THE VIRUS THAT CURES

The Virus That Cures:
Programme Transcript, BBC Online
FRIDAY, 9th March 2001

NARRATOR (JACK FORTUNE):
South of Moscow, north of Turkey, scientists in the Republic of Georgia may hold our last defence against the superbugs, against the advance of antibiotic resistant bacteria.

From this sewage comes a medicine, a medicine made from a virus, the virus that cures.

MAN:
How far away are we from the return to people dying from sore throats...

NARRATOR:
At a press conference on May 23rd 1997 scientists finally acknowledged the arrival of the untreatable bacteria they'd feared for years.

MAN:
It sounds as though we finally discovered in the wild the dreaded superbug we were all fearing, is that right?

MAN:
Yes, in a sense it is a superbug, yes.

NARRATOR:
Today superbugs look triumphant. They are bacteria that resist our antibiotics. The drugs which have kept us safe for 50 years are beginning to fail.

DR GLENN MORRIS:
This is a serious situation. Over the last 5 years we've clearly seen a change in our ability to treat what should have been easily treatable infections because the bacteria have developed the ability of resisting the antibiotics.

NARRATOR:
And the more antibiotics we use, the more resistant bacteria become. Every year more than 5 million people die from infections that don't respond to antibiotics.

These horrifying bacteria have colonised hundreds of hospitals in Britain, and thousands in the USA. And things are going to get worse. Staphylococcus is one of the most dangerous of all bacteria. One by one it has beaten all our best antibiotics. Until now only one is left - vancomycin.

GLENN MORRIS:
If we develop a staphylococci that's resistant to all of our currently available antibiotics including vancomycin, then we're in very serious trouble from the medical standpoint.

NARRATOR:
What Glenn Morris feared has now happened. This year Japanese doctors saw the world's first case of infection with vancomycin- resistant Staphylococcus. A baby boy who was in hospital for major heart surgery became infected. When antibiotics failed, doctors had to pour strong disinfectants directly into the wound on his chest.

PROF. KEIICHI HIRAMATSU:
I was very much shocked because the outcome of that bacteria infection was quite hideous. The patient suffered a lot.

NARRATOR:
These terrible bacteria will inevitably spread, and when they do, being in hospital even for minor surgery, for a hip operation or to have a baby, could be lethal. If even the smallest wound became infected, the bacteria would most probably kill you. They threaten the future of modern medicine.

KEIICHI HIRAMATSU:
Some more patients will die.

MAN:
I'm not quite sure that people have quite realised what might be at stake.

MAN:
It would be very hard to do...the major surgery that you got used to.

GLENN MORRIS:
Transplants that we do, organ transplants, cancer chemo-therapy all depend on our ability to kill bacteria which may infect wounds or may infect patients. We'll lose all that.

NARRATOR:
This appalling situation has been predicted for so many years that it's hard to understand why no new drugs have been developed to save us.

KEIICHI HIRAMATSU:
Pharmaceutical companies should have known this situation will come, but they thought that was not profitable 10 years ago. Now it is profitable, but it is too late. They should have prepared it 10 years ago.

NARRATOR:
Even today drug companies don't promise a new class of antibiotics for at least 10 years, and they may never discover one. They have already exhausted traditional chemistry and computer drug design.

Today they analyse the genes of the bacteria themselves hoping to uncover new ways of attack, but the frightening truth is that no fundamentally new antibiotic has been discovered for more than 30 years.

GLENN MORRIS:
One begins to worry that indeed we are moving to what some people call the post-antibiotic era into a time when our ability to treat virtually any infection with a powerful antibiotic is going to be over.

NARRATOR:
This is an alarming prospect, but there is one thing that kills even the most resistant bacteria. Unknown to the rest of the world, this magic remedy is cherished in one small country in the heart of the Caucasus Mountains.

This is the central hospital of the republic of Georgia, a former Soviet state. Here, as everywhere, the sickest patients are in the intensive care unit. These men are recovering from serious surgery. They are weak and vulnerable and would probably die if they caught an infection

The doctors here know that this ward has a problem. It has become the breeding ground for particularly nasty bacteria which they suspect are resistant to all the antibiotics they have.

They are taking samples from every surface in the ward. They have to find out exactly what they're up against.

DR MARINA GODERDZESHVILI:
These are samples which we took in hospital 2 days ago and this has trace which we got from the samples. Some of them are staphylococci strains.

NARRATOR:
Multi-resistant staphylococcus, one of the most lethal antibiotic resistant bacteria. Anywhere else in the world this would be a death sentence. But here in Georgia the doctors aren't too worried because they have an answer, a unique medicine that stills works on antibiotic resistant infections.

The same amazing potion is used to treat both the patients and the ward. It has a remarkable effect on bacteria.

Both these flasks contain bacteria, but a few drops of the Georgian medicine have been added to the one on the right and it has a magical effect.

The cloudiness is caused by a thick broth of bacteria, but the right-hand flask is clear because the bacteria have all been killed. This astonishing effect is caused by something we usually fear:
a virus, and the virus comes from sewage.

DR TEIMURAZ CHANISHVILI (WITH SUBTITLES):
I first saw this 51 years ago. It was the first experiment I did here. I took the culture of bacteria and added sewage to it, just ordinary sewage water from the drains.

DR ZEMPHYRA ALAVIDZE (WITH SUBTITLES):
I first saw this a long time ago, when I was still a student. We were all very enthusiastic about it.

NARRATOR:
The first man to spot the potential of this effect was an irascible French-Canadian called Felix D'Herelle.

In 1917 he suggested that the viruses which killed bacteria in bottles could also be used to treat disease. An ardent Communist, D'Herelle was enticed to Russia by Stalin who wanted this magic medicine for his army, and in the Finnish war of the 30s, and even in World War II, it was used to protect the Red Army from the dysentery and gangrene that plagued the battlefield.

With Stalin's blessing D'Herelle founded an institute in Tbilisi, the capital of Georgia, that was dedicated to the study of these magical viruses and the way they cure infections.

D'Herelle named these healing viruses bacteriophage, which means bacteria eaters. There is a phage to kill every kind of bacteria. Just as bacteria attack people, these tiny viruses attack them, and they're found wherever bacteria thrive, most often in sewage.

Here they are too small to be seen, but the phage are killing off the bacteria one by one.

Phage have an extraordinary structure. Their bulk is a head in which their genes are stored. They have 6 legs or filaments which attach them to the bacteria and a tail that works like a hypodermic syringe to infect it with their genes. Inside the bacteria the phage viruses grow and multiply. Sometimes as many as 5,000 grow in a single cell. When the new phage burst out they kill the bacteria and then each goes on to find another victim.

TEIMURAZ CHANISHVILI (WITH SUBTITLES):
I love bacteriophages. They bring you something new every day. While I still had good sight, I was fascinated by the electron microscope. I took all these photographs.

This is the phage against staphylococcus... salmonella phage... this phage is against pseudomonas... this is the phage against dysentry...this phage is also against pseudomonas... this one is against dysentery... streptococcus phage.

They are all completely different.

ZEMPHYRA ALAVIDZE (WITH SUB-TITLES):
Phage are specific. Each phage only grows on a particular kind of bacteria. That is why we talk of Staphylococcus phage. It reproduces only on Staphylococcus.

NARRATOR:
Being specific makes phage tricky to work with. It means that good treatment depends on a very precise diagnosis, which takes time and money.

Over the years the Institute trains specialists to find phage, grow them and turn them into medicine. In the 1970s when antibiotic-resistant bacteria became a serious problem in Soviet hospitals, phage became the saviour.

TEIMURAZ CHANISHVILI (WITH SUBTITLES):
A decree was issued that all bacteria resistant to antibiotics and local phages must be sent to the Institute where we made a new preparation, and that is how so many different phages were collected here. It was very difficult to organise but everything we did was centralised.

NARRATOR:
The centralised Soviet system was ideal for the labour-intensive work needed to make phage effective. Together Communism, phage and the Institute thrived.

ARCHIVE RUSSIAN FILM NARRATION:
Phage medicine had its heyday in the 1980s. It was manufactured in factories across the Soviet Union and here in the Tbilisi Institute. At that time Teimuraz Chanishvili and Amiran Meipariani ran the Institute.

AMIRAN MEIPARIANI (WITH SUBTITLES):
We used to inject phage into one, two, three, four vats. There were 500 litres in each vat, and remember we had to take orders on top of that, orders of two and a half tonnes per day.

TEIMURAZ CHANISHVILI (WITH SUBTITLES):
We produced tablets and bottles. We made phages for all the Soviet Union.

AMIRAN:
They weren't only for dysentery but typhoid and Salmonella too.

TEIMURAZ:
Mostly for intestinal infections.

AMIRAN MEIPARIANI (WITH SUB-TITLES):
Phages are our daily bread, we've devoted our lives to them. The prospects for phage are tremendous

NARRATOR:
There is no question that phage medicine can be extremely effective.

WOMAN (WITH SUBTITLES):
My son became ill when he was young. They checked his throat and nose and found Staphylococcus. I went to the Institute and they gave him phage and it cured him.

Phage medicine is a wonderful thing

WOMAN (WITH SUBTITLES):
Phage works against dysentery. Yes, it's good for dysentery.

They even give you phage in an enema.

NARRATOR:
Today when people in Georgia get an infection sometimes they take antibiotics, but often their doctors prescribe phage.

This pharmacy is in the grounds of the Tbilisi Institute.

Every day people who choose to use phage rather than antibiotics come here to have their infections analysed and to pick up prescriptions for medicines, tablets and creams made of phage. They rub the healing viruses into their wounds, drink them for a bad stomach, or swill to cure a gum infection. And every day in the hospital these viruses are used to save lives.

This woman developed gangrene in a wound on her thumb. Five days ago the doctors cut away most of the infected tissue. The rest they treated with phage.

MAN:
It is ultrasound and it pushes phage in the deep tissues, deep in tissues.

NARRATOR:
If the resistant bacteria rife in the hospital got into this woman's wound they would cause blood poisoning that would kill her.

Phage does not work well in the blood-stream.

Being a virus, it's fought off by the immune system, but the surgeons make sure infection doesn't take hold in the first place by using phage to sterilise the room and equipment as well as the wound.

MAN:
We think that the phage used during the first operation had helped the wound to be in such good condition.

NARRATOR:
Phage works wonders in Georgia, and given the chance, it could do the same everywhere. A unique library of phage medicine is held in Tbilisi.

It's a national treasure preserved by the painstaking care of the Institute scientists. It was built up over the 50 years when problem bacteria were sent here from all across the Soviet Union.

Phages were found to fight every new infection, and then they and the bacteria they killed were stored separately for future research.

There are phages here to fight hundreds of different infectious diseases. Some are even originals from the 1940s.

It's the biggest collection of phage medicine in the world.

WOMAN (WITH SUB-TITLES):
Here we have unique strains of bacteria.

They have been collected from all over the world.

We need to store the bacteria because they are used when we breed new phages.

NARRATOR:
All bacteria have to be fed. These particular strains eat meat. In the bottom of each test-tube is a small piece of liver which will keep the bacteria going for about 6 months.

WOMAN (WITH SUB-TITLES):
The worst disease they cause is gangrene. We have strains of botulism that cause such severe poisoning that they're used in biological weapons

WOMAN (WITH SUBTITLES):
This is our collection of phages. The phage against gangrene is most common. This is a museum. Not only are the phage unique, the bottles are as well. They are such an interesting shape.

NARRATOR:
Phage therapy has been so successful here for so long that it's hard to understand why in the West we have never even heard of it.

TEIMURAZ CHANISHVILI (WITH SUBTITLES):
Even in the USSR at the Moscow Centre for Surgery I gave a lecture about phage, and they asked only one question:
why isn't it used in America?

NARRATOR:
To scientists like Dr. Chanishvili it seems incredible that this medicine, once used daily right across the Soviet Union, has been ignored by the West, but the reasons are woven tightly into history.

In Britain today very few people know anything about phage therapy, but those that do are clear about how it became discredited in the West in the 1930s.

DR PAUL BARROW:
Some of the claims that were made for some of these bacteria phages which are isolated were, quite frankly, totally barmy.

There was one commercial preparation, for example, called Enterofagos which supposedly had miraculous powers against both herpes infections and eczema which is totally impossible to believe.

DR JAMES SOOTHILL:
Treating things like herpes which is now known to be a viral infection, urticaria which is an allergic reaction and a whole variety of other conditions including gallstones, which they couldn't possibly work for.

NARRATOR:
These claims were not fraudulent, so much as uninformed. In fact, a lack of understanding plagued most phage work done round the world in the early days.

In India in 1935 even the British Army tried it out on the local population during a cholera epidemic.

PAUL BARROW:
It has to be said that some of the clinical trials that were carried out were exceedingly poor quality. For example, in some of the early work on cholera phage in the 1920s and the 30s there were no control groups whatsoever, so it was impossible to see whether the phage had worked. Some of the trials consisted merely in pouring bacteria phage down drinking wells in a village to see whether it had any effect, with no understanding of dose or a good understanding of the mechanisms whereby bacteria produced the diseases.

JAMES SOOTHILL:
I think some of the problems with the early studies...that they didn't necessarily select the best phages for the job. They didn't necessarily check the organism that was causing the diarrhoea ... that was sensitive to the phage.

NARRATOR:
By 1941 phage was still thought too unreliable to be useful by researchers in the West, and when powerful antibiotics arrived a few years later, phage was quickly forgotten.

Meanwhile unknown to the outside world, the Georgian scientists went on to do their best work.

Thorough medical trials of phage under rigorous conditions, but it made little difference to phage's poor reputation abroad.

PAUL BARROW:
Bacteria phage work that has been going on in Russia, specifically in Tbilisi, has been going on for many, many years. I'm a little bit concerned about it in that very little of it has been published in the West.

NARRATOR:
Research is only considered respectable in the West if it's been published in a well-known scientific journal, but for scientists who lived in Georgia under Communism this has not always been possible.

DR ALEXANDER SULAKVELIDZE:
Researchers were not particularly encouraged to publish in Western journals. Actually you might end up having a problem if you did publish something in a Western journal.

NARRATOR:
Research that proves the worth of phage medicine was published by the Georgian scientists, but only in the Soviet Union, and even today it is ignored because of a strange phenomenon that's true across the world of science - if you don't publish in English your science barely exists.

ALEXANDER SULAKVELIDZE:
Even the best publications again they were published either in Russian or in Georgian. Now not many people in United Kingdom or in the United States can read in Russian, probably even less reading in Georgian, so I think the problem here is not because the science was bad, but because they could not read it, they could not, you know, get acquainted with it.

NARRATOR:
But there is one set of phage experiments that were beautifully designed, carefully conducted and published in English. They were carried out on cows by a maverick veterinary biologist called Willie Smith.

PAUL BARROW:
The thing that sparked my interest in using phage was Willie's experimental work which was absolutely fantastic.

The results are brilliant. I mean nothing about the guy surprised me really, but it really was very exciting.

NARRATOR:
Sadly Willie Smith died in 1987, but his rigorous animal work is the only reason anyone in the West has ever heard of phage therapy. Throughout the phage days his assistant was Mick Huggins.

MICHAEL HUGGINS:
I helped him at the time, really as the muscle collecting the calves.

NARRATOR:
When Smith and Huggins started testing phage in cattle neither really expected it to work and their colleagues were even more sceptical.

MICHAEL HUGGINS:
They thought that there was no future in it because previously a lot of extravagant claims had been made, which was one of the reasons why we did experiments over and over again to make sure that we hopefully weren't going to fall into the same trap.

We collected phage from sewage stations from markets, from slurry pits where we expected to find bacteria that caused the disease. The idea being that you would most likely find these phages in areas where you got a collection of shit.

NARRATOR:
By paying scrupulous attention to detail, they performed work that even today is universally respected. They extracted phage from the cow muck and used it to treat calves suffering from lethal diarrhoea.

MICHAEL HUGGINS:
We found that when they were treated with the phage they did not show signs of diarrhoea at all. The clear-up rate was 100%. We found that the phage was better than most of the antibiotics and as good as the best.

NARRATOR:
With Willie Smith's death, Huggins moved on and the cow work came to an end, but their outstanding work on animals had caught the interest of Paul Barrow who worked in the lab next door.

PAUL BARROW:
I inherited some of Willie Smith's staff and his large collection of bacteria and phage, which he started in 1945 and has now reached over 7,000 cultures. For each of these tiny little vials contains an individual bacterium or bacteriophage preserved which will maintain for many, many years and you can see that it's basically impossible to know what is what without consulting our stock book, but they're all there for our use.

NARRATOR:
Barrow didn't take up research on phage therapy himself, until the crisis of antibiotic resistance came to his attention. Today, he and his small team work on resistant infections in animals.

PAUL BARROW:
We have been extending the work that Willie Smith did using bacteriophages to control and treat blood poisoning and meningitis into chickens, and the experiments have worked very well. We've been able to both prevent and treat E-coli infections in chickens and the experiments have worked fantastically really.

NARRATOR:
James Soothill was also inspired by Willie Smith. He has since directed his research towards humans and the resistant bacteria which infect burns.

JAMES SOOTHILL:
People with large burns get infected with Pseudomonas aeruginosa. It's the biggest cause of death 48 hours after being burnt and it also causes skin grafts to fail. My reason for wanting to work on it is Pseudomonas is normally resistant to many antibiotics and readily acquires new resistance, so it's one of the bacteria that could be a problem in the future.

NARRATOR:
Although Soothill and Barrow realised that antibiotic resistant bacteria could be overcome with phage, they have found it impossible to convince their scientific colleagues who are still wedded to the idea of antibiotics. Ever since 1947 when resistance began to emerge, the immediate answer to any resistant infection has been:
find a new antibiotic.

ARCHIVE FILM NARRATOR:
The individual scientist in the laboratory goes on seeking new germ killers. The industrial chemist continues to develop them and improves production processes. Dr. (NAME):
's streptomycin has been modified and combined with chemicals to slow down the development of resistance by disease germs.

NARRATOR:
But there are profound reasons why this approach will never solve the whole problem of resistance. Every time we take an antibiotic or spray one onto a crop, the weakest bacteria are killed. The few strong ones, resistant to the antibiotic, are left to multiply.

Resistance is inevitable and the more antibiotics we use, the worse the problem becomes. This plate of staphylococcus has been dosed with antibiotics which kill most bacteria, but MRSA, the resistant bacteria, thrive when the sensitive ones die and they soon take over, in a clear example of survival of the fittest.

GLENN MORRIS:
This is evolution in action.

Essentially when you use antibiotics you provide what's called selective pressure. That means that the bacteria which have a gene which allows them to resist the actual antibiotic are better able to survive when you give a patient antibiotics. Consequently, within hospitals and also in the community, we have grown up a generation of bacteria which have an increasing ability to fight off our antibiotics.

NARRATOR:
The key problem with antibiotics is that they are unchanging chemicals. Once bacteria develop resistance to them, they become redundant. But phage is different.

The beauty of phage as a medicine is that they are alive, so they can change, just as bacteria do. When bacteria evolve, resistance phage evolve alongside. When a superbug appears, a super phage will always evolve to attack it.

It's an evolutionary arms race.

Phage offer the world a naturally evolving medicine, able to fight off any new bacteria that emerge.

ZEMPHYRA ALAVIDZE (WITH SUB-TITLES):
Bacteria also develop resistance to phages but it doesn't happen as often and if bacteria are resistant to our phages we can always find another phage

NARRATOR:
Back in Georgia, when the Institute is sent a sample of antibiotic resistant bacteria that is also resistant to all their phages, they go back to basics and search for a new virus.

WOMAN (WITH SUB-TITLES):
The Central Hospital sent us a sample of bacteria which are resistant to all the phages we have in the laboratories. So now we must look for new phages to fight them..

This is where the main drainage flows from the hospital. We come here because sewage water is dirty.

It contains all the bacteria now circulating in the hospital and wherever you get bacteria you get phages too.

NARRATOR:
Lurking in this sewage is the super phage that promises to beat the new resistant strain of bacteria from the hospital. Phage could also hold great promise for the rest of the world, but as ever, there's a catch.

In 1991 the Soviet Union broke up and civil war broke out in Georgia. These events combined to threaten the existence of the Institute and may eventually destroy the precious collection of phage that's held there. Years of power cuts caused by the war mean that already hundreds of phages, carefully stored at just the right temperature in the Institute's refrigerators, have been lost.

DR NINO CHANISHVILI:
In the laboratories we had about plus 5 degrees, 7 degrees because it was not heated at all and we had light something like 2/3 hours per day. We were moving these phages to our refrigerators or back here depending on how it is, but in winter it's OK. We were frozen so the phages were OK.

NARRATOR:
One hot summer and one too many power failures and the Institute could lose 60 years accumulated experience. The Soviet money that funded this unique Institute through most of its life went when Georgia gained independence.

The cost of civil war meant that the Georgian government itself has no money for science.

In the last few years the tiny amount of phage medicine produced here has been made by hand and makes little profit. There has been no money to keep this place going and research has virtually ground to a halt. There seems no future for the Institute or its precious medicine.

Meanwhile, the outside world remains so ignorant about phage that people like Paul Barrow in England have found it almost impossible to get money to fund their research.

PAUL BARROW:
We are in the process of trying to put together grant applications to continue some of this work and expand it and most of the replies that we've had have been negative.

NARRATOR:
Just when it looked like the end for phage therapy, something amazing happened. Everything changed when a popular American science magazine published a piece about the Institute - the first article ever written about the place in English. One of the people who read it was multi- millionaire Caisey Harlingten.

CAISEY HARLINGTEN:
When I first saw the article about the bacteriophage was when I was flying back from Toronto with my girlfriend, Monica, and I was reading a Discover magazine - a new one I just got off the shelf... this one here... and I saw this article on 'The Good Virus'.

Actually it was the last article that I read in the magazine, it didn't look that interesting to me. Then as I read it, it called out to me to investigate it further.

NARRATOR:
Caisey Harlingten is a venture capitalist who made his millions setting up technology deals.

CAISEY HARLINGTEN :
..problems, but it's got to be US cash.

I don't have any science background to speak of at all other than what I read in science journals which I read regularly for interest. My background is stockbroker. I've been a stockbroker since I was about 23 years old and it's thought that there be profit in phage inasmuch as there's profit in antibiotics immediately.

NARRATOR:
After reading the magazine, Caisey Harlingten made contact with the Institute and decided that phage medicine did have a lucrative future.

Within 9 months he'd raised enough capital to set up a company. The business was based in the USA, but it was called Georgia Research Inc., or GRI.

Back in Georgia, GRI opened a small lab in the grounds of the Institute.

NINO CHANISHVILI:
The conditions here are much better than in the main building because this building is completely privatised and the owners manage to have electricity and water running permanently.

CAISEY HARLINGTEN:
The spending hasn't even begun. I mean we're talking about a pharmaceutical development company, you know, I mean you can get into the hundreds of millions of dollars in a fairly short period of time, I'm sure.

NARRATOR:
Fully aware of the problems caused by antibiotic resistant infections in hospital, Caisey's first move was to fund a joint research project between his lab and the republic of Georgia and Glenn Morris's team in the USA.

GLENN MORRIS:
Phage therapy is an interesting idea. Will it ever find wide acceptance? I don't know, but I'm in a position where I find myself not able to treat my patients and under the circumstances I think it's very reasonable to look back at what we have looked at in the past.

ALEXANDER SULAKVELIDZE:
I'm not much of a phage expert and not too many people in this country have been involved in phage studies.

We are sending about 500 antibiotic resistant strains to Georgia. Nino and her colleagues can string those strains against the phages that they already got in their collection. When they identify a specific phage they're going to send that phage hopefully back to us here in Baltimore.

NARRATOR:
The 500 samples all came from patients who had died of different antibiotic resistant infections.

Before the Georgian team could begin their search for the right phages, they had to regrow the resistant bacteria and confirm exactly what they had been sent. But being familiar with the nature of phage and the way they live on the backs of bacteria, they knew what else might lurk in the samples, and after weeks of careful work they found it.

These plates are striped with the resistant bacteria from Baltimore. On the stripe from patient no. 19 they found a clear spot where something was killing the bacteria. They grew it, tested it & confirmed it was phage. And there were even more phages in other samples.

NINO CHANISHVILI:
Here you see how the antibiotic resistant bacteria are killed by the phages.

NARRATOR:
If these phages had been given as medicine in large doses they might have cured the patients that died in America. The magical viruses might have worked where antibiotics failed. This could be a key new drug for the West.

Thrilled by the instant success of the company's first project, Caisey Harlingten decided to bring scientists from round the world to Georgia to discuss the future of phage. Enthusiasts from England, the USA, Canada, Poland and Germany came together for the world's first international conference on therapeutic phage. The conference was hosted in the mountains above Tbilisi at what used to be the Communist Party headquarters.

CAISEY HARLINGTEN:
I'm not sure where we are actually. We're in the wilderness. We feel like pioneers. Broken beds, no flushing toilets, no lights, no washrooms. This is nothing to do with Georgia.

Personally I'm enthralled with Georgia, I really am, the people as well. This just happens to be, you know Communist era and that's all. No big deal.

NARRATOR:
The conference was a marvellous chance for the few people in the world obsessed with phage therapy to compare notes.

DR JAMES SOOTHILL:
It's a great opportunity to talk about phage.

You know normally I talk about phage and everyone doesn't want me to talk about it, but here everybody else wants to talk about it as well which is great.

NARRATOR:
But the company scientists were there to sniff out profitable ways to beat antibiotic resistance.

They had to assess which research Caisey should support and which he could afford to ignore, which skills the company needed to buy and which it could develop for itself.

MAN:
What I hope to do is draw out all the information I can that will help us get these phage approved by the FDA

NARRATOR:
They wanted to judge the Georgian work carefully because both lives and money were at stake.

CAISEY HARLINGTEN:
The bottom line is we'll all benefit if they're capable of providing what they say they have. If they don't have what they say they have, then we will be the big losers and they will be the big winners because they're getting everything that they say they need, to refurbish their facilities and pay scientists and researchers etc., so it's a big gamble for us.

They've got everything to gain and nothing to lose.

TEIMURAZ CHANISHVILI (WITH SUBTITLES):
We will work together to develop phage medicines until we get the patents. When we have the patents for the medicines, who should produce them and where they should be produced will be discussed by the Institute and the company.

NARRATOR:
Company President is Richard Honour, a scientist, businessman and realist.

DR RICHARD HONOUR:
They have a distinct role and we have a distinct role.

Their role, their accomplishments have been in the area of discovery and invention. Now our role, which is quite distinct, is to bring them forward as Western quality, Western standard pharmaceuticals. That makes this marriage a perfect marriage.

NARRATOR:
Whether this really was a perfect marriage remained to be seen, but everyone came together with high hopes.

The Institute was pinning its hopes of survival on the company.

The businessmen were looking for products and profits.

TEIMURAZ CHANISHVILI (WITH SUBTITLES):
Now I am old, phage research is my hobby and I would like my hobby to make me prosperous.

NARRATOR:
There will be big financial gains for some if phage medicine spreads beyond Georgia, but the stakes are higher than that. With antibiotic resistance on the increase, the future of modern medicine may depend on bringing phage therapy to the rest of the world.

RICHARD HONOUR:
The net result of this collaboration is going to be the ultimate development of real pharmaceutical products that will withstand the scrutiny of a regulatory environment any place in the world.

NARRATOR:
The problem of antibiotic resistance grows worse every day, everywhere, but making phage medicine for use in the West would involve a huge amount of work.

Years of medical trials that were carried out at the Institute would have to be repeated to the standards of the American Food and Drug Administration, the all-seeing, all-knowing FDA.

It's doubtful that these vats would ever be acceptable to the FDA, so Caisey Harlingten plans to produce his phage elsewhere.

Back in America, the company has already started building a large pilot production facility on the outskirts of Seattle.

RICHARD HONOUR:
What we're going to do with this very large space is build it in to a phage therapeutics development laboratory and manufacturing facility.

The next step in the process is to go to scale up pilot manufacturing which will also be FDA certifiable for human use therapeutic products using this phage technology.

MAN:
How many employees?

RICHARD HONOUR:
All of this...

NARRATOR:
FDA certifiable proof that phage can help fight antibiotic resistant disease is still many years and many millions of dollars away, but Caisey and the company were firmly convinced by what they saw in Georgia.

RICHARD HONOUR:
We moved into this space one month ago. We signed a 15 year lease to make sure that we could see multiple products through to market from the beginning stages.

AMIRAN MEIPARIANI (WITH SUBTITLES):
Every company tries to do the best for itself. But we have only one problem, and that is survival. We must survive.

CAISEY HARLINGTEN:
I guess it's a matter of who gets there first and who dominates the market.

NINO CHANISHVILI:
I'm absolutely sure that he is good for the Institute because he has very good, very pure intentions. Nothing is hidden behind, everything is said clearly.

CAISEY HARLINGTEN:
It's a technology basically, it's a biological technology. It's just business.

ENDS

Photography JOHN HOWARTH

Sound CHRIS KING

Film Editor RUSSELL REES DAVID PYGRAM

Horizon Unit Manager SHIRLEY ESCOTT

Unit Assistant AMANDA WHEELER

Researcher ANNABEL GILLINGS

Written & Produced by... JUDITH BUNTING

Deputy Editor BETTINA LERNER

Series Editor JOHN LYNCH