LAST OF THE SILVER BULLETS
44 Minute documentary
Reporter: Andrew Fowler
ANDREW FOWLER: For years, farmers have been feeding antibiotics to their animals to make them fatter faster.
DR JEFF FAIRBROTHER, AUSTRALIAN CHICKEN MEAT FEDERATION: The only reason we use this product is because we have a huge economic advantage.
ANDREW FOWLER: The antibiotics they use are the same 'silver bullets' that stop people from dying.
Now there's a link between those drugs and the creation of an unstoppable 'super bug' in the food that we eat.
DR PETER COLLIGNON, DIRECTOR, INFECTIOUS DISEASES, CANBERRA HOSPITAL: They come across the food chain and they can make people sick.
ANDREW FOWLER: Yet there's no formal testing for it.
PROFESSOR WARREN GRUBB: "She'll be right, mate," is the Australian attitude.
It ain't gonna be right.
It's getting worse.
ANDREW FOWLER: Tonight on Four Corners the battle over antibiotics fed to farm animals.
Should they be used?
And are we prepared to pay a potentially deadly price, gambling with the last 'silver bullets'?
Canberra Hospital on Tuesday, August 19.
Inside, a middle-aged woman is recovering from kidney failure.
The night before, we'd approached the hospital and the woman had given us permission to film her as part of this program.
What made her different from the hundreds of other patients -- the strongest antibiotics weren't working.
She'd become infected with a deadly strain of bacteria -- so contagious she was consigned to a special isolation ward to prevent its spread to other patients.
Shortly before we were to start filming her, the woman died.
Four Corners arrived just as her family learnt of the unexpected death and came to pay their last respects.
How do you personally feel at the moment?
DR PETER COLLIGNON, DIRECTOR INFECTIOUS DISEASES, CANBERRA HOSPITAL: Well, I think, you know, like all these situations, this is obviously very sad.
I mean, this is a case where somebody has got multiple problems, and a contributing factor has been a fact that there's a bacteria we couldn't treat adequately.
ANDREW FOWLER: In other hospitals, her death might never have been disclosed for what it was.
There is no national mandatory reporting of this infection.
How she got the bug, no-one is sure.
Fear of the infection has forced many hospitals to keep their outbreaks quiet.
DR PETER COLLIGNON: Well, I think one of the reasons is that it never looks good for your hospital to know you've got these so-called 'super bugs', and that people are having a bad outcome from it.
ANDREW FOWLER: But do you think people have the right to know that?
DR PETER COLLIGNON: Well, I think it is a very good idea if people know that, providing we do it in a way that doesn't unfairly target one hospital.
The paradox of this is that the hospitals that do this better in the short-term and report the data look worse than the hospitals that are often slacker and don't collect the data at all, because they don't know.
Ignorance is bliss.
ANDREW FOWLER: The exact number of infections in Australia is unknown, but estimates run to hundreds.
Since 1994, when the first case appeared at Melbourne's Austin Hospital almost all major hospitals have been hit.
Three weeks ago, the Royal Perth Hospital reported 19 cases.
It had to set up a special isolation unit.
This is what it looks like.
Vancomycin-resistant enterococci -- VRE for short -- is so contagious and hard to treat hospitals are forced to take extraordinary precautions.
The woman who died at Canberra Hospital was allowed only one nurse to take care of her to limit the risk of contamination.
Even after her death, the threat of infection to others continued to pose a problem.
Every part of her room had to be scrubbed, including the walls.
DR PETER COLLIGNON: This is a germ that hangs around on telephones, on the bedrails, on the doorknobs, so you have to have scrupulous cleaning at the end, otherwise the bug can persist.
ANDREW FOWLER: Hospitals use vancomycin as the antibiotic 'silver bullet' to fight infections when all else fails.
As a wonder drug it was over-prescribed in large amounts both by hospitals and general practitioners, and this is where the problems started.
Because of its overuse, the bacteria built up an immunity to it, creating the 'super bug' VRE.
DR PETER COLLIGNON: I think there's an expectation in this community that if you're sick, there is a tablet to make you better.
I think it can be lazy doctoring, because the easiest thing is to give somebody a tablet and get them out, you know, so you can see the next patient.
ANDREW FOWLER: The death of a patient involving bacteria infection is a grim reminder of life before antibiotics.
Until the discovery of penicillin in the middle of the last century patients died with wounds that couldn't be healed.
Now, because of antibiotic misuse, it's happening again.
The fear is that antibiotics will become worthless.
DR PETER COLLIGNON: So no shaking, shivers or chills or anything?
PATIENT: No, no, no.
DR PETER COLLIGNON: OK.
That's all gone?
PATIENT: Yeah.
All gone.
DR PETER COLLIGNON: Did anybody else in the family get sick?
ANDREW FOWLER: Dr Peter Collignon, head of Canberra Hospital's Infectious Diseases Department, accepts that the medical profession should take its share of the blame, but he increasingly believes it's not entirely responsible for creating VRE.
Humans aren't the only ones capable of developing antibiotic-resistant bugs in their system.
When they're fed antibiotics, animals can too.
DR PETER COLLIGNON: When you look at it, you can see the same classes of antibiotics are used in animals as in humans.
And we know from overwhelming evidence, particularly in Europe, that if you do that in animals, resistant bacteria develop, they come across the food chain and they can make people sick.
ANDREW FOWLER: Australia is one of the biggest consumers of agricultural antibiotics in the world.
Antibiotics are fed to lamb and beef in feedlots, pigs in intensive farming and chickens.
The antibiotics help growth and also keep down disease.
Every year Australia consumes 700,000 kilos of antibiotics, three-quarters -- over 500,000 kilos -- in agriculture.
A link between VRE in humans and VRE in animals has been proved in European studies, but never in Australia.
Five years ago, the John Hunter Hospital in Newcastle produced the first evidence.
In the men's medical ward, one of the John Hunter's patients appeared to have developed a resistance to vancomycin.
Many people carry VRE in their bodies and never suffer any illness.
But when they're sick and given strong antibiotics like vancomycin, which kills all other bacteria, VRE flourishes and takes over.
Doctors couldn't understand how the hospital patient could have contracted VRE.
He had no history of vancomycin use, and it seemed unlikely that he'd picked up the infection from the hospital.
DR JOHN FERGUSON, DIRECTOR, MICROBIOLOGY, JOHN HUNTER HOSPITAL: We screened the entire ward and found two other individuals who were also carrying this same strain, and those individuals had had some contact whilst they'd been in hospital.
So it was an infection control issue for us, which really led us to implementing quite stringent isolation.
ANDREW FOWLER: As the doctors struggled for answers, they began looking in unusual places for the source of the mystery infection.
It was just possible that it had come from something the patient had eaten.
They remembered the European studies and wondered if it could have come from local produce.
Instead of calling in further medical opinion, they called in the local Department of Agriculture.
DR JOHN FERGUSON: The Hunter's quite a rural region.
These patients weren't from country areas, but we were aware that there was evidence of transmission through the food chain, even then.
So we did persuade the Agricultural Department to cooperate with some surveys.
ANDREW FOWLER: For the next 10 weeks, teams of Agricultural Department vets begin scouring local farms, taking manure samples from cattle and poultry in a bid to track down the mysterious bug.
Initially, 40 farms were keen to take part in the study.
Disturbingly, in one of the samples from a poultry farm, small amounts of VRE were discovered.
If anyone had eaten that meat, it could have got into their system.
The poultry had been given Avoparcin, a similar drug to the human antibiotic vancomycin.
It was proof that a problem detected overseas could happen here.
DR JOHN FERGUSON: It was certainly very exciting in the lab during those days when we were processing the cultures and seeing the results as they emerged, and finding those strains.
ANDREW FOWLER: What happened next is unclear.
Follow-up investigations were never conducted, and the case was closed.
DR JOHN FERGUSON: I think the finding was very significant and highlighted that we could possibly have a problem with transfer of VRE from animals to humans or vice versa.
ANDREW FOWLER: Why was there such resistance to you going back and doing further studies?
DR JOHN FERGUSON: Oh, I think, politically, it was very sensitive.
It was pointing out, perhaps, that the food may not be as safe as it was thought to be.
And there's a lot of economic advantage that attaches to food safety, or perceived food safety, so that the producers weren't keen, I think, to have surveys done.
ANDREW FOWLER: The chicken industry says it would have supported follow-up studies if a formal proposal had been put to them, but it hardly seemed enthusiastic.
DR JEFF FAIRBROTHER, AUSTRALIAN CHICKEN MEAT FEDERATION: All we wanted was a proper experimental program -- as I recall now -- it was three years ago.
ANDREW FOWLER: Given that you had VRE on at least one of your chicken farms in the Hunter Valley, wouldn't you have wanted to know more about that?
Wouldn't you have been asking questions?
What is this thing?
Where did it come from?
What's the problem?
DR JEFF FAIRBROTHER: Well, if you want to be a purist, you probably would have.
But being sensible about it, it was --
ANDREW FOWLER: What's purist about asking a question about --
DR JEFF FAIRBROTHER: Well, hang on.
ANDREW FOWLER: ..whether you've got VRE on your farm or not?
DR JEFF FAIRBROTHER: The situation was that after that batch of chickens from which that isolation was made had gone, the farm would have been totally cleaned out, virtually sterilised as the end of a batch, and the litter would have been removed.
There would have been no suggestion that the problem still existed.
And probably it wouldn't have.
ANDREW FOWLER: The farms concerned would have been routinely cleaned out, but that's not the point.
Tens of thousands of chickens are presumed to have gone to market, some of them possibly contaminated with VRE.
If the new batch of chicks that replaced them was fed the same antibiotics, there would be equal risk of incubating the resistant bug.
It's a systemic problem.
DR JOHN FERGUSON: We didn't get to know the size of the farms or where exactly they were located.
ANDREW FOWLER: So the names were kept secret from you?
DR JOHN FERGUSON: Yes, that was our choice.
I mean, we felt it was important to have a blinded survey that was done in a proper fashion.
ANDREW FOWLER: Have the names ever been released?
DR JOHN FERGUSON: No, no.
There's been no publicity about that.
I guess -- I'm not sure that it would help anybody to know exactly where they were.
I think the important thing was that --
..those VRE strains were amongst those animals.
ANDREW FOWLER: Do the health authorities know where those strains are?
DR JOHN FERGUSON: No.
There was never any, er --
..advice that went to the Health Department about that issue.
ANDREW FOWLER: There are two strains of VRE -- one predominant in animals, the other in humans.
Ferguson's study discovered both in animals, and both have been discovered in humans too.
DR WARREN GRUBB ('COUNTRYWIDE', 1984): We looked at some bacteria from a farm where they were using antibiotic in the feed, We found that a very large number, a high percentage of the organisms were resistant to that antibiotic, and that antibiotic has use in the clinical field.
ANDREW FOWLER: Warren Grubb is a microbiologist.
For more than two decades, he's been studying the impact on humans of feeding antibiotics to animals.
DR WARREN GRUBB ('STATEWIDE', 1984): Some people require black and white evidence before they'll move.
And there's been lots of evidence around for years which demonstrate the seriousness of the problem -- the more antibiotic you use, the more indiscriminate the use is.
ANDREW FOWLER: Back in 1984, he predicted the probability of dangerous repercussions.
'STATEWIDE' JOURNALIST: It's a fairly frightening prospect, though, that we might have to wait for a death in Australia.
DR WARREN GRUBB: Well, that may be possible.
That may be possible.
ANDREW FOWLER: 17 years later, he's continued that struggle.
Warren Grubb, now a professor, carried out a study into VRE in a factory processing chicken in Western Australia.
PROFESSOR WARREN GRUBB,MICROBIOLOGY, CURTIN UNIVERSITY: So we screened some of those animals on the production line to see whether they had resistance to that antibiotic, and, of course, we found that they did have resistance.
We didn't even tell them we were going to look for VREs.
We were just sampling and that's all that they knew we were doing.
ANDREW FOWLER: His recent study backs the Hunter Valley finding and vindicates his stand.
It found traces of VRE on chicken carcasses.
But the location of the factory had to be kept secret.
That was the condition under which the industry let the tests go ahead.
How difficult is it for you working in that environment, where you discover something which is a public health matter but because of the way in which you carry out your research, you can't reveal the company?
PROFESSOR WARREN GRUBB: Well, it is very difficult.
I mean, really, if you find this information, you look at how you're going to control the problem.
And you can't control the problem unless you find out what practice is being used, where there has been antibiotic which has been responsible, how widespread is the problem.
You can't do anything if you can't go back and identify all the problems.
ANDREW FOWLER: Even the chicken industry was becoming concerned.
Two years ago, it partly funded a study into VRE in poultry by Professor Mary Barton, a vet and an acclaimed expert on the poultry industry.
Her study is considered a landmark work.
It found that 1 in 14 of the chickens she sampled had VRE on the carcass.
Again, no-one knows which processing plants produced the positive samples.
But this time the tests centred on South Australia.
ASSOCIATE PROFESSOR MARY BARTON, PHARMACY & MEDICAL SCIENCES, UNIVERSITY OF SOUTH AUSTRALIA: I think that my finding some was not entirely surprising.
I think they would have been over the moon if I hadn't found any.
But I think, realistically, they realised that there would be some, and there were some.
ANDREW FOWLER: If you knew that a chicken had VRE, would you eat it?
PROFESSOR WARREN GRUBB: No, I don't think I would.
ANDREW FOWLER: Why not?
PROFESSOR WARREN GRUBB: My main reason would be that I think there's sufficient evidence which would indicate that if I ate that chicken with VRE, that the VRE, if it was still alive, could transfer its antibiotic resistance into some of the bacteria in my flora, in my own flora.
ANDREW FOWLER: And that would make you VRE-resistant, too?
PROFESSOR WARREN GRUBB: Well, I would have an organism which has resistance to that antibiotic.
WARREN TRUSS, FEDERAL MINISTER FOR AGRICULTURE: Well, let me say that I eat the food produced by Australian farmers with every confidence that it is the safest and healthiest in the world.
ANDREW FOWLER: Would it surprise you to know that one of the pre-eminent scientists says that he would not eat food if he knew it contained VRE.
WARREN TRUSS: Well, what I've always found amongst scientists is that you can always find somebody with a dissident opinion.
You can always find somebody who is outside of the mainstream.
ANDREW FOWLER: The incidence of VRE in poultry can't just be blamed on chicken farmers.
Even they sometimes don't know what's going on.
Eve Murden used to be a dairy farmer.
Deregulation and competition policy forced down the price of milk and drove her out of the industry.
Now in her 70s, she's starting over again.
18 months ago, she became a poultry farmer.
EVE MURDEN, CHICKEN FARMER: I have always loved animals.
And the little yellow fluffy chickens, as I call them, they're just beautiful.
They each have their own personality.
And you imagine them, when you get up at 5:30am, what they're going to look like when you open those doors, and you're never disappointed.
ANDREW FOWLER: Eve built a state-of-the-art chicken shed.
Everything is controlled electronically, from the heating to the water flow and the feed that the chickens eat.
EVE MURDEN: Once they grow quick, well, then you've got the good meat.
If they don't grow quick, the meat is tough.
And that's why you have these feedlots these days and all this sort of thing to grow good meat.
ANDREW FOWLER: These birds are just a few days old.
By the time they're seven weeks, they'll be fat enough and ready for slaughter.
The pace of growth is so fast that some of them don't make it.
EVE MURDEN: If a chicken has a heart attack, ah, at any stage of its life, even though we've got 26,700 chickens in the shed, I do not like losing one of them.
Because you have them for seven weeks, and at the end of six weeks, if you have a few heart attacks, it sort of knocks the joy out of it.
ANDREW FOWLER: To lower the death rate, antibiotics are routinely mixed into the feed stock.
They prevent disease in crowded sheds and promote growth.
Growers once used Avoparcin, but it was withdrawn because of its links to VRE.
Now there's another product -- Virginiamycin.
It's close to Synercid, another antibiotic in the last-line defence for humans.
But there's another reason chickens are fed antibiotics -- they kill bacteria in the gut.
This makes the digestive system more efficient and saves chicken feed.
DR JEFF FAIRBROTHER, AUSTRALIAN CHICKEN MEAT FEDERATION: The animal, getting better digestion, it makes better use of its feed and you don't have to use as much feed.
So that's the way a growth promotent works.
It means that you can get to a certain weight for age in a slightly shorter time.
ANDREW FOWLER: The chicken industry calls these drugs by many names -- growth promoters, digestion enhancers and antimicrobials.
DR JEFF FAIRBROTHER: Antimicrobials are used to change the gut flora in the chicken, and they destroy or kill bacteria that you don't want present in the bird's gut, and it lets the better bacteria proliferate.
ANDREW FOWLER: But they're still antibiotics like vancomycin.
DR PETER COLLIGNON, DIRECTOR, INFECTIOUS DISEASES, CANBERRA HOSPITAL: They're called growth promoters or sometimes given the name of antimicrobials, but at the end of the day they're antibiotics, because they're agents that kill bacteria and they're the same class of agents as are used in humans.
ANDREW FOWLER: Eve has a close relationship with chicken company Bartter Enterprises.
It provides the chicks and takes them away again after she's grown them.
Bartter even supplies the feed.
Do you know if the feed contains antibiotics?
EVE MURDEN: I have asked this question many times, and I have been told, "No.
It does not antibiotics.
"It is good quality grain with enzymes in it."
ANDREW FOWLER: Do they call them antimicrobials?
EVE MURDEN: I have never heard that mentioned.
ANDREW FOWLER: When you say you've asked many times, why did you ask?
EVE MURDEN: Because people had asked me, the same as you are asking me.
And being a ferret like I am, I like to find things out, and, ah, so therefore I asked.
That's what I was told.
ANDREW FOWLER: Eve isn't alone.
Many farmers don't know they're feeding antibiotics to their chickens.
One manager of more than 12 farms told us he was unaware that there were antibiotics in the stock feed.
ASSOCIATE PROFESSOR MARY BARTON, PHARMACY & MEDICAL SCIENCES, UNIVERSITY OF SOUTH AUSTRALIA: A lot of farmers don't understand that growth promotents are antibiotics.
I mean, they will say to you, "We're not using antibiotics.
We're using growth promotents."
And then you explain to them that a lot of these growth promotents are antibiotics and some are antibiotics of concern to human health authorities.
ANDREW FOWLER: Peter Bartter is the head of Bartter Enterprises, owners of Steggles Company, the second-largest chicken producer in Australia, turning out 2.5 million chickens a week.
Eve Murden, who runs her farm near Newcastle -- she's one of the suppliers of chickens for your company -- says she's asked your company several times what's in the feed and whether, in fact, there are any antibiotics, and she was told that there weren't any.
PETER BARTTER, STEGGLES CHICKENS: Oh, well -- no, I don't know what Eve said or what the conversation was.
Eve is one of our growers and she's one of our better growers, actually.
ANDREW FOWLER: She says she was told that there were just enzymes.
PETER BARTTER: No, well, I don't know.
I don't know who told her that, nor whether the person that was telling her that was qualified to speak on behalf of the company as to exactly what was in the feed.
ANDREW FOWLER: But it would be your general company policy to tell your growers what's in the feed?
PETER BARTTER: Oh, not necessarily.
No, we don't necessarily tell them what's in the feed.
ANDREW FOWLER: But if they ask you they do?
PETER BARTTER: Oh, well, if they ask us, but it depends who they ask.
ANDREW FOWLER: Even Mr Bartter appears unsure what's in the feed.
He first told us his company didn't use Virginiamycin -- an antibiotic that replaced Avoparcin and experts argue can increase the volume of VRE in the community.
He said the company now used another antibiotic called Aviliamycin, which he said was not linked to antibiotics prescribed for humans.
Do you also add Virginiamycin?
PETER BARTTER: No.
ANDREW FOWLER: According to Tim Walker, who's your nutritionist, in a conversation with one of our researchers, you do.
PETER BARTTER: Oh, in the past we have.
In the past we have, Virginiamycin.
We either used one antibiotic or another.
Ah, Virginiamycin has been used in the past.
ANDREW FOWLER: According to Tim Walker, they will be rotated every four to six months, so they'll be rotated back on again.
PETER BARTTER: Well, then, that may be the case if we're in a rotation.
All I know is what we're feeding at the moment.
But if they're rotating, then that's OK.
I've got no problem with that.
My belief is that, ah, Aviliamycin, the product we're using at the moment, is not used -- is not connected with VRE.
ANDREW FOWLER: Right, but Virginiamycin is, and you do still use that.
PETER BARTTER: Well, we have used it, and if it comes into the rotation again, then it will come into the rotation.
ANDREW FOWLER: The industry says that the antibiotics are administered at such low levels they pose no threat.
PETER BARTTER: It's a very small amount of an antimicrobial or antibiotic.
It's, ah -- we feed two --
..in one tonne of feed we put two teaspoons, which is 10 grams in one tonne of feed.
Now that's --
Imagine two teaspoons in 1,000 packets of one-kilo sugar down at the supermarket, if you can imagine what that looks like.
DR PETER COLLIGNON: Well, paradoxically, giving it at a low level may be worse than giving it at a high level.
ANDREW FOWLER: Why's that?
DR PETER COLLIGNON: In the laboratory, if you want to induce antibiotic resistance, what you do is have agar plates with low levels of antibiotics in it, because if you give high levels, the bacteria die.
If you give low levels they persist, and they're given a selective advantage, so resistant varieties are more likely to develop.
ANDREW FOWLER: The chicken industry goes on to say that even if VRE does exist in meat, it's the customers' fault if they get sick.
Prolonged high temperatures kill antibiotic-resistant bacteria.
If the food is cooked properly, the drug-resistant bacteria won't survive, they say.
DR JEFF FAIRBROTHER: If you cook your product, it doesn't matter whether it's a resistant bacteria or not a resistant bacteria, it'll be destroyed by a normal cooking process.
So in the long run, if you've cooked your chicken product or any other meat product for that example, you're not gonna have a problem.
ANDREW FOWLER: But is the industry right?
This is a top Sydney restaurant with impeccable hygiene.
Yet scientists say that if VRE gets into the food chain, even the best practices of the best chefs or the cleanest home kitchen may not be enough.
Handling food contaminated with VRE would need the sterilisation procedures of an operating theatre to be risk-free.
PROFESSOR WARREN GRUBB, MICROBIOLOGY, CURTIN UNIVERSITY: You take the carcass off, or you might use tongs, so you've just handled an uncooked carcass with the tongs.
You then take off the cooked carcass with your tongs -- you recontaminate the carcass that's been cooked.
ANDREW FOWLER: VRE can be anywhere, whether it's chicken, pig or anything you eat.
Even vegetables grown using chicken manure may be contaminated.
It's such a potential problem that three years ago, the Federal Government set up a special task force.
DR PETER COLLIGNON (IN COVERSATION): Mind you, I think it's good that veterinarians are into public health, because they do have a better idea with the food business and where it's at more than medicos.
ASSOCIATE PROFESSOR MARY BARTON: And we're not focused on one species.
DR PETER COLLIGNON: No, you're not, and also you actually know more where the chain goes.
ACTION GROUP MEMBER: -- which is probably beef.
ACTION GROUP MEMBER 2: How do I account for it in poultry?
GROUP MEMBER 1: They're obviously wheat-fed bovines.
ANDREW FOWLER: This is the most recent meeting of the action group arising from that task force -- an august collection of experts in microbiology and infectious diseases, like Dr Collignon and Professor Barton, an expert in the veterinary use of drugs.
They come from opposite sides.
ASSOCIATE PROFESSOR MARY BARTON: Oh, go on.
You've been brainwashed.
DR PETER COLLIGNON: No --
Well, no --
What?
I tell you, I'm regarded as a, sort of, a softie for industry as far as the European perspective goes, I think.
You know, from what I can -- can tell.
I mean --
ASSOCIATE PROFESSOR MARY BARTON: Go on.
DR PETER COLLIGNON: Well --
ASSOCIATE PROFESSOR MARY BARTON: You've been brainwashed.
ANDREW FOWLER: Attempting to bridge this gap is Professor John Turnidge, the chairman of the action group.
How difficult has it been for you to stitch together the people, the disparate groups that there are that sit around the table?
PROFESSOR JOHN TURNIDGE, DIRECTOR, INFECTIOUS DISEASES, WOMEN'S & CHILDREN'S HOSPITAL, ADELAIDE: Um, over some issues it's quite easy.
Over other issues, it can be quite difficult.
Um, we're -- I mean, more or less, at the cutting edge, I think.
Um, you know, on an international scale, of how do you approach this difficult problem where you've got two group -- two professions who've been operating in different ways independently, um, for nigh on 50 years with a class of drugs and are only now trying to see a common ground for operation.
ANDREW FOWLER: The group is acting upon the findings of a Federal Government report which cited conclusive evidence VRE could find its way into the food chain and infect humans.
The chicken industry remains sceptical.
It says the resistant bacteria are then able to spread from one host to another, human to human, animal to animal, animal to human or human to animal.
Either by direct contact, or in the case of bacteria of animal origin, via the food chain.
DR JEFF FAIRBROTHER: Mmm.
ANDREW FOWLER: It's a very conclusive statement.
DR JEFF FAIRBROTHER: Well, that's --
that's what they've said but, er, what y-y-you --
ANDREW FOWLER: Well, this is a cross-party, a cross-industry group of people.
DR JEFF FAIRBROTHER: And that's their theory.
ANDREW FOWLER: Well, that's what they're saying --
DR JEFF FAIRBROTHER: -- this is the way it can happen.
That's what they're saying and I'm saying, in theory, that's what they're saying can happen.
Are you --
Do you agree with that?
DR JEFF FAIRBROTHER: In theory, yes.
In practice, I would have my doubts as to whether it is a significant problem.
ANDREW FOWLER: Don't you have a problem if the very basic premise isn't accepted by the industry?
PROFESSOR JOHN TURNIDGE: Oh, yes, but I guess there are still people who think that the Earth is flat.
Um, and we can't stop them thinking that.
Um, but all we can do is say that the majority of people understand that there is a risk issue here.
Um, we do accept it and we're gonna take measures to change the situation.
ANDREW FOWLER: The action group wants to set up a national system to test for VRE in hospitals, food and on the farm.
But that plan may already be compromised.
One proposal discussed by the action group and the companies which supply veterinary drugs is for drug companies themselves to pay for and supervise testing.
What are the risks of having a drug company paying for the surveillance of its own products?
PROFESSOR JOHN TURNIDGE: Er, the risks of the surveillance, er, being conducted by the pharmaceutical industry alone is that they choose very carefully which things to survey, how to do the surveillance.
We don't get, if you like, the independent view, the proper epidemiological view.
ANDREW FOWLER: How much of a problem is that for you?
PROFESSOR JOHN TURNIDGE: Well, it can be a problem because then we're totally reliant on industry to fund the surveillance and then, er, perhaps prevent -- present the selected view of how to interpret that data.
We would far prefer an independent organisation running the surveillance with, er, with financial assistance.
WARREN TRUSS: Well, there are -- there are --
there are health authorities involved in these issues.
There are industry -- industry people involved in these issues.
They are all supervised by independent agencies.
There are --
ANDREW FOWLER: This is the chairman of the committee who's saying he's worried about the VRE surveillance program that you're gonna be involved in.
WARREN TRUSS: There are 600 million animals in Australia.
18 million people.
And so, er, there are certainly a lot of, er, testing and examination processes that need to be undertaken.
Er, I'm satisfied that the, er, testing arrangements are undertaken with integrity and with a determination to ensure that our health standards are high.
ANDREW FOWLER: He also says we would prefer an independent organisation running the surveillance with financial assistance.
WARREN TRUSS: Well, if the chairman of the committee has got concerns, it's surprising he hasn't raised them with me.
Er, it's surprising that he would go to Four Corners first to raise these sorts of issues.
I think it is important that if there -- if there are agencies that have concerns about the way in which the issues are -- are being dealt with, then they're raising them with the Health Minister and -- and with me, who are jointly looking at the implementation of these recommendations.
ANDREW FOWLER: Government works closely with the agricultural chemical industry.
Here at a conference run by AVCARE, the agricultural chemical companies' umbrella group, representatives from farming and government mix with the agricultural pharmaceutical lobby.
PETER HOLDSWORTH, DIRECTOR, AVCARE: No individual organisation's got all the answers.
We've gotta work together on this and then come up with the --
with the best way forward.
ANDREW FOWLER: Peter Holdsworth is AVCARE's director of regulatory and scientific affairs.
PETER HOLDSWORTH: We're working with the government to come up with the most appropriate surveillance program.
Now, for the end of the day, the, er, the equation is that that is the way the system will work --
Well, we'll deal with it as we -- when we come to that.
ANDREW FOWLER: Whoever funds testing, the model for analysing them is already in place.
It's called the National Residue Survey, part of the Department of Agriculture.
The NRS monitors levels of chemicals and antibiotics in food.
A similar system would be used to test for drug-resistant bacteria like VRE.
The existing arrangement is for the companies being tested to pay the bill.
It's called full cost recovery.
There are accusations that this system has already failed.
We were contacted by a former public servant who worked with the National Residue Survey.
He told Four Corners that the user-pays system and resultant funding shortages bred low staff morale.
He spoke on the condition his face and voice couldn't be identified.
NATIONAL RESIDUE SURVEY SOURCE: Because of the effects of full cost recovery, the number of samples that have tested, say for residues in poultry, has reduced by half.
Er, and the number of tests for helminthics in pigs is reduced by about the same amount.
By about 50 per cent in a 10-year period.
ANDREW FOWLER: What are the residues that have been reduced --
..er, the testing that's been reduced by half in poultry?
Is this for antibiotic residues?
NATIONAL RESIDUE SURVEY SOURCE: Yeah, the residues that are being tested for in poultry, they've been reduced by half --
are antibiotic residues, yes.
ANDREW FOWLER: How significant is that?
NATIONAL RESIDUE SURVEY SOURCE: Well, it's, er -- it's significant in a public health sense.
Because reduction of this testing is -- will reach a stage where it's virtually ineffective.
ANDREW FOWLER: Government statistics confirm the decline in testing for residues under the same user-pays model being proposed for testing for VRE.
In 1989, checks for antibiotic residue were made on 1,125 poultry samples.
A decade later, the number of samples tested had fallen by half.
Isn't it true that the National Residue Service has been lobbying industry for more money for testing because there aren't sufficient funds being made available?
WARREN TRUSS: Well, the industry --
The testing arrangements have been expanded significantly.
We are conducting a whole range of tests through a whole range of industries.
Obviously, you could always do more but you have to place balances between what is reasonable, what is fair and reasonable, and what is likely to achieve significant outcomes for the Australian people.
ANDREW FOWLER: So you see nothing wrong with the people who are responsible for testing the products having to go cap in hand to the producers and asking for money to test their own products that may, in fact, lose to the -- lead to them losing money?
WARREN TRUSS: There are always negotiations that go on between the authorities as to what is an appropriate level of testing within every industry.
We have a much higher level of testing than most countries in the world.
ANDREW FOWLER: In November last year, a visiting European Union delegation issued a damning report about the way that livestock is tested in Australia.
It observed that farms were informed in advance of inspections and therefore testing was unreliable.
The EU report also noted that Australian testing wasn't independent of producers.
WARREN TRUSS: Well, each country has a right to set their own standards in relation to the food that's sold within their borders.
We do that in Australia.
We have some of the highest standards anywhere in the world.
Food sold in Australia meets our standards.
Food sold in Europeans -- in Europe has to meet their standards.
And if Australians choose to export to that country, we will meet their standards.
PETER BARTTER: We'd be happy if the government wants to spend more of their money on doing things and -- and testing and in the field.
If the industry's involved to a certain extent, I'm sure that's only there to defray some of the costs of doing these things.
But, er, you know, I know our company acts in complete integrity any time that we're asked for sampling or testing of anything.
ANDREW FOWLER: But if industry is worried about who pays, it's worth noting that outbreaks of VRE cost Australian hospitals hundreds of thousands of dollars a year in extra staff and special isolation wards to prevent the infection spreading.
If VRE becomes more prevalent in our food, doctors fear it might genetically fuse with golden staph, one of the most aggressive bacteria known to medical science.
There's already a resistant strain of golden staph called MRSA.
That doesn't pass through the food chain but if there's more VRE around the risk of a hybrid 'super super bug' also increases.
What doctors fear is that antibiotic-resistant staph itself may become completely resistant to vancomycin.
DR PETER COLLIGNON: The very people who have the serious infections with the VRE germ often also have these staph germs on them -- these MRSAs.
In the laboratory, the gene encoding for this vancomycin resistance can be transferred from the enterococcus to the golden staph, and it has also happened in experimental animal situations.
If we get a germ that is untreatable with current antibiotics, we're back in the pre-antibiotic era for that super bug.
ANDREW FOWLER: The medical profession must bear some of the blame for the rise of drug-resistant bacteria.
Overprescribing these drugs in the human community is still a huge problem.
But now the animal livestock industry is being called to account.
They've relied upon antibiotic use for a long time, and they don't like change.
DR JEFF FAIRBROTHER: Well, I suppose you can look at it pragmatically, and, you know, how long does it take for the drug resistance to build up?
Or do you just assume that every product you use is going to cause drug resistance?
And if you want to decimate the whole of the livestock industries in this country and around the world, you'd probably go along the --
..on, if you like, that purist view of the medical profession, but I would suggest to you and to the medical profession, if they got their house in order and they didn't overprescribe antibiotics the way they do, we wouldn't probably even be having this discussion.
ASSOCIATE PROFESSOR MARY BARTON: There's -- a lot of the animal industries are operating at -- at fairly marginal levels of -- of -- of -- um --
..uh -- productivity, in the sense that they make a very small margin of cents per kilo of chicken meat or pig meat or whatever it is they're producing.
We should find other ways of achieving that, not using antibiotics.
ANDREW FOWLER: It's taken almost 20 years to accept that antibiotic use in animals poses a threat to human health.
ASSOC. PROF. JOHN TURNIDGE: If we continue to use antibiotics at the levels that we're currently using them in Australia, we're going to have a lot of resistant bugs.
We're going to have a lot of sick people in hospital who have got hard-to-treat infections.
ANDREW FOWLER: After all the years you've spent as a microbiologist, is there any one thing that makes you angry?
PROFESSOR WARREN GRUBB: Probably too little too late.
ANDREW FOWLER: When you say, "Too little too late," what do you mean by that?
PROFESSOR WARREN GRUBB: I think that we should have been doing a lot more, a lot -- a long time ago to try and address this serious problem of antibiotic resistance.
ANDREW FOWLER: Many farmers fear they'll be the losers if they stop using antibiotics, that farming will become more complicated and more costly.
But what are the costs of feeding antibiotics to livestock?
For a mere 60 years, human beings have been able to fight life-threatening infections.
Now the overuse of miracle drugs threatens to destroy this profound benefit to human health.
44 Minute documentary
Reporter: Andrew Fowler
ANDREW FOWLER: For years, farmers have been feeding antibiotics to their animals to make them fatter faster.
DR JEFF FAIRBROTHER, AUSTRALIAN CHICKEN MEAT FEDERATION: The only reason we use this product is because we have a huge economic advantage.
ANDREW FOWLER: The antibiotics they use are the same 'silver bullets' that stop people from dying.
Now there's a link between those drugs and the creation of an unstoppable 'super bug' in the food that we eat.
DR PETER COLLIGNON, DIRECTOR, INFECTIOUS DISEASES, CANBERRA HOSPITAL: They come across the food chain and they can make people sick.
ANDREW FOWLER: Yet there's no formal testing for it.
PROFESSOR WARREN GRUBB: "She'll be right, mate," is the Australian attitude.
It ain't gonna be right.
It's getting worse.
ANDREW FOWLER: Tonight on Four Corners the battle over antibiotics fed to farm animals.
Should they be used?
And are we prepared to pay a potentially deadly price, gambling with the last 'silver bullets'?
Canberra Hospital on Tuesday, August 19.
Inside, a middle-aged woman is recovering from kidney failure.
The night before, we'd approached the hospital and the woman had given us permission to film her as part of this program.
What made her different from the hundreds of other patients -- the strongest antibiotics weren't working.
She'd become infected with a deadly strain of bacteria -- so contagious she was consigned to a special isolation ward to prevent its spread to other patients.
Shortly before we were to start filming her, the woman died.
Four Corners arrived just as her family learnt of the unexpected death and came to pay their last respects.
How do you personally feel at the moment?
DR PETER COLLIGNON, DIRECTOR INFECTIOUS DISEASES, CANBERRA HOSPITAL: Well, I think, you know, like all these situations, this is obviously very sad.
I mean, this is a case where somebody has got multiple problems, and a contributing factor has been a fact that there's a bacteria we couldn't treat adequately.
ANDREW FOWLER: In other hospitals, her death might never have been disclosed for what it was.
There is no national mandatory reporting of this infection.
How she got the bug, no-one is sure.
Fear of the infection has forced many hospitals to keep their outbreaks quiet.
DR PETER COLLIGNON: Well, I think one of the reasons is that it never looks good for your hospital to know you've got these so-called 'super bugs', and that people are having a bad outcome from it.
ANDREW FOWLER: But do you think people have the right to know that?
DR PETER COLLIGNON: Well, I think it is a very good idea if people know that, providing we do it in a way that doesn't unfairly target one hospital.
The paradox of this is that the hospitals that do this better in the short-term and report the data look worse than the hospitals that are often slacker and don't collect the data at all, because they don't know.
Ignorance is bliss.
ANDREW FOWLER: The exact number of infections in Australia is unknown, but estimates run to hundreds.
Since 1994, when the first case appeared at Melbourne's Austin Hospital almost all major hospitals have been hit.
Three weeks ago, the Royal Perth Hospital reported 19 cases.
It had to set up a special isolation unit.
This is what it looks like.
Vancomycin-resistant enterococci -- VRE for short -- is so contagious and hard to treat hospitals are forced to take extraordinary precautions.
The woman who died at Canberra Hospital was allowed only one nurse to take care of her to limit the risk of contamination.
Even after her death, the threat of infection to others continued to pose a problem.
Every part of her room had to be scrubbed, including the walls.
DR PETER COLLIGNON: This is a germ that hangs around on telephones, on the bedrails, on the doorknobs, so you have to have scrupulous cleaning at the end, otherwise the bug can persist.
ANDREW FOWLER: Hospitals use vancomycin as the antibiotic 'silver bullet' to fight infections when all else fails.
As a wonder drug it was over-prescribed in large amounts both by hospitals and general practitioners, and this is where the problems started.
Because of its overuse, the bacteria built up an immunity to it, creating the 'super bug' VRE.
DR PETER COLLIGNON: I think there's an expectation in this community that if you're sick, there is a tablet to make you better.
I think it can be lazy doctoring, because the easiest thing is to give somebody a tablet and get them out, you know, so you can see the next patient.
ANDREW FOWLER: The death of a patient involving bacteria infection is a grim reminder of life before antibiotics.
Until the discovery of penicillin in the middle of the last century patients died with wounds that couldn't be healed.
Now, because of antibiotic misuse, it's happening again.
The fear is that antibiotics will become worthless.
DR PETER COLLIGNON: So no shaking, shivers or chills or anything?
PATIENT: No, no, no.
DR PETER COLLIGNON: OK.
That's all gone?
PATIENT: Yeah.
All gone.
DR PETER COLLIGNON: Did anybody else in the family get sick?
ANDREW FOWLER: Dr Peter Collignon, head of Canberra Hospital's Infectious Diseases Department, accepts that the medical profession should take its share of the blame, but he increasingly believes it's not entirely responsible for creating VRE.
Humans aren't the only ones capable of developing antibiotic-resistant bugs in their system.
When they're fed antibiotics, animals can too.
DR PETER COLLIGNON: When you look at it, you can see the same classes of antibiotics are used in animals as in humans.
And we know from overwhelming evidence, particularly in Europe, that if you do that in animals, resistant bacteria develop, they come across the food chain and they can make people sick.
ANDREW FOWLER: Australia is one of the biggest consumers of agricultural antibiotics in the world.
Antibiotics are fed to lamb and beef in feedlots, pigs in intensive farming and chickens.
The antibiotics help growth and also keep down disease.
Every year Australia consumes 700,000 kilos of antibiotics, three-quarters -- over 500,000 kilos -- in agriculture.
A link between VRE in humans and VRE in animals has been proved in European studies, but never in Australia.
Five years ago, the John Hunter Hospital in Newcastle produced the first evidence.
In the men's medical ward, one of the John Hunter's patients appeared to have developed a resistance to vancomycin.
Many people carry VRE in their bodies and never suffer any illness.
But when they're sick and given strong antibiotics like vancomycin, which kills all other bacteria, VRE flourishes and takes over.
Doctors couldn't understand how the hospital patient could have contracted VRE.
He had no history of vancomycin use, and it seemed unlikely that he'd picked up the infection from the hospital.
DR JOHN FERGUSON, DIRECTOR, MICROBIOLOGY, JOHN HUNTER HOSPITAL: We screened the entire ward and found two other individuals who were also carrying this same strain, and those individuals had had some contact whilst they'd been in hospital.
So it was an infection control issue for us, which really led us to implementing quite stringent isolation.
ANDREW FOWLER: As the doctors struggled for answers, they began looking in unusual places for the source of the mystery infection.
It was just possible that it had come from something the patient had eaten.
They remembered the European studies and wondered if it could have come from local produce.
Instead of calling in further medical opinion, they called in the local Department of Agriculture.
DR JOHN FERGUSON: The Hunter's quite a rural region.
These patients weren't from country areas, but we were aware that there was evidence of transmission through the food chain, even then.
So we did persuade the Agricultural Department to cooperate with some surveys.
ANDREW FOWLER: For the next 10 weeks, teams of Agricultural Department vets begin scouring local farms, taking manure samples from cattle and poultry in a bid to track down the mysterious bug.
Initially, 40 farms were keen to take part in the study.
Disturbingly, in one of the samples from a poultry farm, small amounts of VRE were discovered.
If anyone had eaten that meat, it could have got into their system.
The poultry had been given Avoparcin, a similar drug to the human antibiotic vancomycin.
It was proof that a problem detected overseas could happen here.
DR JOHN FERGUSON: It was certainly very exciting in the lab during those days when we were processing the cultures and seeing the results as they emerged, and finding those strains.
ANDREW FOWLER: What happened next is unclear.
Follow-up investigations were never conducted, and the case was closed.
DR JOHN FERGUSON: I think the finding was very significant and highlighted that we could possibly have a problem with transfer of VRE from animals to humans or vice versa.
ANDREW FOWLER: Why was there such resistance to you going back and doing further studies?
DR JOHN FERGUSON: Oh, I think, politically, it was very sensitive.
It was pointing out, perhaps, that the food may not be as safe as it was thought to be.
And there's a lot of economic advantage that attaches to food safety, or perceived food safety, so that the producers weren't keen, I think, to have surveys done.
ANDREW FOWLER: The chicken industry says it would have supported follow-up studies if a formal proposal had been put to them, but it hardly seemed enthusiastic.
DR JEFF FAIRBROTHER, AUSTRALIAN CHICKEN MEAT FEDERATION: All we wanted was a proper experimental program -- as I recall now -- it was three years ago.
ANDREW FOWLER: Given that you had VRE on at least one of your chicken farms in the Hunter Valley, wouldn't you have wanted to know more about that?
Wouldn't you have been asking questions?
What is this thing?
Where did it come from?
What's the problem?
DR JEFF FAIRBROTHER: Well, if you want to be a purist, you probably would have.
But being sensible about it, it was --
ANDREW FOWLER: What's purist about asking a question about --
DR JEFF FAIRBROTHER: Well, hang on.
ANDREW FOWLER: ..whether you've got VRE on your farm or not?
DR JEFF FAIRBROTHER: The situation was that after that batch of chickens from which that isolation was made had gone, the farm would have been totally cleaned out, virtually sterilised as the end of a batch, and the litter would have been removed.
There would have been no suggestion that the problem still existed.
And probably it wouldn't have.
ANDREW FOWLER: The farms concerned would have been routinely cleaned out, but that's not the point.
Tens of thousands of chickens are presumed to have gone to market, some of them possibly contaminated with VRE.
If the new batch of chicks that replaced them was fed the same antibiotics, there would be equal risk of incubating the resistant bug.
It's a systemic problem.
DR JOHN FERGUSON: We didn't get to know the size of the farms or where exactly they were located.
ANDREW FOWLER: So the names were kept secret from you?
DR JOHN FERGUSON: Yes, that was our choice.
I mean, we felt it was important to have a blinded survey that was done in a proper fashion.
ANDREW FOWLER: Have the names ever been released?
DR JOHN FERGUSON: No, no.
There's been no publicity about that.
I guess -- I'm not sure that it would help anybody to know exactly where they were.
I think the important thing was that --
..those VRE strains were amongst those animals.
ANDREW FOWLER: Do the health authorities know where those strains are?
DR JOHN FERGUSON: No.
There was never any, er --
..advice that went to the Health Department about that issue.
ANDREW FOWLER: There are two strains of VRE -- one predominant in animals, the other in humans.
Ferguson's study discovered both in animals, and both have been discovered in humans too.
DR WARREN GRUBB ('COUNTRYWIDE', 1984): We looked at some bacteria from a farm where they were using antibiotic in the feed, We found that a very large number, a high percentage of the organisms were resistant to that antibiotic, and that antibiotic has use in the clinical field.
ANDREW FOWLER: Warren Grubb is a microbiologist.
For more than two decades, he's been studying the impact on humans of feeding antibiotics to animals.
DR WARREN GRUBB ('STATEWIDE', 1984): Some people require black and white evidence before they'll move.
And there's been lots of evidence around for years which demonstrate the seriousness of the problem -- the more antibiotic you use, the more indiscriminate the use is.
ANDREW FOWLER: Back in 1984, he predicted the probability of dangerous repercussions.
'STATEWIDE' JOURNALIST: It's a fairly frightening prospect, though, that we might have to wait for a death in Australia.
DR WARREN GRUBB: Well, that may be possible.
That may be possible.
ANDREW FOWLER: 17 years later, he's continued that struggle.
Warren Grubb, now a professor, carried out a study into VRE in a factory processing chicken in Western Australia.
PROFESSOR WARREN GRUBB,MICROBIOLOGY, CURTIN UNIVERSITY: So we screened some of those animals on the production line to see whether they had resistance to that antibiotic, and, of course, we found that they did have resistance.
We didn't even tell them we were going to look for VREs.
We were just sampling and that's all that they knew we were doing.
ANDREW FOWLER: His recent study backs the Hunter Valley finding and vindicates his stand.
It found traces of VRE on chicken carcasses.
But the location of the factory had to be kept secret.
That was the condition under which the industry let the tests go ahead.
How difficult is it for you working in that environment, where you discover something which is a public health matter but because of the way in which you carry out your research, you can't reveal the company?
PROFESSOR WARREN GRUBB: Well, it is very difficult.
I mean, really, if you find this information, you look at how you're going to control the problem.
And you can't control the problem unless you find out what practice is being used, where there has been antibiotic which has been responsible, how widespread is the problem.
You can't do anything if you can't go back and identify all the problems.
ANDREW FOWLER: Even the chicken industry was becoming concerned.
Two years ago, it partly funded a study into VRE in poultry by Professor Mary Barton, a vet and an acclaimed expert on the poultry industry.
Her study is considered a landmark work.
It found that 1 in 14 of the chickens she sampled had VRE on the carcass.
Again, no-one knows which processing plants produced the positive samples.
But this time the tests centred on South Australia.
ASSOCIATE PROFESSOR MARY BARTON, PHARMACY & MEDICAL SCIENCES, UNIVERSITY OF SOUTH AUSTRALIA: I think that my finding some was not entirely surprising.
I think they would have been over the moon if I hadn't found any.
But I think, realistically, they realised that there would be some, and there were some.
ANDREW FOWLER: If you knew that a chicken had VRE, would you eat it?
PROFESSOR WARREN GRUBB: No, I don't think I would.
ANDREW FOWLER: Why not?
PROFESSOR WARREN GRUBB: My main reason would be that I think there's sufficient evidence which would indicate that if I ate that chicken with VRE, that the VRE, if it was still alive, could transfer its antibiotic resistance into some of the bacteria in my flora, in my own flora.
ANDREW FOWLER: And that would make you VRE-resistant, too?
PROFESSOR WARREN GRUBB: Well, I would have an organism which has resistance to that antibiotic.
WARREN TRUSS, FEDERAL MINISTER FOR AGRICULTURE: Well, let me say that I eat the food produced by Australian farmers with every confidence that it is the safest and healthiest in the world.
ANDREW FOWLER: Would it surprise you to know that one of the pre-eminent scientists says that he would not eat food if he knew it contained VRE.
WARREN TRUSS: Well, what I've always found amongst scientists is that you can always find somebody with a dissident opinion.
You can always find somebody who is outside of the mainstream.
ANDREW FOWLER: The incidence of VRE in poultry can't just be blamed on chicken farmers.
Even they sometimes don't know what's going on.
Eve Murden used to be a dairy farmer.
Deregulation and competition policy forced down the price of milk and drove her out of the industry.
Now in her 70s, she's starting over again.
18 months ago, she became a poultry farmer.
EVE MURDEN, CHICKEN FARMER: I have always loved animals.
And the little yellow fluffy chickens, as I call them, they're just beautiful.
They each have their own personality.
And you imagine them, when you get up at 5:30am, what they're going to look like when you open those doors, and you're never disappointed.
ANDREW FOWLER: Eve built a state-of-the-art chicken shed.
Everything is controlled electronically, from the heating to the water flow and the feed that the chickens eat.
EVE MURDEN: Once they grow quick, well, then you've got the good meat.
If they don't grow quick, the meat is tough.
And that's why you have these feedlots these days and all this sort of thing to grow good meat.
ANDREW FOWLER: These birds are just a few days old.
By the time they're seven weeks, they'll be fat enough and ready for slaughter.
The pace of growth is so fast that some of them don't make it.
EVE MURDEN: If a chicken has a heart attack, ah, at any stage of its life, even though we've got 26,700 chickens in the shed, I do not like losing one of them.
Because you have them for seven weeks, and at the end of six weeks, if you have a few heart attacks, it sort of knocks the joy out of it.
ANDREW FOWLER: To lower the death rate, antibiotics are routinely mixed into the feed stock.
They prevent disease in crowded sheds and promote growth.
Growers once used Avoparcin, but it was withdrawn because of its links to VRE.
Now there's another product -- Virginiamycin.
It's close to Synercid, another antibiotic in the last-line defence for humans.
But there's another reason chickens are fed antibiotics -- they kill bacteria in the gut.
This makes the digestive system more efficient and saves chicken feed.
DR JEFF FAIRBROTHER, AUSTRALIAN CHICKEN MEAT FEDERATION: The animal, getting better digestion, it makes better use of its feed and you don't have to use as much feed.
So that's the way a growth promotent works.
It means that you can get to a certain weight for age in a slightly shorter time.
ANDREW FOWLER: The chicken industry calls these drugs by many names -- growth promoters, digestion enhancers and antimicrobials.
DR JEFF FAIRBROTHER: Antimicrobials are used to change the gut flora in the chicken, and they destroy or kill bacteria that you don't want present in the bird's gut, and it lets the better bacteria proliferate.
ANDREW FOWLER: But they're still antibiotics like vancomycin.
DR PETER COLLIGNON, DIRECTOR, INFECTIOUS DISEASES, CANBERRA HOSPITAL: They're called growth promoters or sometimes given the name of antimicrobials, but at the end of the day they're antibiotics, because they're agents that kill bacteria and they're the same class of agents as are used in humans.
ANDREW FOWLER: Eve has a close relationship with chicken company Bartter Enterprises.
It provides the chicks and takes them away again after she's grown them.
Bartter even supplies the feed.
Do you know if the feed contains antibiotics?
EVE MURDEN: I have asked this question many times, and I have been told, "No.
It does not antibiotics.
"It is good quality grain with enzymes in it."
ANDREW FOWLER: Do they call them antimicrobials?
EVE MURDEN: I have never heard that mentioned.
ANDREW FOWLER: When you say you've asked many times, why did you ask?
EVE MURDEN: Because people had asked me, the same as you are asking me.
And being a ferret like I am, I like to find things out, and, ah, so therefore I asked.
That's what I was told.
ANDREW FOWLER: Eve isn't alone.
Many farmers don't know they're feeding antibiotics to their chickens.
One manager of more than 12 farms told us he was unaware that there were antibiotics in the stock feed.
ASSOCIATE PROFESSOR MARY BARTON, PHARMACY & MEDICAL SCIENCES, UNIVERSITY OF SOUTH AUSTRALIA: A lot of farmers don't understand that growth promotents are antibiotics.
I mean, they will say to you, "We're not using antibiotics.
We're using growth promotents."
And then you explain to them that a lot of these growth promotents are antibiotics and some are antibiotics of concern to human health authorities.
ANDREW FOWLER: Peter Bartter is the head of Bartter Enterprises, owners of Steggles Company, the second-largest chicken producer in Australia, turning out 2.5 million chickens a week.
Eve Murden, who runs her farm near Newcastle -- she's one of the suppliers of chickens for your company -- says she's asked your company several times what's in the feed and whether, in fact, there are any antibiotics, and she was told that there weren't any.
PETER BARTTER, STEGGLES CHICKENS: Oh, well -- no, I don't know what Eve said or what the conversation was.
Eve is one of our growers and she's one of our better growers, actually.
ANDREW FOWLER: She says she was told that there were just enzymes.
PETER BARTTER: No, well, I don't know.
I don't know who told her that, nor whether the person that was telling her that was qualified to speak on behalf of the company as to exactly what was in the feed.
ANDREW FOWLER: But it would be your general company policy to tell your growers what's in the feed?
PETER BARTTER: Oh, not necessarily.
No, we don't necessarily tell them what's in the feed.
ANDREW FOWLER: But if they ask you they do?
PETER BARTTER: Oh, well, if they ask us, but it depends who they ask.
ANDREW FOWLER: Even Mr Bartter appears unsure what's in the feed.
He first told us his company didn't use Virginiamycin -- an antibiotic that replaced Avoparcin and experts argue can increase the volume of VRE in the community.
He said the company now used another antibiotic called Aviliamycin, which he said was not linked to antibiotics prescribed for humans.
Do you also add Virginiamycin?
PETER BARTTER: No.
ANDREW FOWLER: According to Tim Walker, who's your nutritionist, in a conversation with one of our researchers, you do.
PETER BARTTER: Oh, in the past we have.
In the past we have, Virginiamycin.
We either used one antibiotic or another.
Ah, Virginiamycin has been used in the past.
ANDREW FOWLER: According to Tim Walker, they will be rotated every four to six months, so they'll be rotated back on again.
PETER BARTTER: Well, then, that may be the case if we're in a rotation.
All I know is what we're feeding at the moment.
But if they're rotating, then that's OK.
I've got no problem with that.
My belief is that, ah, Aviliamycin, the product we're using at the moment, is not used -- is not connected with VRE.
ANDREW FOWLER: Right, but Virginiamycin is, and you do still use that.
PETER BARTTER: Well, we have used it, and if it comes into the rotation again, then it will come into the rotation.
ANDREW FOWLER: The industry says that the antibiotics are administered at such low levels they pose no threat.
PETER BARTTER: It's a very small amount of an antimicrobial or antibiotic.
It's, ah -- we feed two --
..in one tonne of feed we put two teaspoons, which is 10 grams in one tonne of feed.
Now that's --
Imagine two teaspoons in 1,000 packets of one-kilo sugar down at the supermarket, if you can imagine what that looks like.
DR PETER COLLIGNON: Well, paradoxically, giving it at a low level may be worse than giving it at a high level.
ANDREW FOWLER: Why's that?
DR PETER COLLIGNON: In the laboratory, if you want to induce antibiotic resistance, what you do is have agar plates with low levels of antibiotics in it, because if you give high levels, the bacteria die.
If you give low levels they persist, and they're given a selective advantage, so resistant varieties are more likely to develop.
ANDREW FOWLER: The chicken industry goes on to say that even if VRE does exist in meat, it's the customers' fault if they get sick.
Prolonged high temperatures kill antibiotic-resistant bacteria.
If the food is cooked properly, the drug-resistant bacteria won't survive, they say.
DR JEFF FAIRBROTHER: If you cook your product, it doesn't matter whether it's a resistant bacteria or not a resistant bacteria, it'll be destroyed by a normal cooking process.
So in the long run, if you've cooked your chicken product or any other meat product for that example, you're not gonna have a problem.
ANDREW FOWLER: But is the industry right?
This is a top Sydney restaurant with impeccable hygiene.
Yet scientists say that if VRE gets into the food chain, even the best practices of the best chefs or the cleanest home kitchen may not be enough.
Handling food contaminated with VRE would need the sterilisation procedures of an operating theatre to be risk-free.
PROFESSOR WARREN GRUBB, MICROBIOLOGY, CURTIN UNIVERSITY: You take the carcass off, or you might use tongs, so you've just handled an uncooked carcass with the tongs.
You then take off the cooked carcass with your tongs -- you recontaminate the carcass that's been cooked.
ANDREW FOWLER: VRE can be anywhere, whether it's chicken, pig or anything you eat.
Even vegetables grown using chicken manure may be contaminated.
It's such a potential problem that three years ago, the Federal Government set up a special task force.
DR PETER COLLIGNON (IN COVERSATION): Mind you, I think it's good that veterinarians are into public health, because they do have a better idea with the food business and where it's at more than medicos.
ASSOCIATE PROFESSOR MARY BARTON: And we're not focused on one species.
DR PETER COLLIGNON: No, you're not, and also you actually know more where the chain goes.
ACTION GROUP MEMBER: -- which is probably beef.
ACTION GROUP MEMBER 2: How do I account for it in poultry?
GROUP MEMBER 1: They're obviously wheat-fed bovines.
ANDREW FOWLER: This is the most recent meeting of the action group arising from that task force -- an august collection of experts in microbiology and infectious diseases, like Dr Collignon and Professor Barton, an expert in the veterinary use of drugs.
They come from opposite sides.
ASSOCIATE PROFESSOR MARY BARTON: Oh, go on.
You've been brainwashed.
DR PETER COLLIGNON: No --
Well, no --
What?
I tell you, I'm regarded as a, sort of, a softie for industry as far as the European perspective goes, I think.
You know, from what I can -- can tell.
I mean --
ASSOCIATE PROFESSOR MARY BARTON: Go on.
DR PETER COLLIGNON: Well --
ASSOCIATE PROFESSOR MARY BARTON: You've been brainwashed.
ANDREW FOWLER: Attempting to bridge this gap is Professor John Turnidge, the chairman of the action group.
How difficult has it been for you to stitch together the people, the disparate groups that there are that sit around the table?
PROFESSOR JOHN TURNIDGE, DIRECTOR, INFECTIOUS DISEASES, WOMEN'S & CHILDREN'S HOSPITAL, ADELAIDE: Um, over some issues it's quite easy.
Over other issues, it can be quite difficult.
Um, we're -- I mean, more or less, at the cutting edge, I think.
Um, you know, on an international scale, of how do you approach this difficult problem where you've got two group -- two professions who've been operating in different ways independently, um, for nigh on 50 years with a class of drugs and are only now trying to see a common ground for operation.
ANDREW FOWLER: The group is acting upon the findings of a Federal Government report which cited conclusive evidence VRE could find its way into the food chain and infect humans.
The chicken industry remains sceptical.
It says the resistant bacteria are then able to spread from one host to another, human to human, animal to animal, animal to human or human to animal.
Either by direct contact, or in the case of bacteria of animal origin, via the food chain.
DR JEFF FAIRBROTHER: Mmm.
ANDREW FOWLER: It's a very conclusive statement.
DR JEFF FAIRBROTHER: Well, that's --
that's what they've said but, er, what y-y-you --
ANDREW FOWLER: Well, this is a cross-party, a cross-industry group of people.
DR JEFF FAIRBROTHER: And that's their theory.
ANDREW FOWLER: Well, that's what they're saying --
DR JEFF FAIRBROTHER: -- this is the way it can happen.
That's what they're saying and I'm saying, in theory, that's what they're saying can happen.
Are you --
Do you agree with that?
DR JEFF FAIRBROTHER: In theory, yes.
In practice, I would have my doubts as to whether it is a significant problem.
ANDREW FOWLER: Don't you have a problem if the very basic premise isn't accepted by the industry?
PROFESSOR JOHN TURNIDGE: Oh, yes, but I guess there are still people who think that the Earth is flat.
Um, and we can't stop them thinking that.
Um, but all we can do is say that the majority of people understand that there is a risk issue here.
Um, we do accept it and we're gonna take measures to change the situation.
ANDREW FOWLER: The action group wants to set up a national system to test for VRE in hospitals, food and on the farm.
But that plan may already be compromised.
One proposal discussed by the action group and the companies which supply veterinary drugs is for drug companies themselves to pay for and supervise testing.
What are the risks of having a drug company paying for the surveillance of its own products?
PROFESSOR JOHN TURNIDGE: Er, the risks of the surveillance, er, being conducted by the pharmaceutical industry alone is that they choose very carefully which things to survey, how to do the surveillance.
We don't get, if you like, the independent view, the proper epidemiological view.
ANDREW FOWLER: How much of a problem is that for you?
PROFESSOR JOHN TURNIDGE: Well, it can be a problem because then we're totally reliant on industry to fund the surveillance and then, er, perhaps prevent -- present the selected view of how to interpret that data.
We would far prefer an independent organisation running the surveillance with, er, with financial assistance.
WARREN TRUSS: Well, there are -- there are --
there are health authorities involved in these issues.
There are industry -- industry people involved in these issues.
They are all supervised by independent agencies.
There are --
ANDREW FOWLER: This is the chairman of the committee who's saying he's worried about the VRE surveillance program that you're gonna be involved in.
WARREN TRUSS: There are 600 million animals in Australia.
18 million people.
And so, er, there are certainly a lot of, er, testing and examination processes that need to be undertaken.
Er, I'm satisfied that the, er, testing arrangements are undertaken with integrity and with a determination to ensure that our health standards are high.
ANDREW FOWLER: He also says we would prefer an independent organisation running the surveillance with financial assistance.
WARREN TRUSS: Well, if the chairman of the committee has got concerns, it's surprising he hasn't raised them with me.
Er, it's surprising that he would go to Four Corners first to raise these sorts of issues.
I think it is important that if there -- if there are agencies that have concerns about the way in which the issues are -- are being dealt with, then they're raising them with the Health Minister and -- and with me, who are jointly looking at the implementation of these recommendations.
ANDREW FOWLER: Government works closely with the agricultural chemical industry.
Here at a conference run by AVCARE, the agricultural chemical companies' umbrella group, representatives from farming and government mix with the agricultural pharmaceutical lobby.
PETER HOLDSWORTH, DIRECTOR, AVCARE: No individual organisation's got all the answers.
We've gotta work together on this and then come up with the --
with the best way forward.
ANDREW FOWLER: Peter Holdsworth is AVCARE's director of regulatory and scientific affairs.
PETER HOLDSWORTH: We're working with the government to come up with the most appropriate surveillance program.
Now, for the end of the day, the, er, the equation is that that is the way the system will work --
Well, we'll deal with it as we -- when we come to that.
ANDREW FOWLER: Whoever funds testing, the model for analysing them is already in place.
It's called the National Residue Survey, part of the Department of Agriculture.
The NRS monitors levels of chemicals and antibiotics in food.
A similar system would be used to test for drug-resistant bacteria like VRE.
The existing arrangement is for the companies being tested to pay the bill.
It's called full cost recovery.
There are accusations that this system has already failed.
We were contacted by a former public servant who worked with the National Residue Survey.
He told Four Corners that the user-pays system and resultant funding shortages bred low staff morale.
He spoke on the condition his face and voice couldn't be identified.
NATIONAL RESIDUE SURVEY SOURCE: Because of the effects of full cost recovery, the number of samples that have tested, say for residues in poultry, has reduced by half.
Er, and the number of tests for helminthics in pigs is reduced by about the same amount.
By about 50 per cent in a 10-year period.
ANDREW FOWLER: What are the residues that have been reduced --
..er, the testing that's been reduced by half in poultry?
Is this for antibiotic residues?
NATIONAL RESIDUE SURVEY SOURCE: Yeah, the residues that are being tested for in poultry, they've been reduced by half --
are antibiotic residues, yes.
ANDREW FOWLER: How significant is that?
NATIONAL RESIDUE SURVEY SOURCE: Well, it's, er -- it's significant in a public health sense.
Because reduction of this testing is -- will reach a stage where it's virtually ineffective.
ANDREW FOWLER: Government statistics confirm the decline in testing for residues under the same user-pays model being proposed for testing for VRE.
In 1989, checks for antibiotic residue were made on 1,125 poultry samples.
A decade later, the number of samples tested had fallen by half.
Isn't it true that the National Residue Service has been lobbying industry for more money for testing because there aren't sufficient funds being made available?
WARREN TRUSS: Well, the industry --
The testing arrangements have been expanded significantly.
We are conducting a whole range of tests through a whole range of industries.
Obviously, you could always do more but you have to place balances between what is reasonable, what is fair and reasonable, and what is likely to achieve significant outcomes for the Australian people.
ANDREW FOWLER: So you see nothing wrong with the people who are responsible for testing the products having to go cap in hand to the producers and asking for money to test their own products that may, in fact, lose to the -- lead to them losing money?
WARREN TRUSS: There are always negotiations that go on between the authorities as to what is an appropriate level of testing within every industry.
We have a much higher level of testing than most countries in the world.
ANDREW FOWLER: In November last year, a visiting European Union delegation issued a damning report about the way that livestock is tested in Australia.
It observed that farms were informed in advance of inspections and therefore testing was unreliable.
The EU report also noted that Australian testing wasn't independent of producers.
WARREN TRUSS: Well, each country has a right to set their own standards in relation to the food that's sold within their borders.
We do that in Australia.
We have some of the highest standards anywhere in the world.
Food sold in Australia meets our standards.
Food sold in Europeans -- in Europe has to meet their standards.
And if Australians choose to export to that country, we will meet their standards.
PETER BARTTER: We'd be happy if the government wants to spend more of their money on doing things and -- and testing and in the field.
If the industry's involved to a certain extent, I'm sure that's only there to defray some of the costs of doing these things.
But, er, you know, I know our company acts in complete integrity any time that we're asked for sampling or testing of anything.
ANDREW FOWLER: But if industry is worried about who pays, it's worth noting that outbreaks of VRE cost Australian hospitals hundreds of thousands of dollars a year in extra staff and special isolation wards to prevent the infection spreading.
If VRE becomes more prevalent in our food, doctors fear it might genetically fuse with golden staph, one of the most aggressive bacteria known to medical science.
There's already a resistant strain of golden staph called MRSA.
That doesn't pass through the food chain but if there's more VRE around the risk of a hybrid 'super super bug' also increases.
What doctors fear is that antibiotic-resistant staph itself may become completely resistant to vancomycin.
DR PETER COLLIGNON: The very people who have the serious infections with the VRE germ often also have these staph germs on them -- these MRSAs.
In the laboratory, the gene encoding for this vancomycin resistance can be transferred from the enterococcus to the golden staph, and it has also happened in experimental animal situations.
If we get a germ that is untreatable with current antibiotics, we're back in the pre-antibiotic era for that super bug.
ANDREW FOWLER: The medical profession must bear some of the blame for the rise of drug-resistant bacteria.
Overprescribing these drugs in the human community is still a huge problem.
But now the animal livestock industry is being called to account.
They've relied upon antibiotic use for a long time, and they don't like change.
DR JEFF FAIRBROTHER: Well, I suppose you can look at it pragmatically, and, you know, how long does it take for the drug resistance to build up?
Or do you just assume that every product you use is going to cause drug resistance?
And if you want to decimate the whole of the livestock industries in this country and around the world, you'd probably go along the --
..on, if you like, that purist view of the medical profession, but I would suggest to you and to the medical profession, if they got their house in order and they didn't overprescribe antibiotics the way they do, we wouldn't probably even be having this discussion.
ASSOCIATE PROFESSOR MARY BARTON: There's -- a lot of the animal industries are operating at -- at fairly marginal levels of -- of -- of -- um --
..uh -- productivity, in the sense that they make a very small margin of cents per kilo of chicken meat or pig meat or whatever it is they're producing.
We should find other ways of achieving that, not using antibiotics.
ANDREW FOWLER: It's taken almost 20 years to accept that antibiotic use in animals poses a threat to human health.
ASSOC. PROF. JOHN TURNIDGE: If we continue to use antibiotics at the levels that we're currently using them in Australia, we're going to have a lot of resistant bugs.
We're going to have a lot of sick people in hospital who have got hard-to-treat infections.
ANDREW FOWLER: After all the years you've spent as a microbiologist, is there any one thing that makes you angry?
PROFESSOR WARREN GRUBB: Probably too little too late.
ANDREW FOWLER: When you say, "Too little too late," what do you mean by that?
PROFESSOR WARREN GRUBB: I think that we should have been doing a lot more, a lot -- a long time ago to try and address this serious problem of antibiotic resistance.
ANDREW FOWLER: Many farmers fear they'll be the losers if they stop using antibiotics, that farming will become more complicated and more costly.
But what are the costs of feeding antibiotics to livestock?
For a mere 60 years, human beings have been able to fight life-threatening infections.
Now the overuse of miracle drugs threatens to destroy this profound benefit to human health.