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Life and Death in the 21st Century:
Future Plagues

BBC2 8:00pm Wednesday 5th January 2000

A secure laboratory PAUL MAYHO: I’d been given 10 weeks to live. I could either (a) die or (b) take the medication and run the risk of having to spend the rest of my life in a room 10 by 8. Death often seemed a very attractive option.

NARRATOR (DILLY BARLOW): Paul Mayho has a disease that was completely unknown only a few decades ago. He was then infected with another disease that was thought to have disappeared entirely from the West. As we enter the 21st-century with all our modern medical weaponry the question is: how could these things be happening? The dominant species on this planet are not humans. They are organisms too small to see with the naked eye, viruses and bacteria. Many believed that we would have won the battle against these microbes in the last century, but things turned out very differently. The new things that will kill us in this century will be unknown emerging microbes and the return of old plagues that we thought had been defeated. Scientists now know that we can never defeat nature itself.

DR JOE McCORMICK (Epidemiologist): Let’s understand that this is a serious evolutionary, biological war that we’re fighting with, with bacteria and viruses and they’ve been at it one hell of a lot longer than we have.

DR C.J. PETERS (Center for Disease Control): We’re setting the stage for the emergence of more and more infections and surprisingly enough every 2 or 3 years something absolutely brand new comes along.

ARCHIVE FILM PRESENTER: 25 years ago, only 25 years, penicillin, antihistamines, polio vaccine, heart surgery, all those things that I’ve mentioned haven’t been discovered yet. The greatest advance in the history of medicine has taken place.

NARRATOR: In the last century science launched an extraordinary global battle against infectious disease.

LAURIE GARRETT (Epidemiology Historian): I think it’s very hard for modern, contemporary young people to imagine what the euphoria was like in the industrialised world regarding health.

NARRATOR: In a burst of scientific creativity, antibiotics were developed against killer bacteria and vaccines against the deadliest viruses. With these magical new weapons the World Health Organisation enthusiastically set out to immunise the whole world and rid us finally of some of the most feared infectious diseases.

LAURIE GARRETT: The epidemics yielded to one intervention after another and then massive vaccine campaigns seemed to present the possibility of truly eradicating infectious diseases. There claimed to be this sense even inside the World Health Organisation that one could actually set up a timetable for eradication. By next year, according to the original time-table, there was to be no tuberculosis on planet Earth. The first one on the timetable was smallpox and indeed we succeeded, we eradicated smallpox in 1977 and that was a tremendous victory for humanity, tremendous. Then we set targets on measles, polio, tuberculosis, diphtheria, one after another, we were going to get rid of every single one of them.

C.J. PETERS: My belief when I was in medical school was that that medicine textbook would not change, it would just get more complete. We would find additional ways to treat things and things would just get better and better and better.

NARRATOR: These were the microbes that scientists believed would soon be defeated. The bacteria that caused tuberculosis, diphtheria, septicaemia and many lethal viruses, like those that cause polio and smallpox. 100 years ago we lived in fear, two-thirds of children died before adolescence, a simple cut could lead to a lethal blood infection and now the hope was that many of these diseases would be history.

DR JULIE PARSONETT(Stanford University): We had antibiotics that could cure infection, we knew how to treat tuberculosis, we had vaccines for polio and measles and the diseases that killed children and everybody was just enormously optimistic that infections just weren’t going to do anything. I think now in retrospect we realise that that’s just incredibly naïve.

NARRATOR: After decades of success optimism led to complacency. The pace of research into viruses and bacteria began to slow down. This was to prove a fatal mistake. Scientists did not anticipate what would happen next. Behind the scenes a series of strange, new, lethal viruses began to appear around the world. They came as a complete surprise to epidemiologists. No-one knew where they came from or why they were emerging. Many of them were different from other known viruses and some caused dramatic and horrific diseases: Hantaan, Junin, Rift Valley fever, Lassa, Ebola.

C.J. PETERS: Literally the virus [Ebola] is a very destructive virus by itself. There’s bleeding in about half the cases and these cases the bleeding probably results from the virus chewing up the blood vessels and on around 9 or 10 days about 80% of the patients die. We understand how they propagate once they start, but we don’t understand what starts them and, they’ve been relatively easy to control, but we still have this enormous blank space in terms of our understanding of those viruses.

NARRATOR: When analysed some of these new viruses had DNA unrelated to anything science knew of. The mystery deepened. It was only through years of painstaking epidemiology, tracing each epidemic to its source, that a picture of why they were emerging has started to come into focus. We now know that as human development encroaches on places that have never been touched before we come into contact with animals that carry viruses and diseases never seen before. We are stumbling on the viruses that have lain dormant around the world until now, viruses that could mutate to cross species and infect humans.

C.J. PETERS: We’ve changed the world tremendously in the process of our development and this has led the pace for development of new infections. As we’ve changed the world microbes have evolved and began to fill ecological niches that weren’t there before, so we’re setting the stage for the emergence of more and more infections.

NARRATOR: Inside this lab they’re preparing for the 21st-century. This is the hot zone. Here scientists handle the most deadly emerging viruses. Sealed inside spacesuits, hooked up to air from outside, they never breathe in the lab air. They work in complete isolation and shower in disinfectant before returning to the outside world. Labs like this have restarted the battle against the virus. Joe McCormick is one of the new breed of virus trouble-shooters. He has been involved in the identification of many of the new emerging viruses. When there’s an outbreak of any mysterious or unknown disease anywhere in the world this team flies out to collect blood samples and brings them back to identify the virus.

JOE McCORMICK: If an outbreak occurs somewhere we’ll be looking to identify new viruses that we haven’t seen before that may require this kind of containment. Out there in that cauldron of animal world we are churning over these viruses by the trillions all the time. They have been emerging and changing for centuries and we’ve got to believe that that’s going to continue to happen. We’re getting a huge population. It means that we can transmit viruses more rapidly to more people and this provides a greater opportunity for even more death.

NARRATOR: The increase in world population and travel means new viruses could potentially spread more rapidly than ever. The full danger of emerging viruses is just beginning to dawn. One in particular has shaken the medical establishment to its core. It never occurred to scientists that a completely unknown virus could emerge, become epidemic and within 20 years turn into the world’s biggest infectious killer: HIV. DR JIM CURRAN (Epidemiologist): That something could overcome and overtake other causes of death and come from nowhere, from not causing any death to be the highest cause of death. That wasn’t on the radar screen, that was not something that scientists even thought to speculate about. There was universal inability to see just how big this problem could get to be. This remains truly a new disease. Over 40 million people throughout the world are estimated to be infected, or have been infected. Between 11 and 15 million people have died. There are tens of millions of orphans, of parents who have died of HIV and the disease is just starting to show its true burden.

NARRATOR: HIV, the virus that causes AIDS, is so complex it has yet to be beaten by modern medicine. Every time scientists try to make a vaccine the virus mutates so rapidly the vaccine becomes redundant. Science has been left struggling.

JIM CURRAN: People are scurrying to find new therapies, but there hasn’t been a cure. There are not people that are cured from HIV infection.

LAURIE GARRETT: It is now endemic rather than epidemic in most of the world. HIV certainly has given us adequate alert, alarm and proof that a virus previously unknown can emerge simultaneously on 3 continents and come to be one of the truly great plagues in the history of humanity.

NARRATOR: With their success in the battle against smallpox and polio many scientists believe that vaccines would eventually defeat most viruses, but this concept of unstoppable progress has now changed. In the 21st-century our continual development of the planet will inevitably lead to the unearthing of yet more killer viruses and the next emerging virus could be the next Great Plague.

C.J. PETERS: What we didn’t take into account was that the world changes in a lot of different ways and that these viruses and other disease causing agents can evolve and that came as a complete surprise.

NARRATOR: This evolution of microbes across the planet has produced a superbug for the 21st-century, very different from viruses. Mutant forms of bacteria are now threatening to defeat one of our most powerful medical weapons: antibiotics. Antibiotics are chemicals secreted by moulds. They cannot kill viruses, but they do destroy bacteria. When they were first invented they seemed miraculous and saved millions of lives. Antibiotics became the most widely used chemical in medicine and we became completely dependent on them, and then something began to change: nature fought back.

PROF. ROBERT DAUM (University of Chicago): Bacteria evolve like humans evolve. The difference is bacteria have a new generation every 20 minutes and humans have a new generation every 25 years, so the pace of bacterial evolution is truly dizzying.

NARRATOR: This is a picture of something extraordinary: bacteria having sex. It is one of the key ways that bacteria can evolve. Under certain conditions when two come into contact one becomes male and the one female. They develop thin tubes that connect with each other and through these pili the bacteria randomly exchange parts of their DNA in a microscopic mating game. They then divide and the next generation will have new genetic characteristics. We now know that bacteria can evolve with the genetic characteristics that give them resistance to antibiotics and these strongest will be the ones that survive. The circled bacteria in this colony is a stronger resistant mutant. When an antibiotic is added to the petri dish the weaker, un-resistant bacteria are all killed allowing the resistant one to thrive and multiply.

LAURIE GARRETT: A petri dish full of bacteria can tomorrow be an entirely genetically different petri dish full of bacteria that have mutated and adapted under whatever pressure we’ve put on them and grow to be millions and millions or billions and billions that can now withstand whatever that antibiotic might have been.

NARRATOR: Over the years scientists have altered the chemical composition of antibiotics to overcome the ever-changing defences of bacteria. But the more antibiotics we use, the more resistant the surviving bacteria become, and now bacteria have evolved into Superbugs.

ROBERT DAUM: What we humans are trying to do here is to outstrip the pace of evolution. There’s no if to the evolution of the resistance mechanisms. In every case where an antibiotic’s been introduced bacteria learn to become resistant. It’s a question of how fast and by what mechanism.

NARRATOR: The place where these resistant forms of bacteria have begun to colonise is the one place where you go to be cured, the place where the most antibiotics are used and, therefore, the resistant bacteria thrive: in hospitals.

ROBERT DAUM: You have sick people who hang around the hospital, they get more infections, they see more antibiotics, they also come in contact with other people who have resistant organisms on their skin, or on their nose, or on their mouth and so the net effect of all of this is that the hospital’s a special milieu, we don’t want to be there unless we’re sick.

NARRATOR: Hospitals have now become breeding grounds for antibiotic resistant superbugs.

LAURIE GARRETT: Now we have such aggressive microbes that have evolved so magnificently to defy the system that they’ll actually grow inside medical equipment and there may actually be colonies of microbes growing in certain rubber gaskets, certain bits of silicone and so on. Last year in the United States 88,000 people died as a result of hospital acquired infections. People want to frame this whole concern of emerging diseases as what will arise out of Africa. Well excuse me people, it’s arising right out of our wealthy, fancy high-tech hospitals.

NARRATOR: This is the bacterium that is now raising the most alarm bells in the medical world: Staphylococcus aureus, or Staph a. It has evolved into a superstrain and seems to become resistant to every antibiotic we devise against it. These bacteria can live harmlessly on our skin, but if they enter the bloodstream they can kill within days. The antibiotic that scientists have depended upon until now to fight Staph a is Methicillin, but a new strain of a bacterium has evolved – MRSA – Methicillin -resistant Staph a.

ROBERT DAUM: The MRSA problem has gotten worse and worse and so that we now have in this country and in yours and in fact most countries, a major problem with MRSA being major components of the Staphylococcle bacterial population.

NARRATOR: In the future with the relentless increase in resistant bacteria being in hospital for routine surgery for a hip replacement or a Caesarean could be lethal. If even the smallest wound became infected it could kill you, and this is already happening.

ROBERT DAUM: There’ve already been several deaths at this institution from infections, literally caused by germs that are resistant to every antibiotic there is, both licensed and coming down the pike. We’ve lost at least 3 children in recent memory that way so we’ve got to work quickly.

NARRATOR: Until now resistant strains of this bacteria only evolved within the unique hospital environment where most antibiotics are use, but the Superbug has now taken the scientific world by surprise. It’s begun to evolve in the outside world. In this affluent suburb of Chicago a teenage girl recently went to have her ears pierced. A minor infection turned into a nightmare.

LINDSAY KICKERT: I got my ear pierced first in January and then it was OK for a while and then it started to get infected.

WOMAN: Feel like you’ve got the clamp?

LINDSAY: Yeah.

The day it started this slowly it got like 4 or 5 times the size my regular ear and it just started to flop in and it turned blue and purple. I don’t know if my ear’s going to fall off or what.

WOMAN: Try this.

NARRATOR: One by one the infection beat every antibiotic and Lindsay’s condition worsened. The situation became critical. Unless something worked the infection could spread and kill her. Lindsay was rushed to hospital and what scientists discovered there shocked them.

ROBERT DAUM: And the organism we got was MRSA. That was sort of heretic.

NARRATOR: There was only one antibiotic left that could kill MRSA: Vancomycin, a powerful and toxic drug, the drug of last resort. It’s rarely used in the hope that bacteria won’t become resistant to it. For 2 hours a day Lindsay was given intravenous Vancomycin. This drug of last resort saved her life.

JOE McCORMICK: The issue of an era where antibiotics are no longer effective is coming to us much more rapidly than we might have expected. I think that in fact it’s come very rapidly.

NARRATOR: In some places the situation has already become more dangerous. In Japan a baby contracted a Staph a infection during heart surgery and this time not even Vancomycin worked.

ROBERT DAUM: This isolate was the first Vancomycin resistant isolate and sounded a warning cry really that’s been heard around the world. Vancomycin resistance has now been reported from at least 4 different continents and it’s been a problem for about a year and a half, so fasten your seatbelts. No-one knows how fast this will go and we’ll just have to wait and see.

NARRATOR: At the height of our success in the battle against bacteria science slowed down its search for new antibiotics. Now scientists are hard at work trying to create new antibiotics through chemistry, computer drug design and analysing the genes of bacteria themselves hoping to find new ways of attack. This year a new antibiotic was licensed – Synercid – and 3 more are on the way. They will kill all known current resistant strains, but inevitably the stronger our attack, the more the bacteria will evolve even stronger resistant strains. Evolution will for ever keep the bacteria one step ahead.

JOE McCORMICK: These organisms have been up against probably a lot tougher environmental enemies than our antibiotics and they’ve managed to weather it by developing all of these strategies that we haven’t understood. The idea that yes, we’ll make a few antibiotics and now we’ve gotten rid of that, that bacteria has suddenly disappeared and with it some of the confidence I think that we had that, that we were winning this war.

NARRATOR: There is yet another consequence of the growth of antibiotic resistance. Diseases we used to die of that we thought we’d long conquered have begun to evolve and are returning in more sinister forms.

DR RICHARD COKER (Tuberculosis Consultant): 50 years ago people were writing books about the conquest of tuberculosis, tuberculosis the requiem, so when we look back we see that, that the predictions that were being proffered then were clearly wrong.

LAURIE GARRETT: We actually do now have, throughout the world, strains of universally drug-resistant tuberculosis and one of the major places where you see them right now is Russia and the former Soviet Union. These are untreatable cases. Now about one out of every five tuberculosis patients in Russia is treated surgically which is to say the drugs don’t work anymore, let’s go back to the 19th-century and cut out the infected lung.

NARRATOR: This return to the past will become the story of the future. Drug-resistant strains are now appearing in the wealthiest cities of the world. An outbreak of multi-drug-resistant tuberculosis has taken New York City by surprise. It’s been one of the most serious epidemics to hit the West since the early 20th-century and this is only the beginning of a possible global disaster. The city was utterly unprepared to cope with either the scale or nature of this epidemic. Paula Fujiwara was brought in to stop the disease in its tracks.

DR PAULA FUJIWARA (New York City Department of Health): It’s hard to convey the sense of panic I think that happened in New York City. People who were infected, especially those who were HIV infected and then on top of that got tuberculosis, were dying. Tuberculosis usually in a situation where you have the correct drugs it’s not a disease one dies from.

RICHARD COKER: There was a fear that transmission of this potentially untreatable disease could occur and could affect anybody irrespective of whether they’re a commuter from Connecticut, whether they’re living on the Upper West Side, or whether they’re living in central Harlem.

NARRATOR: There was only one way to cure this new resistant strain of TB and it was extremely unpleasant: by taking a massive daily cocktail of toxic drugs, antibiotics and injections for up to 2 years. The problem was the treatment was so horrendous that few managed to keep it up and without finishing their antibiotic courses patients encouraged ever stronger bacteria to survive and spread.

PAULA FUJIWARA: We said this was a battle that could be won, but it was going to be won patient by patient and that meant giving the patient medicine, watching the patient take medicine.

NARRATOR: The only sure way to control the disease was a drastic and almost medieval solution. On this island off Manhattan people are imprisoned. They have not committed a crime. They have contracted tuberculosis. In Goldwater Memorial Hospital they are being forcibly detained and treated. They will be imprisoned until they’re cured. That can take years.

RICHARD COKER: In New York they changed the law, the health codes so that they could lock up people. If you don’t comply with the treatment then you can be detained and you’ll be detained until you’ve completed your treatment and that may be 6 months or that may be 12 months or it may be 2 years.

DESIREE WILLIAMS: The police came, handcuffed me. I thought I was under arrest for something and they sent me to Goldwater. When you get there that’s when you find out that you ain’t going nowhere no time soon. When you get there they don’t tell you none of that, but you know, I mean I already know it could happen but I didn’t believe ‘em, so now reality hit me and I, I was in there.

NARRATOR: Desiree Williams had TB. She found it hard to keep attending clinics and taking her multitude of drugs, so she was forcibly taken away and locked up in Goldwater for the remainder of her treatment to make sure that she completed her antibiotics course.

DESIREE WILLIAMS: I’ll be honest, when you get there, when you finally get to Goldwater you ain’t leaving out of there till you’ve completed your medication because, if they had me placed somewhere but they make you take it they ain’t going to trust you, you know, so once you get there you stay in there till you finish.

PAULA FUJIWARA: When we started this programme, detention programme, I felt that it shouldn’t be done at all. In an ideal world it shouldn’t be done, it shouldn’t need to be done, but it’s been what we call a credible threat of detention. Most people, some people if you dangle that in front of them will say OK, OK, I’ll take my medications, you don’t have to do that, but I feel like it has been necessary.

NARRATOR: The detention of patients in New York seems draconian, but at the moment science can provide no easy alternative. The strains of multi-drug-resistant TB are now spreading throughout the world until science has another answer. In the future, detention may be the only option.

RICHARD COKER: What do we do about antibiotic resistance? I think that’s the, the $64 million question. Nobody knows what we do with multi-drug-resistance tuberculosis.

NARRATOR: It’s a problem we now face in Britain.

PAUL MAYHO: I didn’t know that I had been exposed. The first indication I had was a phone call from the hospital saying you need to come in straightaway. I was absolutely petrified.

NARRATOR: Paul Mayho has HIV. Whilst being treated in hospital he then caught multi-drug-resistant tuberculosis. This combination is called the Devil’s Alliance.

PAUL MAYHO: I’d heard about MDR TB. I knew it was becoming a big problem in the States, I knew that in people who were positive the mortality rate was thought to be very, very high.

NARRATOR: It was essential to isolate him as soon as possible.

PAUL MAYHO: Hospitals didn’t have negative pressure isolation rooms, they had none, so I was sort of isolated in a side room where they hurriedly built me one.

NARRATOR: Paul's chances of survival were low.

PAUL MAYHO: I’ve done an awful lot of medication to treat the TB. I was on about 30 pills a day and 3 intra-muscular injections a week. Death often seemed a very attractive option. When I was infected with TB I was on a 6 bedded bay of the ward. Everybody on the bay was infected and to my knowledge I’m the only survivor.

NARRATOR: Paul Mayho is now completely cured of TB. His isolation was voluntary, but 4 people were forcibly detained in London last year. More countries are now changing their laws to allow long-term detention of patients. In this new century we may find ourselves resorting to this age-old solution more and more often, the equivalent of leper colonies for TB, or perhaps worse.

RICHARD COKER: There is a school of thought, that people quietly say in corridor, that we should let those with multi-drug-resistant tuberculosis die.

NARRATOR: It is virtually impossible to keep up with the evolution of microbes. In the future the solution to some infectious disease will no longer come from high tech medicine, but from a return to more primitive measures. In 1998 in Malaysia a deadly pig virus began to kill humans. The only way it could be halted was by the extermination of nearly 2 million pigs. A lethal influenza outbreak in Hong Kong was only controlled by the slaughter of the carriers of the virus. The entire chicken population was killed. For all the many brilliant achievements of medicine in the 20th-century one lesson has been learned: science will never again be complacent about infectious disease. Outwitting viruses and bacteria has become a continuous struggle and scientists are already trying to explore new ways to defeat the microbes. These mice may hold one answer. They’ve been injected with a lethal dose of Salmonella bacteria, but they’re thriving. They’re being protected by a completely new kind of vaccine, a vaccine that could free us from our dependence on antibiotics in the future. Like many other scientists around the world, geneticist Mike Mahan and his team are looking for alternatives to antibiotics. They’ve discovered the very gene in Salmonella that triggers disease.

PROF. MIKE MAHAN (University of California, Santa Barbara): Well there’s basically two main points to our findings. One is we’ve, we believe we have uncovered a master switch controlling bacterial infection and when we knock out this switch it completely disables the ability of the bacterium to cause disease. Point 2 is that we’ve utilised this information to devolve a vaccine. Mice immunised with this vaccine elicit a fully protective immune response, that is these mice are completely protected against subsequent bacterial infection.

NARRATOR: Once in the body bacteria normally hide from the immune system until they reach their target cells. There they switch on the gene that stimulates the production of the poisons that make us ill. It’s not until this moment that the body recognises the invader and attacks it. By then it’s too late to stop the bacteria from causing disease.

MIKE MAHAN: Bacteria only turn on genes if they have to, and with regards to the immune system they don’t like to reveal their weapons. If they do they get nailed.

NARRATOR: In his vaccine Mike Mahan has engineered the master gene so that the bacteria are recognised by the immune system the very second they enter the body. The body immediately launches an attack destroying the bacteria before it can do harm. This white blood cell, part of the immune system, is engulfing and destroying an invading bacterium. This is what happens when the new vaccine is used. From now on the body is forever alerted to attack invading bacteria before they can cause disease. When lab mice were given this new vaccine their body’s response was so intense they became completely immune to any dose of salmonella without the need for antibiotics.

MIKE MAHAN: These mice didn’t die. Actually at levels 10,000 times the dose that, that would kill mice these mice have no symptoms whatsoever.

NARRATOR: If a similar gene can be shown to affect other types of bacteria then in the future we might have vaccines against most bacterial diseases without ever having to resort to antibiotics.

MIKE MAHAN: We really believe that this is going to lead to a new generation of vaccines. This is really, it’s new hope against a really serious battle which at the moment we’re, we’re not winning.

NARRATOR: This way of replacing antibiotics with a new medical solution is not the end of the battle. Bacteria will eventually evolve and find a way round even this, so the search for the next solution continues. But scientists have had to face another unexpected shock. They’re beginning to realise that these deadly microbes may be more pervasive than they ever thought. Dr. Sandeep Gupta is one of several specialists around the world who are puzzled by some strange statistics. He doesn’t work with bacteria or viruses. In fact, he’s a specialist in heart disease.

DR SANDEEP GUPTA (Consultant Cardiologist): We all recognise that smoking, high cholesterol, blood-pressure, diabetes, a family history is all important as, as a risk factor for coronary heart disease, but the, the point is this that those risk factors fail to explain everything.

NARRATOR: For decades scientists have focused on lifestyle factors as the cause of the sharp increase in heart disease in the West. For those with a genetic predisposition it’s believed that smoking, high cholesterol foods and high blood-pressure are key factors, but when analysing statistics on the subject, scientists saw some puzzling anomalies.

SANDEEP GUPTA: Some patients who have heart attacks don’t smoke, they don’t have high cholesterol. Japan has some of the highest rates of smoking, cigarette smoking in the world and yet some of the lowest rates of coronary heart disease. Patients from Afro-Caribbean population often have some of the highest rates of diabetes and high blood-pressure and yet some of the lowest rates of coronary heart disease.

NARRATOR: Many scientists came to believe that there must be another, hidden risk factor that was somehow triggering heart attacks and now they think they may have discovered it. In the blood of many heart patients scientists have found an unexpected bacterium: Chlamydia pneumoniae. Chlamydia pneumoniae is a bacterium that usually lives only in the lungs where it causes nothing more than a mild cold, but it’s become clear that this bacterium is also able to get into the bloodstream and travel to the heart. Scientists suspected that Chlamydia pneumoniae could be the missing link and that heart disease could actually have an infectious element to it. Sandeep Gupta was the first to put this idea to the test. He decided to look at some of his patients who’d suffered heart attacks and had Chlamydia pneumoniae in their blood. He gave them antibiotics to kill the bacteria and he discovered that at the same time the swelling in the arteries of many of his patients was reduced.

WOMAN: When this comes to a stop I’m just going to take your blood-pressure one more time.

MAN: OK.

SANDEEP GUPTA: Done very well, very good. So the, two of the main heart valves…

NARRATOR: Dr. Gupta’s initial results seem to confirm the theory, but it’s still too early to know for sure if there really is a connection between the bacterium Chlamydia pneumoniae and heart disease.

SANDEEP GUPTA: So basically it’s sound waves being bounced off… We still don’t know whether this organism is an innocent thing that has nothing to do with coronary heart disease, but the implications are major, that the ultimate aim if we prove this story would be to develop a vaccine against Chlamydia pneumoniae.

NARRATOR: But heart disease is only the first of a whole range of chronic diseases that we now surprisingly being linked to viruses and bacteria. Bizarrely scientists are beginning to realise that even cancer may be infectious.

JULIE PARSONETT: I think if you went and talked to people on the street and asked them did infection cause cancer most people would say you’re crazy. Took 60 years for people to really believe that a virus could cause cancer and the main argument against it was that viruses just didn’t cause cancer. That was, it wasn’t any more logical than that, that there was cancer and there were viruses and they weren’t the same thing and they didn’t do the same thing.

NARRATOR: Research has now shown that some of the leading cancers in the world are caused by infection. Some stomach cancer is caused by the Helicobacter pylori bacterium. Cervical cancer is almost universally caused by Papilloma virus. Liver cancer is known to be caused by the Hepatitis viruses.

JULIE PARSONETT: If you eliminated smoking as a cause of cancer, if we could get people to stop smoking then infection would be by far the most common cause of, of cancer that we know of. I think at the end of the day we’re going to find that almost all disease is caused, in some way, by infection either directly or indirectly by the way we’ve evolved to respond to them, or by the exposures that we had from childhood that affect us many years later.

NARRATOR: Now scientists are beginning to understand how pervasive these microbes are. Labs like these will continue to be in demand in this new century, a century of renewed struggle against viruses and bacteria, some of them as yet unknown. The optimism of the past is over and now it’s clear that the ingenuity of scientists is all that will keep us one step ahead of nature.

ROBERT DAUM: On the whole, I have a rosy picture of how it’s going to play out. I think we’ll be, we humans are smart too and we’ll identify new targets and make new antibiotics. On the other hand, we’ve got to work quickly.

JOE McCORMICK: We’ve got a lot to learn and we should stop assuming that once we’ve got something conquered we suddenly outsmarted nature and evolution. We haven’t done that.

C.J. PETERS: We’re racing the viruses and the bacteria and if we’re not out there running that race I think we’ll come up losers in the end.

JULIE PARSONETT: We live in a microbial world. They are the dominant force, living force, on this earth and we’re not going to escape them.

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