Adult Intensive care ward at the Hospital for Tropical Diseases, Ho Chi Minh City, ©Chau Doan/Getty Images

In the infectious disease wards of Ho Chi Minh City’s main hospital for tropical illnesses, patients are arranged behind plate-glass windows like mannequins in a department store. Those that are conscious stare blankly through the glass that separates them and their frightening pathogens—cryptococcal meningitis, perhaps, or septicaemia—from the efficient hum of nurses and orderlies on the ward. A runner comes in and hands a doctor a sheaf of papers, the latest batch of results from the microbiology lab.

For the glassed-in patients—the hospital’s most serious cases—these reports are rarely encouraging. The pathogens that have colonised their blood, lungs, or tissues have evolved their way around every drug that could have been used to combat them. And researchers working on the frontline of resistance blame the mutant bugs, in part, on fake and second-rate medicines.

This may be happening far away, but it is the west’s problem too. In these days of global tourism, travel and migration, drug-resistant bacteria are highly mobile. “Humans think a lot of themselves,” said Paul Newton, professor of tropical medicine at Oxford University, who works out of a microbiology lab in Vientiane, the capital of Laos. “But in fact we’re really just exoskeletons for bacteria. They take cheap flights as often as we do.”

No-longer curable variants of bugs bred in Ho Chi Minh City may be coming to a hospital near you. In 2008, an especially nasty genetic mutation that made several bacteria resistant to multiple classes of antibiotic was identified in a Swedish patient returning from India (hence its name, New Delhi metallo-beta-lactamase 1, or NDM-1). It was found in Britain that same year, and by 2013, in over 70 other countries. And it is not the only such infection to come to Europe. Multi-drug resistant staphylococcus, third-generation cephalosporin-resistant E.coli and K.pneumoniae have also travelled the world. At the last count, these infections and other resistant ones were already killing 25,000 Europeans a year—without measuring newer imports, such as NDM-1.

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