The musical Lifeline tells the story of Sir Alexander Fleming’s discovery of antibiotics, as these revolutionary drugs continue to lose their efficacy

The medications that doctors use to treat bacterial, fungal and other microbial infections are becoming less and less effective around the world as microbes evolve to survive exposure to the drugs. In 2021 antibiotic-resistant bacterial infections killed 1.14 million people and played a role in the deaths of an estimated 3.57 million others. The best estimates, released just this month, show that 39 million people will die of such infections between 2025 and 2050.

Today’s dire situation is the result of the overuse or improper use of these microbe-killing compounds in both medicine and in agriculture. As Lifeline dramatizes, Fleming saw this coming as far back as 1945, the year he shared a Nobel Prize for the discovery. “The greatest possibility of evil … is the use of too-small doses, so that, instead of clearing up the infection, the microbes are educated to resist penicillin,”

In 2016 Meghan Perry, an infectious diseases clinician at the University of Edinburgh, had an idea: to teach kids about antibiotic resistance with a musical. So she suggested it to composer and theater company co-founder Robin Hiley, the spouse of one of her colleagues.

“I was initially perhaps a bit skeptical about this being a good topic for a musical,” Hiley says. “But she was persistent, as clinician scientists are.” The earliest iteration of the musical was a children’s play called The Mould That Changed the World, with students playing singing and dancing bacteria and telling the story of Fleming’s discovery of penicillin.

Over time, Hiley, the show’s composer and lyricist, found himself drawn to Fleming’s life story. The Scottish physician treated soldiers during World War I, when the frontline treatment for infected wounds were harsh antiseptics that often did more harm than good. His discovery of bacteria-killing compounds later turned the once-shy scientist into an international celebrity.