Question Period Note: ANTIMICROBIAL RESISTANCE

Antimicrobial resistant infections are becoming more frequent and increasingly difficult to treat. Coordinated ‘One Health’ action across the human and animal health sectors and the environment is needed to address the growing threat to Canadians and our healthcare system.

Key Messages

• Our Government recognizes that antimicrobial resistance is increasing worldwide and is posing a serious and growing threat to human health, the health of animals and the environment.
• We are working across multiple jurisdictions and sectors to preserve the effectiveness of antimicrobials and limit the development and spread of antimicrobial resistance to improve health for all.
• The Government’s multi-pronged, One Health approach to antimicrobial resistance includes an emphasis on stewardship, research and innovation, surveillance, infection prevention and control, and increasing public and professional awareness to combat antimicrobial resistance.
• The Government has committed to spending $28.4 million over five years, beginning in 2021-22, with $5.7 million per year ongoing to expand efforts in key areas of surveillance and monitoring to help control antimicrobial resistance and support the appropriate use of antimicrobials in Canada.
• The Government of Canada, through the Canadian Institutes of Health Research, leads Canada’s research efforts and is a global leader in antimicrobial resistance research. Over the past five years, the Canadian Institutes of Health Research have invested $130.7 million in antimicrobial resistance-related research, investing $26.3 million in 2019-2020 alone.

The antibiotics we rely on to treat common infections are becoming less effective, resulting in serious illness and death. Already, 1 in 4 bacterial infections are resistant to the first line of antibiotic treatment. In Canada in 2018, antimicrobial resistance resulted in 5,400 deaths, $1.4 billion in healthcare system costs, and a loss of $2 billion in GDP. By 2050, cumulative costs could rise as high as 396,000 lives, $120 billion in hospital costs, and $388 billion in GDP if action is not taken.

The Council of Canadian Academies (CCA) released a report on November 12, 2019, commissioned by the Public Health Agency of Canada (PHAC), that describes the serious threat of antibiotic resistance. Already, 1 in 4 bacterial infections are resistant to the first line of antibiotic treatment, and in 2018 approximately 5,400 Canadians died from a resistant infection. If current AMR trends are left unchecked, projections of growth to 40 percent resistance by 2050 and 400,000 deaths are plausible according to the CCA.

Government of Canada Actions and Investments
The Government of Canada, through Budget 2021, committed to providing $28.4 million over five years, beginning in 2021-22, with $5.7 million per year ongoing, to the Public Health Agency of Canada, Health Canada, and the Canadian Food Inspection Agency. These investments will support efforts to prevent the inappropriate use of antimicrobials and expand efforts to monitor the emergence of antimicrobial resistance in Canada.

The Government of Canada, through the Canadian Institutes of Health Research (CIHR), leads Canada’s research efforts and is a global leader in AMR research. Over the past five years, CIHR has invested $130.7 million in AMR-related research, investing $26.3 million in 2019-2020 alone, to strengthen research in areas such as antimicrobial discovery, target identification, alternatives, diagnostics, surveillance, and stewardship.

CIHR is also a founding member and major funder of the Joint Programming Initiative on Antimicrobial Resistance (JPIAMR)—a collaboration of 28 member states aimed at coordinating research in AMR to achieve long-term reductions in resistance levels and better public health outcomes. Through CIHR, Canada is leading the development of the JPIAMR Virtual Research Institute—a global virtual network of researchers, facilities and infrastructure of AMR research.

The Government of Canada outlined its commitment to addressing AMR in the Federal Framework on AMR and its supporting Action Plan under a One Health approach. In July 2018, the first Progress Report on the Federal Action Plan was released.

Recognizing that the federal government cannot reduce the threat of AMR alone, and consistent with our international partners, the Government of Canada led efforts with provinces, territories, and stakeholders to develop the pan-Canadian AMR Framework, which was released in September 2017. Work has been underway on a pan-Canadian AMR Action Plan to identify optimal and concrete actions to address this complex issue across the human and animal health, and agri-food sectors. This work has been undertaken in consultation, and with input from provincial and territorial partners and key stakeholders. The focus by all jurisdictions in recent months on the response to the COVID-19 pandemic has slowed progress on finalizing the Action Plan. PHAC is working with federal departments, and provinces and territories to determine the way forward to ensure that governments and stakeholders can advance priority actions on AMR in the short and medium-term.

An AMR Task Force is being formed within PHAC to establish a clear focus for AMR work across federal departments and agencies. The AMR Task Force will centralise key functions such as policy development and integration. In its convenor role, the Task Force will also work to advance intergovernmental, stakeholder and international engagement to optimize governance and accountability and drive action and results.

Regulatory and Policy Changes
As of 2017, amendments were made to the Food and Drug Regulations, including policy changes under existing regulatory tools, to address gaps in the regulation of veterinary drugs to support the prudent use of medically important antimicrobials (MIAs) in animals by:
• controlling the “own use” importation of veterinary drugs
• increasing oversight on importation and quality of veterinary active pharmaceutical ingredients
• facilitating access to low risk veterinary health products, as additional tools to enhance animal health and wellness
• requiring reports of veterinary antimicrobial sales to support resistance surveillance;
• removing growth promotion claims from MIAs
• increasing veterinary oversight with prescriptions required before the sale of all MIAs

Health Canada continues to work with other federal partners to focus on enhancing animal health and wellness in order to reduce the reliance on routine use of antimicrobials in animals. In 2020, Health Canada published a risk-based approach to determine whether the availability of antimicrobials in veterinary medicine may contribute to AMR in humans (that is, whether it increases the risk that antimicrobials become ineffective in treating infections in humans).

Additionally, Health Canada maintains a Pathogens of Interest List that serves to inform companies of the bacterial pathogens in most urgent need of innovative therapeutic products in Canada. Health Canada has also sponsored a challenge under the Innovative Solutions Canada program, where up to $1 million is available to innovators and entrepreneurs to support the development of new, easy-to-use and cost effective, point-of-care diagnostic tools to help combat the rise of AMR.

Key Facts
• Antimicrobial Resistance (AMR) is characterized by a decline in the effectiveness of antimicrobial drugs in treating an infection. Resistance can develop naturally over time; however, the inappropriate use of antimicrobials in human and veterinary medicine has greatly accelerated its emergence and spread across the human, animal, food chain, and environmental interface, making it a One Health issue.
• Without effective antimicrobials, our ability to fight infectious diseases will significantly decline. For example, routine medical procedures, joint replacements and even chemotherapy for cancer patients that depend on antibiotics, will become more risky for Canadians.