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