0:00:03 > 0:00:07Tonight, Panorama asks - is farming fuelling one of the biggest
0:00:07 > 0:00:09health threats facing humanity?
0:00:10 > 0:00:15What I'm scared of is a future where resistance of infections rises,
0:00:15 > 0:00:18so we lose what I call modern medicine.
0:00:18 > 0:00:22We meet the people for whom the drugs have stopped working.
0:00:22 > 0:00:24I ended up in intensive care
0:00:24 > 0:00:28and we were at the point of my two grown-up children having to
0:00:28 > 0:00:31make a decision whether to turn off the life support or not.
0:00:34 > 0:00:36Superbugs are on the rise.
0:00:36 > 0:00:40Is that being made worse by antibiotic use on farm animals?
0:00:40 > 0:00:42So what did you discover?
0:00:42 > 0:00:45These large blue colourings are all MRSA.
0:00:47 > 0:00:51We put farms to the test, looking for drug resistance.
0:00:51 > 0:00:54QUIETLY: I'm just going to go in and try and get a sample
0:00:54 > 0:00:57from as close to the edge of the farm as I can.
0:00:58 > 0:01:04And we ask whether antibiotic overuse is threatening to take us back to the Dark Ages of medicine.
0:01:22 > 0:01:25We'll take all these off on the way out - in the room -
0:01:25 > 0:01:28and leave anything that we might have picked up on our surface
0:01:28 > 0:01:29in the room.
0:01:31 > 0:01:33'I've come to St James's Hospital
0:01:33 > 0:01:36'in Leeds to meet Pamela Maddison-Bird.'
0:01:36 > 0:01:37Hi there.
0:01:37 > 0:01:41'She's been in hospital on and off for five years
0:01:41 > 0:01:43'after a routine stomach operation.
0:01:43 > 0:01:45'But we're not allowed to see her,
0:01:45 > 0:01:49'except under strict infection-control rules.
0:01:49 > 0:01:52'And this could be the shape of things to come.
0:01:53 > 0:01:57'Five years ago, Pam was taken seriously ill with blood poisoning
0:01:57 > 0:01:59'caused by a superbug.'
0:01:59 > 0:02:03I'd collapsed in the garden and my daughter found me in the garden.
0:02:03 > 0:02:06I was rushed into intensive care and I was there for 11 days
0:02:06 > 0:02:08in an induced coma.
0:02:08 > 0:02:10It then attacked all my internal organs,
0:02:10 > 0:02:12so I lost four-fifths of me bowel.
0:02:12 > 0:02:14Then I got told I had this Klebsiella bug,
0:02:14 > 0:02:17and because it's antibiotic-resistant,
0:02:17 > 0:02:19suddenly everybody started wearing blue overalls,
0:02:19 > 0:02:23including porters and anybody else that came near me.
0:02:23 > 0:02:26- Do you feel a bit like a pariah? - Absolutely. Absolutely.
0:02:26 > 0:02:27You can see people sort of look in
0:02:27 > 0:02:31and almost covering their mouths to prevent them breathing in the germs
0:02:31 > 0:02:33because they don't know what I've got.
0:02:33 > 0:02:38It can make you feel very alienated, very isolated, especially
0:02:38 > 0:02:41when you're in a room like this, like I've been for a long time now,
0:02:41 > 0:02:42one room on your own.
0:02:51 > 0:02:54'England's Chief Medical Officer, Sally Davies,
0:02:54 > 0:02:59'has made fighting antibiotic resistance her core mission.'
0:02:59 > 0:03:02Our modelling for the whole UK suggests that
0:03:02 > 0:03:05over the next 20 years, if we do not take action,
0:03:05 > 0:03:08so we continue with drug-resistant infections
0:03:08 > 0:03:09at the present level,
0:03:09 > 0:03:13there will be at least 200,000 infections
0:03:13 > 0:03:16that are resistant to antibiotics,
0:03:16 > 0:03:20of which there will be 80,000 deaths. That's a serious problem.
0:03:22 > 0:03:2614 months ago, Pam needed further surgery
0:03:26 > 0:03:30and the drug-resistant superbug she'd picked up almost killed her.
0:03:31 > 0:03:35My surgeon and I have already had a conversation about life expectancy
0:03:35 > 0:03:37and I do know that it's been reduced.
0:03:37 > 0:03:41The antibiotic-resistant bug's played quite a big part in this,
0:03:41 > 0:03:43and again I ended up in intensive care
0:03:43 > 0:03:46and we were at the point of my two grown-up children
0:03:46 > 0:03:51having to make a decision whether to turn off the life support or not.
0:03:51 > 0:03:55And because they were indecisive, my surgeon said, "Well, let's just
0:03:55 > 0:03:59- "give her another two or three days and see what happens."- Wow.
0:03:59 > 0:04:02And I did come round, gradually.
0:04:02 > 0:04:04But you don't get closer to death
0:04:04 > 0:04:07- than someone's finger hovering over the button.- Absolutely.
0:04:08 > 0:04:11It's growing in importance...
0:04:11 > 0:04:14'Microbiologist Professor Mark Wilcox is managing patients
0:04:14 > 0:04:18'against a growing tide of drug resistance.'
0:04:18 > 0:04:21It's definitely increasing and it's moved from something that was
0:04:21 > 0:04:25a rarity that we'd all talk about as "Look at this"
0:04:25 > 0:04:28to actually something we're having to deal with on a weekly basis.
0:04:30 > 0:04:33Hospitals up and down the country are increasingly
0:04:33 > 0:04:35seeing their antibiotics fail.
0:04:36 > 0:04:37The rate of increase
0:04:37 > 0:04:42of the appearance of these multi-drug-resistant organisms
0:04:42 > 0:04:44is very steep.
0:04:44 > 0:04:48It might spread through the blood to another part of the body,
0:04:48 > 0:04:52cause another infection or related infection, which may...
0:04:52 > 0:04:56which will further compromise that patient's ability to get better.
0:04:56 > 0:04:59It could mean that they're more likely to die.
0:05:05 > 0:05:08So how do these superbugs evolve?
0:05:10 > 0:05:12Antibiotics kill certain bacteria.
0:05:14 > 0:05:16They just wipe them out.
0:05:18 > 0:05:21But bacteria exist in their trillions
0:05:21 > 0:05:24and if, down to some genetic fluke,
0:05:24 > 0:05:27just one or two are resistant to the drug,
0:05:27 > 0:05:31then they can go on to spawn a superbug.
0:05:31 > 0:05:35And whenever you use antibiotics, on humans or animals,
0:05:35 > 0:05:38you increase the chances of that happening.
0:05:47 > 0:05:49'Sue Pascoe is an outpatient from Leeds
0:05:49 > 0:05:53'for whom the drugs have also stopped working.
0:05:53 > 0:05:57'Like Pam, she carries a Klebsiella pneumonia bug in her gut.
0:05:57 > 0:06:02'It was discovered after surgery in India and the UK.'
0:06:02 > 0:06:04I've become very conscious about
0:06:04 > 0:06:08what I do, where I go, and...
0:06:08 > 0:06:10and it's little things, you know.
0:06:10 > 0:06:15Before, if I'd got a cut in my arm, I wouldn't have worried too much.
0:06:15 > 0:06:17Now I'm very conscious that,
0:06:17 > 0:06:20actually, that could be life-threatening.
0:06:20 > 0:06:24Sue's infection is resistant to all but one antibiotic,
0:06:24 > 0:06:28and if it spreads to her blood or organs through surgery or illness,
0:06:28 > 0:06:29it could kill her.
0:06:31 > 0:06:32It's a pneumoniae bug.
0:06:32 > 0:06:36It's resistant to every single antibiotic apart from Colistin.
0:06:38 > 0:06:43'That drug, Colistin, is only used as a last resort in our hospitals,
0:06:43 > 0:06:45'when all other antibiotics have failed.'
0:06:47 > 0:06:51They're very reluctant to give it to me unless I get infected,
0:06:51 > 0:06:56because what they don't want to do is get to the situation where
0:06:56 > 0:07:01this super-resistant bug becomes resistant to that as well,
0:07:01 > 0:07:04because then I'm properly back into the days pre-antibiotics.
0:07:11 > 0:07:13Colistin is an old antibiotic
0:07:13 > 0:07:16that was retired because of its side effects.
0:07:16 > 0:07:17It's been brought back
0:07:17 > 0:07:21because so many other antibiotics have been failing.
0:07:21 > 0:07:26But now, in China, one of our most deadly bacteria, E. coli,
0:07:26 > 0:07:29is found to be increasingly beating the drug.
0:07:31 > 0:07:35Professor Tim Walsh was part of the team that made the discovery.
0:07:36 > 0:07:39Resistance has evolved to a point
0:07:39 > 0:07:43whereby we are reliant on one or two antibiotics
0:07:43 > 0:07:45in many parts of the world.
0:07:45 > 0:07:49And Colistin is one of those one or two antibiotics.
0:07:49 > 0:07:53So if we lose Colistin from our therapeutic arsenal,
0:07:53 > 0:07:56that means we'd be fast approaching the pre-antibiotic era.
0:07:58 > 0:08:03There are well-established concerns about how the worldwide misuse
0:08:03 > 0:08:06of antibiotics in human medicine is fuelling drug resistance.
0:08:07 > 0:08:11BABY CRIES
0:08:11 > 0:08:16Panorama warned of this threat emerging in hospitals across India a year ago.
0:08:17 > 0:08:20We're really concerned and, in fact, scared,
0:08:20 > 0:08:24because the bug was Klebsiella, and it was showing resistance to
0:08:24 > 0:08:27all the antibiotics, including carbapenems and even Colistin.
0:08:29 > 0:08:30And then, in October,
0:08:30 > 0:08:35another step change in resistance to this last-resort antibiotic emerged.
0:08:37 > 0:08:41Bacteria are becoming resistant to the last group of antibiotics
0:08:41 > 0:08:43that can still fight superbugs.
0:08:43 > 0:08:46They say the risk of infections could make routine surgery,
0:08:46 > 0:08:48like hip replacements, deadly.
0:08:51 > 0:08:55News of Colistin resistance in China broke worldwide,
0:08:55 > 0:08:56but it came with a twist.
0:08:58 > 0:08:59China's a unique case
0:08:59 > 0:09:03because it hasn't used Colistin in the human sector at all.
0:09:04 > 0:09:07What China has done, though,
0:09:07 > 0:09:10is to use Colistin in animal farms for a few decades.
0:09:10 > 0:09:12If it was only used on farms, that's
0:09:12 > 0:09:16- the only place that the resistance could have emerged.- Exactly.
0:09:16 > 0:09:20The discovery led Government scientists to look for
0:09:20 > 0:09:23Colistin resistance here in the UK.
0:09:23 > 0:09:26And in December, they found it - on four pig farms.
0:09:30 > 0:09:34Experts are continuing to assess the scale of the problem,
0:09:34 > 0:09:37and vets have agreed to only use it as a last resort.
0:09:40 > 0:09:43Bloodstream infections due to multi-drug-resistant E. coli
0:09:43 > 0:09:47continue to rise. Thousands of people are infected with this
0:09:47 > 0:09:50and thousands of people are dying.
0:09:50 > 0:09:54Therefore, it actually places much greater importance on Colistin
0:09:54 > 0:09:56resistance coming into the UK.
0:09:58 > 0:10:01In the NHS, Colistin is prescribed sparingly
0:10:01 > 0:10:03in order to preserve its potency.
0:10:04 > 0:10:08We use about 300kg annually in hospitals.
0:10:08 > 0:10:13But in 2014, we used almost three times that much on livestock.
0:10:18 > 0:10:22So could the use of antibiotics on farms be contributing
0:10:22 > 0:10:26to the growing resistance to antibiotics in Britain's hospitals?
0:10:30 > 0:10:32It's time for some fieldwork.
0:10:38 > 0:10:43I'm heading into Yorkshire, farming country, to collect dung samples
0:10:43 > 0:10:45from pig and poultry farms.
0:10:45 > 0:10:47If farms and drugs breed superbugs,
0:10:47 > 0:10:50the evidence should show up in the dung.
0:10:50 > 0:10:51Oh!
0:10:51 > 0:10:54It's quite sinky on this manure pile.
0:10:54 > 0:10:58We're collecting the manure because antibiotic resistance on the farm
0:10:58 > 0:11:01will show up in the dung of the animals.
0:11:01 > 0:11:02That's a good sample there.
0:11:08 > 0:11:09This is a pile of chicken manure,
0:11:09 > 0:11:12right next to the public footpath that I'm on.
0:11:14 > 0:11:17The farms have not done anything wrong.
0:11:17 > 0:11:19In the UK, antibiotics for farm animals
0:11:19 > 0:11:22are always prescribed by a vet.
0:11:22 > 0:11:25But we're going to discreetly collect some samples ourselves
0:11:25 > 0:11:27to see what they contain.
0:11:27 > 0:11:31I've decided to come back to this farm just as the light is falling
0:11:31 > 0:11:33because I think that'll make it easier.
0:11:43 > 0:11:45QUIETLY: I'm just going to go in and
0:11:45 > 0:11:48try and get a sample from as close to the edge of the farm as I can.
0:12:00 > 0:12:01Got it.
0:12:06 > 0:12:09Well, I made it back across the fields with my sample.
0:12:09 > 0:12:11Now it's off to the lab to get it tested.
0:12:16 > 0:12:18Meanwhile, I've come to a dairy farm
0:12:18 > 0:12:20linked to Cambridge University,
0:12:20 > 0:12:24where they're investigating the growth of antibiotic resistance.
0:12:24 > 0:12:26The evidence that I see when I go onto farms
0:12:26 > 0:12:29is that there's more resistance,
0:12:29 > 0:12:30not less resistance,
0:12:30 > 0:12:35and also that the spread, the diversity of the resistance genes
0:12:35 > 0:12:36is getting higher.
0:12:36 > 0:12:39I see things this year that I didn't see last year,
0:12:39 > 0:12:41that hadn't been recorded before.
0:12:44 > 0:12:46Ten years ago, the World Health Organization
0:12:46 > 0:12:50warned of the dangers to people of using antibiotics in farming.
0:12:50 > 0:12:53They listed three groups of drugs
0:12:53 > 0:12:55as critically important to human health.
0:12:55 > 0:12:57One is called modern cephalosporins.
0:12:59 > 0:13:03So you might be surprised to find them still being used on livestock.
0:13:05 > 0:13:07This cow is lame.
0:13:07 > 0:13:09We've used our tip-over crush to tip her up
0:13:09 > 0:13:11so we can have a really good look at it.
0:13:11 > 0:13:15'Vet Ellie Button helps manage this herd of 200 cows.'
0:13:15 > 0:13:17We can see the foot is quite warm to touch,
0:13:17 > 0:13:20around the top of the horn here.
0:13:20 > 0:13:23She hasn't responded to our previous treatments.
0:13:23 > 0:13:24What will you use, what antibiotic?
0:13:24 > 0:13:26Third-generation cephalosporin,
0:13:26 > 0:13:30which is very good for these cases of foul in the foot.
0:13:32 > 0:13:36'She also uses the same antibiotic to treat a common condition
0:13:36 > 0:13:40'called mastitis, an inflammation of the udder.
0:13:40 > 0:13:43'I ask her whether this is usual.'
0:13:43 > 0:13:46I think it still gets used more often than we would like.
0:13:46 > 0:13:48The farmers, they give the antibiotic.
0:13:48 > 0:13:50They can milk the cow straightaway.
0:13:53 > 0:13:56Far from being a drug of last resort, it is a drug of choice
0:13:56 > 0:14:02in dairy farming, also used in large quantities to prevent disease.
0:14:02 > 0:14:05We had an intern two years ago who was from the Netherlands,
0:14:05 > 0:14:07and he was really surprised because
0:14:07 > 0:14:09you're not allowed to use some of these newer drugs
0:14:09 > 0:14:12because of their importance in human medicine.
0:14:13 > 0:14:17This farm is among many in the industry that are now working
0:14:17 > 0:14:20to reduce their usage of cephalosporins.
0:14:20 > 0:14:24In Europe, we are among the lower users of antibiotics in livestock.
0:14:24 > 0:14:28But when they're deemed critically important to human health,
0:14:28 > 0:14:30why are farms using them at all?
0:14:31 > 0:14:35- MARK HOLMES:- Cephalosporins are particularly effective treatment.
0:14:35 > 0:14:40They will kill the different types of bugs that cause mastitis
0:14:40 > 0:14:43and, additionally, there is no antibiotic left in the milk
0:14:43 > 0:14:47after a short period of time and it can go back into food production.
0:14:47 > 0:14:51- Which helps to save money for the farmer, because he's not losing that milk?- Exactly.
0:14:54 > 0:14:58I want to see evidence that antibiotic use on farms
0:14:58 > 0:15:00can fuel drug resistance.
0:15:00 > 0:15:02Now, nothing we show in the programme is a threat
0:15:02 > 0:15:06to the safety of any properly prepared dairy, meat
0:15:06 > 0:15:08or poultry products.
0:15:08 > 0:15:10But there's a story to tell in the bacteria
0:15:10 > 0:15:14Mark Holmes has grown in unpasteurised milk.
0:15:14 > 0:15:19- So what did you discover?- These large blue colonies are all MRSA.
0:15:19 > 0:15:22So all those dots I can see there
0:15:22 > 0:15:24represent a thriving colony of MRSA?
0:15:24 > 0:15:26Exactly.
0:15:26 > 0:15:30We found that about one in every 40 dairy farms
0:15:30 > 0:15:33actually has some sort of MRSA.
0:15:34 > 0:15:40Multi-drug-resistant MRSA wreaked havoc in our hospitals a decade ago.
0:15:40 > 0:15:43Mark Holmes says this new MRSA strain
0:15:43 > 0:15:46poses a further threat to patients
0:15:46 > 0:15:48and it has a disturbing characteristic.
0:15:50 > 0:15:53One of the things that struck us quite early on
0:15:53 > 0:16:00was that the new MRSA appears to be more resistant to cephalosporins.
0:16:01 > 0:16:07He and his team mapped the bug's DNA and what he found came as a shock.
0:16:08 > 0:16:10It appeared to have evolved
0:16:10 > 0:16:14due to the use of cephalosporins on our farms.
0:16:15 > 0:16:18In the last decade, there has been an increase
0:16:18 > 0:16:21in cephalosporin resistance in UK patients.
0:16:22 > 0:16:25Hospitals have reduced use of the drug as a result,
0:16:25 > 0:16:29yet on livestock the use has almost doubled.
0:16:31 > 0:16:34In hospitals, it is used to prevent cancer patients
0:16:34 > 0:16:37and other critically ill people dying from common infections,
0:16:37 > 0:16:41and yet it's used regularly on our farms.
0:16:41 > 0:16:44Could that be writing the death sentence for a future patient?
0:16:48 > 0:16:53I asked the UK's Chief Vet whether this practice had to change.
0:16:53 > 0:16:55We're looking to reduce the use
0:16:55 > 0:16:59of all of the highest-category antibiotics,
0:16:59 > 0:17:01these cephalosporins and fluoroquinolones.
0:17:01 > 0:17:03If they were being widely used on farms,
0:17:03 > 0:17:05this is something you'd have concerns about?
0:17:05 > 0:17:08We'd want to drive it out of the system, yes.
0:17:10 > 0:17:14Helen Browning runs one of the biggest organic pig farms in Britain
0:17:14 > 0:17:18and is involved in the Alliance to Save Our Antibiotics.
0:17:18 > 0:17:21She says she's kept her antibiotic use to a minimum
0:17:21 > 0:17:25by moving away from standard pig-farming practices.
0:17:26 > 0:17:28If you wean pigs at three to four weeks,
0:17:28 > 0:17:34which is the norm, they are inclined to get gut problems, diarrhoeas,
0:17:34 > 0:17:37and that's where a lot of the antibiotic is being used
0:17:37 > 0:17:40in intensive livestock systems.
0:17:40 > 0:17:45So, if you wean them later and give their gut a chance to mature,
0:17:45 > 0:17:47give them the protection of their mother's milk,
0:17:47 > 0:17:51it's rarely necessary to use antibiotics once they're weaned.
0:17:53 > 0:17:55She says in order to lower drug use,
0:17:55 > 0:17:59the pressure on farmers to produce cheap food has to be reduced.
0:18:01 > 0:18:06We are going to need to take the price pressure off producers
0:18:06 > 0:18:09and encourage them to change their systems.
0:18:09 > 0:18:12I think the supermarkets are vital in this,
0:18:12 > 0:18:16in that they need to be encouraging, probably enforcing,
0:18:16 > 0:18:19the reduction of antibiotics in the products
0:18:19 > 0:18:21that they sell on the shelves.
0:18:21 > 0:18:25But they also need to be making sure that the industry can afford
0:18:25 > 0:18:27to go in that direction.
0:18:27 > 0:18:29Farmers are driven to what you would call
0:18:29 > 0:18:34more intensive forms of production by low farm-gate prices.
0:18:34 > 0:18:38If you don't get much money for your product,
0:18:38 > 0:18:42then you're going to have to produce it more efficiently.
0:18:42 > 0:18:46We're treating these animals because we push them quite hard.
0:18:46 > 0:18:50We have some of the best farmers in the world.
0:18:50 > 0:18:52They produce the highest milk yields,
0:18:52 > 0:18:56they produce the cheapest meat in the world, you know.
0:18:56 > 0:18:58But we do that at a bit of a cost.
0:18:58 > 0:19:01And that cost is we get more endemic disease.
0:19:03 > 0:19:06Given the threat, the Government has commissioned
0:19:06 > 0:19:11a review on antibiotic resistance that comes from the top.
0:19:11 > 0:19:14I think this is a very serious threat.
0:19:14 > 0:19:18We are in danger of going back to the Dark Ages of medicine.
0:19:19 > 0:19:22I've come to meet the man the Prime Minister chose
0:19:22 > 0:19:24to find a solution.
0:19:24 > 0:19:26The quicker we do something about it,
0:19:26 > 0:19:30the much less likely the cost will be so high.
0:19:30 > 0:19:32It means deaths.
0:19:32 > 0:19:37There are 700,000 people around the world probably dying today.
0:19:37 > 0:19:39Don't do something about it,
0:19:39 > 0:19:41those numbers are going to grow dramatically.
0:19:41 > 0:19:42In addition,
0:19:42 > 0:19:48we have estimated that the potential loss of global GDP
0:19:48 > 0:19:53could be a staggering 100 trillion
0:19:53 > 0:19:55between now and 2050.
0:19:57 > 0:20:03Up to 75% of antibiotics used in livestock are excreted intact.
0:20:05 > 0:20:09Jim O'Neill has highlighted how both they and drug-resistant bugs
0:20:09 > 0:20:14leak into the environment, such as when dung is spread as fertiliser.
0:20:18 > 0:20:21Remember those samples I collected?
0:20:21 > 0:20:25They were tested by microbiologist Tim Walsh in Cardiff.
0:20:25 > 0:20:27And I've come back to see what he's found.
0:20:29 > 0:20:32So, Tim, very colourful. What are we looking at here?
0:20:32 > 0:20:34Well, we've gone through each of the samples.
0:20:34 > 0:20:37Sample number 21 is remarkably clean.
0:20:37 > 0:20:40- It is.- It's incredible. - Nothing on there.
0:20:40 > 0:20:42Nothing. Virtually nothing on there.
0:20:42 > 0:20:45So, you know, a big tick in the box for farm number 21.
0:20:46 > 0:20:50However, the lab did identify drug resistance on other farms.
0:20:50 > 0:20:54The white discs on the plates are antibiotics.
0:20:54 > 0:20:59When they're working, the bacteria won't go near them, as on the right.
0:20:59 > 0:21:03But resistant strains will grow up close, as on the left.
0:21:05 > 0:21:07Sample number 19 is very interesting
0:21:07 > 0:21:12because we do have growth around both the fluoroquinolone disc
0:21:12 > 0:21:15and also the cephalosporin disc.
0:21:17 > 0:21:20Some antibiotic resistance does occur naturally.
0:21:21 > 0:21:25But Professor Walsh says the level of resistance found in the samples
0:21:25 > 0:21:31points to it having been caused by exposure to pharmaceutical drugs.
0:21:32 > 0:21:35Given the fact that we are seeing it in such high numbers,
0:21:35 > 0:21:38there is a very strong possibility
0:21:38 > 0:21:41that the use of antibiotics enhances
0:21:41 > 0:21:43the growth of these bacteria.
0:21:43 > 0:21:48Professor Walsh also identified a drug-resistant bug
0:21:48 > 0:21:51from the MRSA family, known as MRSE.
0:21:51 > 0:21:55It is highly suggestive that on these farms
0:21:55 > 0:21:58there is the use of antibiotics that are selecting for
0:21:58 > 0:22:02the maintenance and growth of MRSE.
0:22:02 > 0:22:04In this particular study,
0:22:04 > 0:22:07because we found it on some farms in such high numbers...
0:22:07 > 0:22:09this has not come from the environment.
0:22:11 > 0:22:13Of 20 pig farms tested,
0:22:13 > 0:22:15four had MRSE,
0:22:15 > 0:22:19likely to have been caused through antibiotic use.
0:22:19 > 0:22:23Both chicken-dung samples we tested also had MRSE.
0:22:23 > 0:22:27Nearly half of the pig-farm samples had some form of resistance
0:22:27 > 0:22:33to the critically important cephalosporin antibiotic.
0:22:33 > 0:22:35Come on, girls. Come on.
0:22:35 > 0:22:38I've brought our results to Richard Lister,
0:22:38 > 0:22:41chairman of the National Pig Association.
0:22:41 > 0:22:45His family has been pig farming since the 1950s
0:22:45 > 0:22:49and now sends 2,000 pigs a week to market.
0:22:49 > 0:22:52He says the pig industry has just begun
0:22:52 > 0:22:54an antibiotic reduction programme
0:22:54 > 0:22:58and are doing all they can to cut down on antibiotic use.
0:23:00 > 0:23:04Some farms are coping with very little usage or no usage.
0:23:04 > 0:23:08Other farms have health problems. And this is what occurs.
0:23:08 > 0:23:11But, you know, the pig industry has absolutely nothing to hide.
0:23:11 > 0:23:15We are 100% committed to a process of antibiotic reduction.
0:23:15 > 0:23:19There's certainly very little use of critically important antibiotics
0:23:19 > 0:23:20within the pig industry.
0:23:20 > 0:23:23And it's not just intensive farms
0:23:23 > 0:23:26that are experiencing drug resistance.
0:23:26 > 0:23:29We tested samples from two organic farms
0:23:29 > 0:23:32and they, too, showed resistance to cephalosporins.
0:23:33 > 0:23:36These are two organic herds
0:23:36 > 0:23:38that have had very little antibiotic
0:23:38 > 0:23:40and certainly none of the cephalosporins.
0:23:40 > 0:23:42It seems to me that once these antimicrobials
0:23:42 > 0:23:44leak into our environment,
0:23:44 > 0:23:47they can end up in places where there hasn't been direct treatment,
0:23:47 > 0:23:49so it feels as though we've not just got to ban
0:23:49 > 0:23:52the critically important antibiotics,
0:23:52 > 0:23:56but we've got to absolutely reduce to a minimum
0:23:56 > 0:23:58the use of all other antibiotics, too.
0:23:58 > 0:24:03The man leading the Government's review wants to see decisive action.
0:24:03 > 0:24:04What is your recommendation
0:24:04 > 0:24:09in terms of what we should do about last-resort antibiotics in the UK?
0:24:09 > 0:24:13We should ban them in agricultural usage.
0:24:13 > 0:24:16From the evidence we've seen, a large number of antibiotics
0:24:16 > 0:24:19are being used at ease in agriculture,
0:24:19 > 0:24:22and the so-called last-in-line defence ones
0:24:22 > 0:24:25that are vital for human health, they should be banned immediately.
0:24:25 > 0:24:27- PIGS SQUEAL - Come on, you. Come on, noisy.
0:24:29 > 0:24:31Richard Lister says an immediate withdrawal
0:24:31 > 0:24:33could affect animal welfare.
0:24:35 > 0:24:38In some cases, we may be endangering animal health and welfare.
0:24:38 > 0:24:42If we've got a condition on farm that we can't treat with anything else,
0:24:42 > 0:24:43then I think that would be wrong.
0:24:45 > 0:24:49He says the industry should be seen as part of the solution
0:24:49 > 0:24:51but that it needs support.
0:24:51 > 0:24:54The Government have held various meetings recently
0:24:54 > 0:24:57without the pig-industry involvement,
0:24:57 > 0:24:59and it's the pig industry that's going to provide the solutions.
0:24:59 > 0:25:03If the Government is going to deliver on this,
0:25:03 > 0:25:06it requires vision and commitment.
0:25:06 > 0:25:09And some of that commitment requires money.
0:25:09 > 0:25:13It's got to work with industry. It can't just ride roughshod over it.
0:25:13 > 0:25:15Are you offering any support from the Government
0:25:15 > 0:25:17to help this transition?
0:25:17 > 0:25:20Currently, the Government is using our funding
0:25:20 > 0:25:23to support farmers to produce
0:25:23 > 0:25:25disease-control systems.
0:25:25 > 0:25:28The Government is not currently offering support
0:25:28 > 0:25:30for things like building new buildings.
0:25:31 > 0:25:33The last six months have been particularly tough.
0:25:33 > 0:25:37We've probably lost another 20,000 sows out of the national herd,
0:25:37 > 0:25:39which is hugely disappointing.
0:25:39 > 0:25:43But, you know, people are not prepared to produce animals at a loss.
0:25:43 > 0:25:45The farmers we've spoken to are angry
0:25:45 > 0:25:49about what might be going to happen in relation to antibiotics.
0:25:49 > 0:25:53They feel not supported by either the retail sector or the Government.
0:25:53 > 0:25:55Do you understand their concerns?
0:25:55 > 0:25:56I do.
0:25:56 > 0:25:59And it's been particularly hard because the market
0:25:59 > 0:26:01has had very low prices.
0:26:01 > 0:26:05I think the answer lies in properly valuing the food they produce,
0:26:05 > 0:26:08including the very best disease-control systems
0:26:08 > 0:26:10so they don't need to use antibiotics.
0:26:10 > 0:26:13So we'd have to pay a little bit more for our food?
0:26:13 > 0:26:15Well, let's see what can be done.
0:26:15 > 0:26:18But your suggestion is, it should reflect the cost of making it?
0:26:18 > 0:26:19It's quite possible, yes.
0:26:21 > 0:26:25Paying more for food may be unpalatable,
0:26:25 > 0:26:29but failing to tackle the problem could have a higher cost.
0:26:29 > 0:26:32Think of the one child every five minutes
0:26:32 > 0:26:38dying under the age of five in Asia because of resistant infections.
0:26:38 > 0:26:41We don't want that future for our public.
0:26:41 > 0:26:47What I'm scared of is a future where resistance of infections rises
0:26:47 > 0:26:51so that we do not have antibiotics to treat or prevent infections,
0:26:51 > 0:26:54so we lose what I call modern medicine.
0:26:56 > 0:27:00And Pam has already lost that protection.
0:27:00 > 0:27:03Her Klebsiella superbug is resistant to cephalosporins
0:27:03 > 0:27:06and many other antibiotics.
0:27:06 > 0:27:09She is preparing for an uncertain future.
0:27:09 > 0:27:12I think about it a lot. And I try and get...
0:27:12 > 0:27:15I'm trying to get me house in order, if you like,
0:27:15 > 0:27:18so if the worst thing happens, then, you know, I'm not leaving a mess.
0:27:18 > 0:27:21And I've tried to talk to me daughter, to me son.
0:27:21 > 0:27:23They'd have to tell the kids and all that.
0:27:23 > 0:27:25Got to be done. It's not beaten me yet.
0:27:25 > 0:27:28It ain't beating me at the last hurdle.
0:27:29 > 0:27:31Pam has to be fed through a tube.
0:27:31 > 0:27:35She hasn't been able to eat a proper meal for more than a year.
0:27:35 > 0:27:38What is it you really miss in food and drink?
0:27:39 > 0:27:40I would love to sit down
0:27:40 > 0:27:43with a great big bacon-and-egg sandwich in front of me
0:27:43 > 0:27:46and be able to eat it, not just look at it.
0:27:46 > 0:27:48It'd be heaven.
0:27:50 > 0:27:53With no new antibiotics on the horizon,
0:27:53 > 0:27:56we've got to look after the ones we've got.
0:27:56 > 0:27:58So, do we all need to make a choice?
0:27:58 > 0:28:02Support our doctors and farmers to deliver change
0:28:02 > 0:28:06or risk losing the life-saving benefits of modern medicine?