIDN'T GO AND TEST
THEM.

The Narrator says AS A PRECAUTIONARY MEASURE,
THE MINISTRY OF HEALTH OFFERED
FREE AND VOLUNTARY ONSITE TB
SCREENING TO ALL PAST AND
CURRENT RESIDENTS OF THE
APARTMENT BLOCK OVER THREE
DAYS.

Hsu says I THINK THAT'S A VERY
FASCINATING EXAMPLE OF HOW TB
SPREADS IN SINGAPORE OR IN ANY
COUNTRY FOR THAT MATTER, AND HOW
DIFFICULT IT IS ACTUALLY TO
PIECE TOGETHER WHAT HAPPENED.
AND IT WAS ONLY BECAUSE WE HAVE
A VERY GOOD TEAM AT CONTACT
TRACING AND WE HAVE GOT VERY
GOOD MOLECULAR TOOLS THAT WE
WERE ABLE TO UNDERSTAND WHAT
HAPPENED.

The Narrator says WITH INCREASED GLOBALIZATION
AND URBANIZATION,
MULTI-DRUG-RESISTANT TB WILL
CONTINUE TO BE A CHALLENGE FOR
DENSELY POPULATED CITIES.
WE MIGHT SEE MORE CASES IN
DEVELOPED NATIONS WHERE TB IS A
FORGOTTEN DISEASE.
PROFESSOR GAN YUNN HWEN AND HER
TEAM HAVE MADE AN UNNERVING
DISCOVERY.
THEY SPOTTED AN UNEXPECTED AND
UNWELCOME CHARACTERISTIC IN
KLEBSIELLA PNEUMONIAE, A STRAIN
OF BACTERIA RESISTANT TO THE
LAST LINE OF ANTIBIOTICS.

Gan is in her forties, with short brown hair. She wears a white doctor apron over black trousers and a face mask.

In a lab, Gan says WOW.
YEAH.
THIS IS MORE THAN 10
CENTIMETRES.
YEAH, IT'S VERY
HYPERMUCOVISCOUS, VERY STICKY.

The Narrator says VERY STRINGY AND STICKY
COATING IS OFTEN FOUND ON
HYPERVIRULENT BACTERIA STRAINS
THAT READILY CAUSE DISEASES BUT
CAN NORMALLY BE TREATED BY
ANTIBIOTICS.

The caption changes to "Associate Professor Gan Yunn Hwen. Nus Yong Loo Lin School of Medicine."

Gan says SO, THESE HYPERVIRULENT
STRAINS, THEY TEND TO
OVERPRODUCE THEIR CAPSULE.
SO, THEY HAVE THIS THICK SLIME
AROUND THEM.

The Narrator says IT IS, HOWEVER, NOT A COMMON
FEATURE FOUND IN DRUG-RESISTANT
BACTERIA STRAINS.
COULD THESE TWO STRAINS HAVE
MERGED?
GAN ORDERS MORE TESTS, AND THE
FINDINGS CONFIRM HER
SUSPICIONS.

Gan says SO, THESE ARE STRAINS THAT
ARE BOTH MULTI-DRUG-RESISTANT,
CARBAPENEM-RESISTANT AS WELL AS
HYPERVIRULENT.

The Narrator says THIS IS THE DEFINITION OF A
SUPERBUG, A BACTERIA THAT
CAUSES DISEASES EASILY AND
CAN'T BE TREATED BY MOST
ANTIBIOTICS.
WHAT FASCINATED GAN WAS HOW
THESE TWO STRAINS CONVERGED.
THE ANTIBIOTIC-RESISTANT GENE
HAD PENETRATED THE
HYPERVIRULENT BACTERIA
STRAIN'S THICK CELL WALL.

A male scientist rubs a stick against a Petri dish.

Gan says PEOPLE HAVE HYPOTHESIZED
THAT THERE'S THIS BARRIER THAT
PREVENT THE GENE EXCHANGE.
BUT WE HAVE FOUND THAT IT CAN
HAPPEN AND WE CAN REPRODUCE THAT
IN THE LAB TO SEE THAT IT
HAPPENS AT A HIGH ENOUGH
FREQUENCY TO MAKE IT POSSIBLE IN
THE NATURAL SETTING.

The Narrator says SUPERBUGS ARE A GROWING
PUBLIC HEALTH CRISIS.
THEY ALREADY INFECT HUNDREDS OF
THOUSANDS OF PEOPLE WORLDWIDE.
MANY WILL NOT SURVIVE WITHOUT
EFFECTIVE TREATMENT.

Gan says ANTI-MICROBIAL
DRUG-RESISTANCE IS SIMILAR TO
CLIMATE CHANGE IN THAT IT IS
SLOWLY ENCROACHING UPON US, LIKE
THE FROG SITTING IN A POT OF
WARMING WATER.
THE WATER IS SLOWLY COMING TO A
BOIL.
AT SOME POINT, WE MIGHT REACH A
PLACE OR A POINT OF NO RETURN.

The Narrator says IT'S MUCH MORE PROFITABLE
DEVELOPING DRUGS THAT TREAT
CHRONIC DISEASES, AS PEOPLE
REQUIRE DAILY DOSES,
AND NOT MEDICATIONS THAT ARE
ONLY TO BE TAKEN ONLY WHEN
NEEDED, AND PRESCRIBED AND USED
WITH DISCRETION.
THIS IS WHY THERE HASN'T BEEN
NEW ANTIBIOTICS IN THE MARKET
IN RECENT YEARS.
UNITED ARAB EMIRATES.
DR. NAVEED KHAN IS LOOKING FOR
BACTERIA-KILLING MOLECULES IN
AN UNLIKELY SOURCE: A
UNIVERSALLY DETESTED PEST.
THE IDEA CAME TO KHAN WHEN HE
SPOTTED COCKROACHES SCURRYING
AWAY AS HE USHERED HIS CHILDREN
TO WASH THEIR HANDS IN THE
BATHROOM.

The caption changes to "Professor Naveed Ahmed Khan. American University of SHARJAH." Naveed is in his late forties, clean-shaven with brown hair. He wears a white doctor apron over a light blue shirt and a patterned tie.

Naveed says HOW COME THESE SPECIES ARE
ABLE TO RESIST OR PROTECT
THEMSELVES AGAINST INFECTIOUS
DISEASES, THAT WE ARE TELLING
OUR CHILDREN THAT WE HAVE TO
CONSTANTLY WASH OUR HANDS AND
USE ANTI-BACTERIAL SOAPS?
COCKROACHES, THEY HAVE BEEN HERE
FOR MORE THAN 300 MILLION YEARS.
THESE SPECIES HAVE BEEN SO
SUCCESSFUL IN ADAPTING AND
EVOLVING THEY MUST HAVE
SOMETHING, SOME MOLECULES IN
THEM, TO PROTECT THEM AGAINST
INFECTIOUS DISEASES.

The Narrator says KHAN BELIEVES IF WE CAN
IDENTIFY SUCH MOLECULES IN THE
COCKROACHES, THEY COULD HELP
US.

Naveed says WE DISSECTED ALL PARTS OF
COCKROACHES AND SURPRISINGLY,
INSTEAD OF GUT OR MUSCLE OR EVEN
THE BLOOD WHICH IS KNOWN AS
HAEMOLYMPH FOR COCKROACHES, WE
FOUND MORE POWERFUL
ANTI-BACTERIAL ACTIVITY IN THE
BRAINS OF COCKROACHES.
WHEN WE INOCULATED THESE BRAIN
LYSATES AND THEN WE PUT THEM
TOGETHER WITH THE SUPERBUG
COMMONLY KNOWN AS MRSA, JUST
LESS THAN FIVE MICROGRAM OF
COCKROACH BRAIN LYSATE WAS ABLE
TO KILL MORE THAN ONE MILLION
SUPERBUGS COMPLETELY.
A 100 percent KILL RATE.
WE HAVE TESTED THEM AGAINST A
RANGE OF DIFFERENT KINDS OF
HUMAN CELL.
AND NONE OF THESE MOLECULES WERE
TOXIC TO HUMAN CELLS.
THEY WERE ONLY PROVING VERY
POTENT AGAINST BACTERIA.

The Narrator says KHAN WANTS TO BRING THE
MOLECULES INTO ANIMAL TESTING,
WITH AN ACUTE SENSE OF URGENCY.

Naveed says WE ARE REALLY HEADING TOWARDS
A MORE OR LESS PRE-ANTIBIOTIC
ERA, WHERE NONE OF THE
ANTIBIOTICS WILL BE EFFECTIVE IF
WE DO NOT COME UP WITH NOVEL
ANTI-BACTERIA.

The Narrator says THE RACE IS ON.
SCIENTISTS ALL OVER THE WORLD
ARE HUNTING FOR A SOLUTION TO
ANTIBIOTIC RESISTANCE.
AND NATURE MIGHT JUST HAVE
SOMETHING ELSE TO OFFER.

Wilfried takes a stroll in the woods.

Wilfried says AND IF YOU LOOK
AROUND YOU, WE CAN TAKE A DROP
OF THAT WATER AND WE CAN DIG A
LITTLE BIT IN THAT SOIL, AND I'M
PRETTY SURE WE'LL FIND
BACTERIOPHAGES.

The Narrator says LITERALLY MEANING "BACTERIA
EATER," BACTERIOPHAGES, OR
PHAGES FOR SHORT, ARE
BACTERIA'S NATURAL NEMESIS.
THEY ARE VIRUSES THAT LIVE
WITHIN BACTERIA.
A PHAGE HAS A 20-SIDED HEAD
ATOP A LONG TAIL WITH LEG-LIKE
FIBRES.
IT INFECTS ITS VICTIM BY
PUNCTURING THROUGH THE CELL
WALL AND INJECTING ITS DNA,
HIJACKING THE BACTERIA'S
RESOURCES TO REPLICATE ITSELF.
WITHIN MINUTES, ITS VICTIM IS
OVERRUN BY BRAND-NEW PHAGES.
IN ONE FINAL BLOW, THE PHAGE
EXPRESSES AN ENZYME THAT
PUNCHES HOLES IN THE BACTERIA,
BURSTING IT AND RELEASING NEW
PHAGES.
PHAGES WERE DISCOVERED
INDEPENDENTLY BY TWO
SCIENTISTS: FREDERICK TWORT AND
FÉLIX D'HÉRELLE IN THE EARLY
20TH CENTURY.
BY THE 1940S, WITH THE ADVENT
OF ANTIBIOTICS IN THE WEST,
PHAGE STUDIES WERE SIDELINED.

Wilfried says GEORGE ELIAVA, WHO
STUDIED UNDER FÉLIX D'HÉRELLE,
WENT BACK TO HIS COUNTRY,
GEORGIA, IN TBILISI, THE
CAPITAL, WHERE HE ESTABLISHED A
PHAGE RESEARCH CENTRE.
SO, ALTHOUGH THE REST OF EUROPE
AND THE REST OF THE WORLD WERE
DEVELOPING ANTIBIOTICS, IN
GEORGIA AND THEN LATER ON THE
SOVIET UNION, BACTERIAL PHAGES
HAVE BEEN CONTINUOUSLY USED FOR
THE LAST HUNDRED YEARS.
AND AT SOME POINT, I THINK EVERY
SOLDIER OF THE RUSSIAN ARMY HAD
VIALS OF BACTERIOPHAGE
PREPARATION ON THEM.

The Narrator says AS ANTIBIOTIC RESISTANCE
RISES, INTEREST IN
BACTERIOPHAGES HAS SURGED.

Wilfried says PHAGES AND BACTERIA HAVE
CO-EVOLVED FOR EONS OF YEARS.
WHEN BACTERIA WILL DEVELOP
RESISTANCE TO PHAGES, PHAGES
WILL ALSO EVOLVE.

The Narrator says BESIDES BEING A LIVING AND
EVOLVING NATURAL BACTERIA
KILLER, PHAGES HAVE ANOTHER
EDGE.

Wilfried says WHEN YOU USE ANTIBIOTICS,
IT'S THE EQUIVALENT OF A CARPET
BOMBING.
YOU KILL ALL BACTERIA
INDISCRIMINATELY, INCLUDING THE
VERY GOOD BACTERIA.
BACTERIAL PHAGES ARE LIKE A
SNIPER SHOT.
THEY ONLY INFECT AND CURE A VERY
SPECIFIC BACTERIA, AND THEY
LEAVE THE GOOD BACTERIA INTACT
AND UNAFFECTED.

The Narrator says OVER THE PAST TWO YEARS,
MOREIRA AND HIS TEAM HAVE BUILT
ONE OF THE LARGEST
BACTERIOPHAGE BANKS IN
SOUTHEAST ASIA, HOUSED IN THE
NATIONAL UNIVERSITY OF
SINGAPORE.
AND THEY'RE CONSTANTLY LOOKING
OUT FOR MORE.

Wilfried says WE ARE ALSO
DEVELOPING WHAT WE CALL
GENETIC-ENGINEERING
CAPABILITIES, TO BASICALLY MAKE
THEM STRONGER AND MORE
EFFICACIOUS.

(liquid sloshing)
A device spins in a lab.

The Narrator says WHILE NATURE OFFERS
READY-MADE BACTERIA KILLERS
LIKE PHAGES, SCIENTISTS AT
NANYANG TECHNOLOGICAL
UNIVERSITY ARE DESIGNING THEIR
OWN BACTERIA ASSAILANT.
THEY ARE CREATING A COMPOUND
OUT OF HISTIDINE, ONE OF THE
SEVEN ESSENTIAL AMINO ACIDS IN
THE HUMAN BODY, BY JOINING
TOGETHER A LONG CHAIN OF
SYNTHETIC HISTIDINE MOLECULES.
THIS POLYMER IS THE BRAINCHILD
OF PROFESSOR MARY CHAN.

The caption changes to "Professor Mary Chan. Nanyang Technological University, Singapore." Mary is in her late forties, with short wavy brown hair. She wears glasses and a white doctor apron over a black skirt.

Mary says ANTIMICROBIAL POLYMERS ARE
VERY BEAUTIFUL IN THE SENSE THAT
THEY ARE LARGE CHAIN MOLECULES.
SO, THEY ARE MADE OF MANY
REPEATS OF THE SAME.
AFTER THE POLYMER KILL THE
BACTERIA, YOU CAN PROGRAM YOUR
POLYMER SO THAT IT CAN DEGRADE
AND BREAK DOWN INTO SMALLER
PIECES THAT ARE NON-TOXIC, AND
THEY CAN BE EASILY EXCRETED BY
OUR BODY.

The Narrator says ANOTHER BEAUTY ABOUT CHAN'S
POLYMER IS ITS UNIQUE ATTACK
MECHANISM.
BEING POSITIVELY CHARGED, THE
POLYMER GETS ATTRACTED TO
NEGATIVELY CHARGED BACTERIA.
ONCE IT LANDS ON THE SURFACE,
THE POLYMER PENETRATES THE
BACTERIA'S RESPIRATORY PATHWAY.
THERE, IT DELIVERS THE FINAL
DEADLY PUNCH BY TRAPPING THE
BACTERIUM'S DNA.
CHAN'S DESIGN ALSO MAKES IT
HARDER FOR BACTERIA TO EVOLVE
RESISTANCE.

Mary and a young male doctor draw DNA sequences on a clear wall.

Mary says ALTHOUGH BACTERIA CAN
CHANGE THE CHARGE...
BUT NOT VERY EASILY, BECAUSE
IT'S A PHYSICAL CHARACTERISTIC.
ANOTHER REASON IS THAT IT'S HARD
FOR THE BACTERIA TO OVERCOME ALL
THESE MULTIPLE TARGETS COMING
TOGETHER.

The Narrator says THE POLYMER HAS BEEN TESTED
SUCCESSFULLY AGAINST THE
SUPERBUG IN PROFESSOR GAN'S
LAB.
THE TEAM HAS HIGH HOPES TO
DEVELOP THE POLYMER INTO A NEW
ANTIBIOTIC IN THE NEAR FUTURE.
MEANWHILE, IT CAN BE FIRST
INTRODUCED AS AN ANTI-BACTERIAL
COATING ON MEDICAL DEVICES AND
DIABETIC WOUND DRESSINGS.

Mary says BACTERIA WILL ALWAYS BE
WITH US, BUT WE NEED TO KILL
THEM WITH SOMETHING THAT ARE
SUSTAINABLE AND THAT ARE
ENVIRONMENTALLY FRIENDLY.
AND I THINK MAYBE POLYMER
SCIENCE IS ONE OF THE FEW WAYS
THAT YOU CAN DO SO.

The Narrator says WE LIVE AND BREATHE WITH
BACTERIA ALL AROUND US.
SOME MIGHT SAY HUMANS ARE
TENANTS ON AN EARTH FULL OF
BACTERIA.
HOW DO WE FIND A WAY TO LIVE
WITH THEM HARMONIOUSLY?

Timothy saves samples in a freezer.

Timothy says A TREASURE CHEST OF BACTERIA.
IT'S THE LATEST.
SET, SAFELY STORED.

The Narrator says ANOTHER STRAIN OF BACTERIA
IS ADDED TO DR. BARKHAM'S
COLLECTION.
THIS FREEZER IS HIS ARSENAL.

Timothy says WE HAVE BEEN COLLECTING
BACTERIA SINCE I CAME HERE.
BACK IN THE UK WHERE I TRAINED,
WHERE THEY DID THE SAME THING,
THEY WANTED TO KNOW WHERE THE
BACTERIA CAME FROM.
THEY WANTED TO BE ABLE TO
CHARACTERIZE THE BACTERIA SO
THEY COULD WATCH CHANGES.
BECAUSE BY WATCHING CHANGES, WE
UNDERSTAND WHAT'S HAPPENING AND
IT ENABLES US TO MAYBE PUT IN AN
INTERVENTION.
IT'S ALL ABOUT ENABLING A FUTURE
INVESTIGATION.
THAT'S WHY WE SAVE THESE
BACTERIA.

The Narrator says WHILE NOT KNOWING WHERE AND
WHEN THE NEXT BACTERIA PANDEMIC
MIGHT BE, ARMED WITH TOOLS TO
INVESTIGATE AND TO DEVELOP NEW
DEFENCES, DISEASE HUNTERS ARE
READY FOR THE BATTLE.

(enchanting piano music plays)

The end credits roll.

Writer and Producer, Jen Tsai.

Executive Producer, Mark Pestana.

Copyright 2020, MCN International Pte. Ltd. All rights reserved.

Watch: Battle Against Bacteria