Antibiotic Crisis Panorama


Antibiotic Crisis

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Tonight, Panorama asks - is farming fuelling one of the biggest

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health threats facing humanity?

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What I'm scared of is a future where resistance of infections rises,

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so we lose what I call modern medicine.

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We meet the people for whom the drugs have stopped working.

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I ended up in intensive care

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and we were at the point of my two grown-up children having to

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make a decision whether to turn off the life support or not.

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Superbugs are on the rise.

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Is that being made worse by antibiotic use on farm animals?

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So what did you discover?

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These large blue colourings are all MRSA.

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We put farms to the test, looking for drug resistance.

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QUIETLY: I'm just going to go in and try and get a sample

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from as close to the edge of the farm as I can.

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And we ask whether antibiotic overuse is threatening to take us back to the Dark Ages of medicine.

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We'll take all these off on the way out - in the room -

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and leave anything that we might have picked up on our surface

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in the room.

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'I've come to St James's Hospital

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'in Leeds to meet Pamela Maddison-Bird.'

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Hi there.

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'She's been in hospital on and off for five years

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'after a routine stomach operation.

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'But we're not allowed to see her,

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'except under strict infection-control rules.

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'And this could be the shape of things to come.

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'Five years ago, Pam was taken seriously ill with blood poisoning

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'caused by a superbug.'

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I'd collapsed in the garden and my daughter found me in the garden.

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I was rushed into intensive care and I was there for 11 days

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in an induced coma.

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It then attacked all my internal organs,

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so I lost four-fifths of me bowel.

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Then I got told I had this Klebsiella bug,

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and because it's antibiotic-resistant,

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suddenly everybody started wearing blue overalls,

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including porters and anybody else that came near me.

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-Do you feel a bit like a pariah?

-Absolutely. Absolutely.

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You can see people sort of look in

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and almost covering their mouths to prevent them breathing in the germs

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because they don't know what I've got.

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It can make you feel very alienated, very isolated, especially

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when you're in a room like this, like I've been for a long time now,

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one room on your own.

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'England's Chief Medical Officer, Sally Davies,

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'has made fighting antibiotic resistance her core mission.'

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Our modelling for the whole UK suggests that

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over the next 20 years, if we do not take action,

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so we continue with drug-resistant infections

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at the present level,

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there will be at least 200,000 infections

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that are resistant to antibiotics,

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of which there will be 80,000 deaths. That's a serious problem.

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14 months ago, Pam needed further surgery

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and the drug-resistant superbug she'd picked up almost killed her.

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My surgeon and I have already had a conversation about life expectancy

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and I do know that it's been reduced.

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The antibiotic-resistant bug's played quite a big part in this,

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and again I ended up in intensive care

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and we were at the point of my two grown-up children

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having to make a decision whether to turn off the life support or not.

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And because they were indecisive, my surgeon said, "Well, let's just

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-"give her another two or three days and see what happens."

-Wow.

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And I did come round, gradually.

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But you don't get closer to death

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-than someone's finger hovering over the button.

-Absolutely.

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It's growing in importance...

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'Microbiologist Professor Mark Wilcox is managing patients

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'against a growing tide of drug resistance.'

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It's definitely increasing and it's moved from something that was

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a rarity that we'd all talk about as "Look at this"

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to actually something we're having to deal with on a weekly basis.

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Hospitals up and down the country are increasingly

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seeing their antibiotics fail.

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The rate of increase

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of the appearance of these multi-drug-resistant organisms

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is very steep.

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It might spread through the blood to another part of the body,

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cause another infection or related infection, which may...

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which will further compromise that patient's ability to get better.

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It could mean that they're more likely to die.

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So how do these superbugs evolve?

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Antibiotics kill certain bacteria.

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They just wipe them out.

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But bacteria exist in their trillions

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and if, down to some genetic fluke,

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just one or two are resistant to the drug,

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then they can go on to spawn a superbug.

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And whenever you use antibiotics, on humans or animals,

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you increase the chances of that happening.

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'Sue Pascoe is an outpatient from Leeds

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'for whom the drugs have also stopped working.

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'Like Pam, she carries a Klebsiella pneumonia bug in her gut.

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'It was discovered after surgery in India and the UK.'

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I've become very conscious about

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what I do, where I go, and...

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and it's little things, you know.

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Before, if I'd got a cut in my arm, I wouldn't have worried too much.

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Now I'm very conscious that,

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actually, that could be life-threatening.

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Sue's infection is resistant to all but one antibiotic,

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and if it spreads to her blood or organs through surgery or illness,

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it could kill her.

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It's a pneumoniae bug.

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It's resistant to every single antibiotic apart from Colistin.

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'That drug, Colistin, is only used as a last resort in our hospitals,

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'when all other antibiotics have failed.'

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They're very reluctant to give it to me unless I get infected,

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because what they don't want to do is get to the situation where

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this super-resistant bug becomes resistant to that as well,

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because then I'm properly back into the days pre-antibiotics.

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Colistin is an old antibiotic

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that was retired because of its side effects.

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It's been brought back

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because so many other antibiotics have been failing.

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But now, in China, one of our most deadly bacteria, E. coli,

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is found to be increasingly beating the drug.

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Professor Tim Walsh was part of the team that made the discovery.

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Resistance has evolved to a point

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whereby we are reliant on one or two antibiotics

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in many parts of the world.

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And Colistin is one of those one or two antibiotics.

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So if we lose Colistin from our therapeutic arsenal,

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that means we'd be fast approaching the pre-antibiotic era.

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There are well-established concerns about how the worldwide misuse

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of antibiotics in human medicine is fuelling drug resistance.

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BABY CRIES

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Panorama warned of this threat emerging in hospitals across India a year ago.

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We're really concerned and, in fact, scared,

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because the bug was Klebsiella, and it was showing resistance to

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all the antibiotics, including carbapenems and even Colistin.

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And then, in October,

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another step change in resistance to this last-resort antibiotic emerged.

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Bacteria are becoming resistant to the last group of antibiotics

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that can still fight superbugs.

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They say the risk of infections could make routine surgery,

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like hip replacements, deadly.

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News of Colistin resistance in China broke worldwide,

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but it came with a twist.

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China's a unique case

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because it hasn't used Colistin in the human sector at all.

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What China has done, though,

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is to use Colistin in animal farms for a few decades.

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If it was only used on farms, that's

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-the only place that the resistance could have emerged.

-Exactly.

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The discovery led Government scientists to look for

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Colistin resistance here in the UK.

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And in December, they found it - on four pig farms.

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Experts are continuing to assess the scale of the problem,

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and vets have agreed to only use it as a last resort.

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Bloodstream infections due to multi-drug-resistant E. coli

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continue to rise. Thousands of people are infected with this

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and thousands of people are dying.

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Therefore, it actually places much greater importance on Colistin

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resistance coming into the UK.

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In the NHS, Colistin is prescribed sparingly

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in order to preserve its potency.

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We use about 300kg annually in hospitals.

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But in 2014, we used almost three times that much on livestock.

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So could the use of antibiotics on farms be contributing

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to the growing resistance to antibiotics in Britain's hospitals?

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It's time for some fieldwork.

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I'm heading into Yorkshire, farming country, to collect dung samples

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from pig and poultry farms.

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If farms and drugs breed superbugs,

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the evidence should show up in the dung.

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Oh!

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It's quite sinky on this manure pile.

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We're collecting the manure because antibiotic resistance on the farm

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will show up in the dung of the animals.

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That's a good sample there.

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This is a pile of chicken manure,

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right next to the public footpath that I'm on.

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The farms have not done anything wrong.

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In the UK, antibiotics for farm animals

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are always prescribed by a vet.

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But we're going to discreetly collect some samples ourselves

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to see what they contain.

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I've decided to come back to this farm just as the light is falling

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because I think that'll make it easier.

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QUIETLY: I'm just going to go in and

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try and get a sample from as close to the edge of the farm as I can.

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Got it.

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Well, I made it back across the fields with my sample.

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Now it's off to the lab to get it tested.

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Meanwhile, I've come to a dairy farm

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linked to Cambridge University,

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where they're investigating the growth of antibiotic resistance.

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The evidence that I see when I go onto farms

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is that there's more resistance,

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not less resistance,

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and also that the spread, the diversity of the resistance genes

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is getting higher.

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I see things this year that I didn't see last year,

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that hadn't been recorded before.

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Ten years ago, the World Health Organization

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warned of the dangers to people of using antibiotics in farming.

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They listed three groups of drugs

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as critically important to human health.

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One is called modern cephalosporins.

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So you might be surprised to find them still being used on livestock.

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This cow is lame.

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We've used our tip-over crush to tip her up

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so we can have a really good look at it.

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'Vet Ellie Button helps manage this herd of 200 cows.'

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We can see the foot is quite warm to touch,

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around the top of the horn here.

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She hasn't responded to our previous treatments.

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What will you use, what antibiotic?

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Third-generation cephalosporin,

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which is very good for these cases of foul in the foot.

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'She also uses the same antibiotic to treat a common condition

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'called mastitis, an inflammation of the udder.

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'I ask her whether this is usual.'

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I think it still gets used more often than we would like.

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The farmers, they give the antibiotic.

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They can milk the cow straightaway.

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Far from being a drug of last resort, it is a drug of choice

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in dairy farming, also used in large quantities to prevent disease.

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We had an intern two years ago who was from the Netherlands,

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and he was really surprised because

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you're not allowed to use some of these newer drugs

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because of their importance in human medicine.

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This farm is among many in the industry that are now working

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to reduce their usage of cephalosporins.

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In Europe, we are among the lower users of antibiotics in livestock.

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But when they're deemed critically important to human health,

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why are farms using them at all?

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-MARK HOLMES:

-Cephalosporins are particularly effective treatment.

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They will kill the different types of bugs that cause mastitis

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and, additionally, there is no antibiotic left in the milk

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after a short period of time and it can go back into food production.

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-Which helps to save money for the farmer, because he's not losing that milk?

-Exactly.

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I want to see evidence that antibiotic use on farms

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can fuel drug resistance.

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Now, nothing we show in the programme is a threat

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to the safety of any properly prepared dairy, meat

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or poultry products.

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But there's a story to tell in the bacteria

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Mark Holmes has grown in unpasteurised milk.

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-So what did you discover?

-These large blue colonies are all MRSA.

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So all those dots I can see there

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represent a thriving colony of MRSA?

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Exactly.

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We found that about one in every 40 dairy farms

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actually has some sort of MRSA.

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Multi-drug-resistant MRSA wreaked havoc in our hospitals a decade ago.

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Mark Holmes says this new MRSA strain

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poses a further threat to patients

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and it has a disturbing characteristic.

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One of the things that struck us quite early on

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was that the new MRSA appears to be more resistant to cephalosporins.

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He and his team mapped the bug's DNA and what he found came as a shock.

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It appeared to have evolved

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due to the use of cephalosporins on our farms.

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In the last decade, there has been an increase

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in cephalosporin resistance in UK patients.

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Hospitals have reduced use of the drug as a result,

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yet on livestock the use has almost doubled.

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In hospitals, it is used to prevent cancer patients

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and other critically ill people dying from common infections,

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and yet it's used regularly on our farms.

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Could that be writing the death sentence for a future patient?

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I asked the UK's Chief Vet whether this practice had to change.

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We're looking to reduce the use

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of all of the highest-category antibiotics,

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these cephalosporins and fluoroquinolones.

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If they were being widely used on farms,

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this is something you'd have concerns about?

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We'd want to drive it out of the system, yes.

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Helen Browning runs one of the biggest organic pig farms in Britain

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and is involved in the Alliance to Save Our Antibiotics.

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She says she's kept her antibiotic use to a minimum

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by moving away from standard pig-farming practices.

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If you wean pigs at three to four weeks,

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which is the norm, they are inclined to get gut problems, diarrhoeas,

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and that's where a lot of the antibiotic is being used

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in intensive livestock systems.

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So, if you wean them later and give their gut a chance to mature,

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give them the protection of their mother's milk,

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it's rarely necessary to use antibiotics once they're weaned.

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She says in order to lower drug use,

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the pressure on farmers to produce cheap food has to be reduced.

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We are going to need to take the price pressure off producers

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and encourage them to change their systems.

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I think the supermarkets are vital in this,

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in that they need to be encouraging, probably enforcing,

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the reduction of antibiotics in the products

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that they sell on the shelves.

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But they also need to be making sure that the industry can afford

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to go in that direction.

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Farmers are driven to what you would call

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more intensive forms of production by low farm-gate prices.

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If you don't get much money for your product,

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then you're going to have to produce it more efficiently.

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We're treating these animals because we push them quite hard.

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We have some of the best farmers in the world.

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They produce the highest milk yields,

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they produce the cheapest meat in the world, you know.

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But we do that at a bit of a cost.

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And that cost is we get more endemic disease.

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Given the threat, the Government has commissioned

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a review on antibiotic resistance that comes from the top.

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I think this is a very serious threat.

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We are in danger of going back to the Dark Ages of medicine.

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I've come to meet the man the Prime Minister chose

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to find a solution.

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The quicker we do something about it,

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the much less likely the cost will be so high.

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It means deaths.

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There are 700,000 people around the world probably dying today.

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Don't do something about it,

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those numbers are going to grow dramatically.

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In addition,

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we have estimated that the potential loss of global GDP

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could be a staggering 100 trillion

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between now and 2050.

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Up to 75% of antibiotics used in livestock are excreted intact.

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Jim O'Neill has highlighted how both they and drug-resistant bugs

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leak into the environment, such as when dung is spread as fertiliser.

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Remember those samples I collected?

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They were tested by microbiologist Tim Walsh in Cardiff.

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And I've come back to see what he's found.

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So, Tim, very colourful. What are we looking at here?

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Well, we've gone through each of the samples.

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Sample number 21 is remarkably clean.

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-It is.

-It's incredible.

-Nothing on there.

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Nothing. Virtually nothing on there.

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So, you know, a big tick in the box for farm number 21.

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However, the lab did identify drug resistance on other farms.

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The white discs on the plates are antibiotics.

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When they're working, the bacteria won't go near them, as on the right.

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But resistant strains will grow up close, as on the left.

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Sample number 19 is very interesting

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because we do have growth around both the fluoroquinolone disc

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and also the cephalosporin disc.

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Some antibiotic resistance does occur naturally.

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But Professor Walsh says the level of resistance found in the samples

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points to it having been caused by exposure to pharmaceutical drugs.

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Given the fact that we are seeing it in such high numbers,

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there is a very strong possibility

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that the use of antibiotics enhances

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the growth of these bacteria.

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Professor Walsh also identified a drug-resistant bug

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from the MRSA family, known as MRSE.

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It is highly suggestive that on these farms

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there is the use of antibiotics that are selecting for

0:21:550:21:58

the maintenance and growth of MRSE.

0:21:580:22:02

In this particular study,

0:22:020:22:04

because we found it on some farms in such high numbers...

0:22:040:22:07

this has not come from the environment.

0:22:070:22:09

Of 20 pig farms tested,

0:22:110:22:13

four had MRSE,

0:22:130:22:15

likely to have been caused through antibiotic use.

0:22:150:22:19

Both chicken-dung samples we tested also had MRSE.

0:22:190:22:23

Nearly half of the pig-farm samples had some form of resistance

0:22:230:22:27

to the critically important cephalosporin antibiotic.

0:22:270:22:33

Come on, girls. Come on.

0:22:330:22:35

I've brought our results to Richard Lister,

0:22:350:22:38

chairman of the National Pig Association.

0:22:380:22:41

His family has been pig farming since the 1950s

0:22:410:22:45

and now sends 2,000 pigs a week to market.

0:22:450:22:49

He says the pig industry has just begun

0:22:490:22:52

an antibiotic reduction programme

0:22:520:22:54

and are doing all they can to cut down on antibiotic use.

0:22:540:22:58

Some farms are coping with very little usage or no usage.

0:23:000:23:04

Other farms have health problems. And this is what occurs.

0:23:040:23:08

But, you know, the pig industry has absolutely nothing to hide.

0:23:080:23:11

We are 100% committed to a process of antibiotic reduction.

0:23:110:23:15

There's certainly very little use of critically important antibiotics

0:23:150:23:19

within the pig industry.

0:23:190:23:20

And it's not just intensive farms

0:23:200:23:23

that are experiencing drug resistance.

0:23:230:23:26

We tested samples from two organic farms

0:23:260:23:29

and they, too, showed resistance to cephalosporins.

0:23:290:23:32

These are two organic herds

0:23:330:23:36

that have had very little antibiotic

0:23:360:23:38

and certainly none of the cephalosporins.

0:23:380:23:40

It seems to me that once these antimicrobials

0:23:400:23:42

leak into our environment,

0:23:420:23:44

they can end up in places where there hasn't been direct treatment,

0:23:440:23:47

so it feels as though we've not just got to ban

0:23:470:23:49

the critically important antibiotics,

0:23:490:23:52

but we've got to absolutely reduce to a minimum

0:23:520:23:56

the use of all other antibiotics, too.

0:23:560:23:58

The man leading the Government's review wants to see decisive action.

0:23:580:24:03

What is your recommendation

0:24:030:24:04

in terms of what we should do about last-resort antibiotics in the UK?

0:24:040:24:09

We should ban them in agricultural usage.

0:24:090:24:13

From the evidence we've seen, a large number of antibiotics

0:24:130:24:16

are being used at ease in agriculture,

0:24:160:24:19

and the so-called last-in-line defence ones

0:24:190:24:22

that are vital for human health, they should be banned immediately.

0:24:220:24:25

-PIGS SQUEAL

-Come on, you. Come on, noisy.

0:24:250:24:27

Richard Lister says an immediate withdrawal

0:24:290:24:31

could affect animal welfare.

0:24:310:24:33

In some cases, we may be endangering animal health and welfare.

0:24:350:24:38

If we've got a condition on farm that we can't treat with anything else,

0:24:380:24:42

then I think that would be wrong.

0:24:420:24:43

He says the industry should be seen as part of the solution

0:24:450:24:49

but that it needs support.

0:24:490:24:51

The Government have held various meetings recently

0:24:510:24:54

without the pig-industry involvement,

0:24:540:24:57

and it's the pig industry that's going to provide the solutions.

0:24:570:24:59

If the Government is going to deliver on this,

0:24:590:25:03

it requires vision and commitment.

0:25:030:25:06

And some of that commitment requires money.

0:25:060:25:09

It's got to work with industry. It can't just ride roughshod over it.

0:25:090:25:13

Are you offering any support from the Government

0:25:130:25:15

to help this transition?

0:25:150:25:17

Currently, the Government is using our funding

0:25:170:25:20

to support farmers to produce

0:25:200:25:23

disease-control systems.

0:25:230:25:25

The Government is not currently offering support

0:25:250:25:28

for things like building new buildings.

0:25:280:25:30

The last six months have been particularly tough.

0:25:310:25:33

We've probably lost another 20,000 sows out of the national herd,

0:25:330:25:37

which is hugely disappointing.

0:25:370:25:39

But, you know, people are not prepared to produce animals at a loss.

0:25:390:25:43

The farmers we've spoken to are angry

0:25:430:25:45

about what might be going to happen in relation to antibiotics.

0:25:450:25:49

They feel not supported by either the retail sector or the Government.

0:25:490:25:53

Do you understand their concerns?

0:25:530:25:55

I do.

0:25:550:25:56

And it's been particularly hard because the market

0:25:560:25:59

has had very low prices.

0:25:590:26:01

I think the answer lies in properly valuing the food they produce,

0:26:010:26:05

including the very best disease-control systems

0:26:050:26:08

so they don't need to use antibiotics.

0:26:080:26:10

So we'd have to pay a little bit more for our food?

0:26:100:26:13

Well, let's see what can be done.

0:26:130:26:15

But your suggestion is, it should reflect the cost of making it?

0:26:150:26:18

It's quite possible, yes.

0:26:180:26:19

Paying more for food may be unpalatable,

0:26:210:26:25

but failing to tackle the problem could have a higher cost.

0:26:250:26:29

Think of the one child every five minutes

0:26:290:26:32

dying under the age of five in Asia because of resistant infections.

0:26:320:26:38

We don't want that future for our public.

0:26:380:26:41

What I'm scared of is a future where resistance of infections rises

0:26:410:26:47

so that we do not have antibiotics to treat or prevent infections,

0:26:470:26:51

so we lose what I call modern medicine.

0:26:510:26:54

And Pam has already lost that protection.

0:26:560:27:00

Her Klebsiella superbug is resistant to cephalosporins

0:27:000:27:03

and many other antibiotics.

0:27:030:27:06

She is preparing for an uncertain future.

0:27:060:27:09

I think about it a lot. And I try and get...

0:27:090:27:12

I'm trying to get me house in order, if you like,

0:27:120:27:15

so if the worst thing happens, then, you know, I'm not leaving a mess.

0:27:150:27:18

And I've tried to talk to me daughter, to me son.

0:27:180:27:21

They'd have to tell the kids and all that.

0:27:210:27:23

Got to be done. It's not beaten me yet.

0:27:230:27:25

It ain't beating me at the last hurdle.

0:27:250:27:28

Pam has to be fed through a tube.

0:27:290:27:31

She hasn't been able to eat a proper meal for more than a year.

0:27:310:27:35

What is it you really miss in food and drink?

0:27:350:27:38

I would love to sit down

0:27:390:27:40

with a great big bacon-and-egg sandwich in front of me

0:27:400:27:43

and be able to eat it, not just look at it.

0:27:430:27:46

It'd be heaven.

0:27:460:27:48

With no new antibiotics on the horizon,

0:27:500:27:53

we've got to look after the ones we've got.

0:27:530:27:56

So, do we all need to make a choice?

0:27:560:27:58

Support our doctors and farmers to deliver change

0:27:580:28:02

or risk losing the life-saving benefits of modern medicine?

0:28:020:28:06

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