On the night of November 30, 1940, German bombs tore through a police station in Southampton, England, killing a sergeant and injuring two constables. One of them, a reserve officer named Albert Alexander, survived the blast, but a scratch near his mouth became infected, then spread to his scalp, lungs and eyes. By February, he was dying.
In nearby Oxford, a small team led by Howard Florey and Ernst Chain had spent two years chasing a discovery that had sat mostly ignored in the scientific literature. They had just enough of a substance called penicillin to try it on a human being.
They gave it to Alexander and within a day his fever broke, his eyes cleared and he began to eat. And then the penicillin ran out. He relapsed and died on March 15, 1941—the first person ever treated with the drug that would go on to save more lives than any medicine in history.
A Decade in Waiting
The substance that failed to save Alexander had been sitting in plain sight since 1928, when a Scottish bacteriologist named Alexander Fleming returned from holiday to his lab in London and noticed something strange: a stray mold, Penicillium notatum, had contaminated a petri dish of Staphylococcus bacteria—and everywhere the mold grew, the bacteria had died. Fleming published his observation in 1929, but isolating and purifying whatever the mold was producing proved too difficult for the technology of the day. The finding languished until Ernst Chain came across Fleming's paper and proposed to Florey that they try, again, to isolate penicillin. Though their work was a partial victory, it proved the concept, and exposed the single problem left to solve: how do you make enough?
Alexander Fleming in his lab, where in 1928 he made the discovery that gave rise to the antibiotic era.
By 1943, at the height of WW2, the U.S. and the U.K. had developed deep-tank fermentation to produce large quantities of penicillin. The antibiotic became standard battlefield medicine, saving countless Allied lives.
Madeline Powers, who served as the CDC Foundation’s antibiotic stewardship public health specialist on the Antibiotic Stewardship Resources Project.
Answering at Industrial Scale
By 1943, at the height of World War II, the United States and United Kingdom made penicillin production a wartime industrial priority, developing deep-tank fermentation methods that could brew thousands of gallons of the drug. Suddenly, wound infections and battlefield pneumonia became survivable, and penicillin became standard battlefield medicine.
By the war’s end in 1945, the drug was moving into civilian hospitals across much of the world. Its arrival marked the beginning of what historians call the antibiotic era—the point at which pneumonia, septicemia and infected wounds became routinely treatable. In the eight decades since, antibiotics are estimated to have saved roughly 200 million lives.
A Threat That Hasn’t Gone Away
Despite the remarkable impact of his discovery, Fleming had a concern.
“There is the danger that the ignorant man may easily underdose himself and, by exposing his microbes to non-lethal quantities of the drug, make them resistant,” Fleming said while receiving the Nobel Prize alongside Florey and Chain in 1945.
Fleming’s concern was to prove prophetic. Resistant bacteria began appearing within a decade of penicillin’s first use in a person, and the race between new antibiotics and highly adaptable bacteria has continued ever since. Antimicrobial resistance (AMR)—also referred to as drug-resistant infections—now ranks among the top global health threats, associated with millions of deaths worldwide each year. In the United States alone, drug-resistant infections sicken an estimated 2.8 million people and kill roughly 35,000 annually.
“Every time an antimicrobial is used, bacteria have an opportunity to adapt, and unnecessary or inappropriate use accelerates this adaptation,” said Christine Emmons, PhD, antibiotic resistance program coordinator for Nevada’s Office of State Epidemiology, hired through the CDC Foundation’s Workforce Services program. “But antimicrobial resistance is not an inevitable catastrophe. People respond better when they understand that this is a serious problem we can influence.”
That balance—protecting a vital resource without frightening people away from using it—has even found its way onto the stage. In 2022, the CDC Foundation helped bring an Edinburgh Fringe musical called The Mold that Changed the World to audiences in Atlanta and Washington, D.C. The show follows an aging Alexander Fleming reflecting on his discovery and his prize, and on the warning he tried to convey about its use.
Kathleen Jacobson, associate director for programs at the CDC Foundation.
Alexander Fleming, Howard Florey and Ernst Chain won the 1945 Nobel Prize for their work with penicillin, brought to life onstage by a production called "The Mold that Changed the World."
Dr. Christine Emmons, antibiotic resistance program coordinator for Nevada’s Office of State Epidemiology.
Many Fronts, One Resource
Outpatient clinics are where 80 to 90 percent of all human antibiotic use occurs and where, by the Centers for Disease Control and Prevention’s (CDC) estimate, roughly one in three prescriptions are unnecessary. To address that issue, the CDC Foundation has supported projects aimed at combating antimicrobial resistance, each addressing a different piece of the same challenge. Through the recent Antibiotic Stewardship Resources Project, the CDC Foundation partnered with CDC’s Office of Antibiotic Stewardship to connect state Medicaid programs with health department stewardship teams. The project used Medicaid’s own prescribing data to help clinics better understand and improve how antibiotics were being prescribed.
“Healthcare payers, including state Medicaid programs, are well positioned to improve healthcare quality through their ability to influence clinical practice,” said Madeline Powers, who served as the CDC Foundation’s antibiotic stewardship public health specialist on the project. “Using antibiotics only when needed helps ensure patients receive the best treatment, reduces unnecessary side effects and slows the development of antimicrobial resistance.”
Through a project called Detecting, Responding and Containing Carbapenem-Resistant Organisms, the CDC Foundation is helping assess gaps that may keep resource-limited health systems from identifying and containing a particular drug-resistant bacterium before it spreads. Because protecting antibiotics for Americans means strengthening systems globally, a CDC Foundation companion project in India is helping bolster hospital infection prevention and control and expand AMR surveillance networks across dozens of hospitals, partnering with India’s leading medical institutions.
Using antibiotics only when needed slows the development of antimicrobial resistance.
Eight decades after an Oxford laboratory produced too little of a miracle drug to save one man’s life, the work of protecting antibiotics happens quietly—a health department analyzing data, a lab tracking a resistant strain, a doctor deciding to wait one more day before writing a prescription.
Kathleen Jacobson, the CDC Foundation’s associate director for programs who oversees its infectious disease portfolio, grew up about 15 miles from Fleming’s birthplace in Scotland. This spring, when she came down with a respiratory infection, her own doctor took a thoughtful, deliberate approach—carefully discussing her options before ultimately deciding an antibiotic would be beneficial for her treatment.
“That's a sign,” Jacobson said, “The system is working the way it’s supposed to."
