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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.