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