Question Period Note: ANTIMICROBIAL RESISTANCE

Antimicrobial resistance has become a leading cause of death and has been declared a top global health threat by the World Health Organization. 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.

• The Government of Canada recognizes that antimicrobial resistance is increasing worldwide and is posing a serious and growing threat to human health, the health of animals, and their shared environment.
• We have made a commitment to work with partners to take increased and expedited action to monitor, prevent, and mitigate the serious and growing threat of AMR and preserve the effectiveness of the antimicrobials Canadians rely upon every day.
• In October 2021, the Public Health Agency of Canada created a dedicated AMR Task Force to drive progress on policies, programs and actions to combat AMR both domestically and globally.
• We have identified two main priorities that will have the greatest impact on tackling AMR: securing access to new antimicrobials for Canadians, and preserving the effectiveness of existing and new antimicrobials.
• The Government of Canada is making progress in both areas. Significant investments have been made in research in areas such as antimicrobial discovery and alternatives and diagnostics. We are also currently undertaking a comprehensive assessment of economic pull incentives for encouraging market entry and sustained market availability of high-value antimicrobials in Canada.
• In parallel to securing access to antimicrobials, we are taking steps to preserve the effectiveness of the life-saving antimicrobials we currently have.
• Through Budget 2021, the Government committed over $28 million over five years, beginning in 2021-22, to expand efforts in key areas of surveillance and monitoring, including integrating wastewater into our AMR surveillance, leveraging Canada’s success with its COVID-19 wastewater surveillance experience.
• In addition, we are using public opinion research and behavioural science to better understand what Canadians know about AMR and antimicrobial use. We will leverage surveillance data and trends to better target public awareness initiatives, and to implement successful stewardship policies and practices.The ongoing COVID-19 pandemic has taught us the importance of a responsive and prepared public health system. Investing further in antimicrobial resistance efforts now will ensure that Canada addresses this growing threat in an impactful way to better protect Canadians.

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, it is estimated that antimicrobial resistance (AMR) resulted in 5,400 deaths, $1.4 billion in healthcare system costs, and a loss of $2 billion in GDP. If current AMR trends are left unchecked, by 2050 cumulative costs could rise as high as 396,000 lives, $120 billion in healthcare costs, and $388 billion in GDP.

There is sustained momentum to address AMR through collaboration and concerted action, both domestically and globally.

Government of Canada Actions and Investments

The Government of Canada, through Budget 2021, committed $28.6 million over five years, beginning in 2021-22, with $5.7 million per year ongoing, to the Public Health Agency of Canada (PHAC), 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 AMR in Canada.

An AMR Task Force was created within PHAC to establish a clear focus for AMR work across federal departments and agencies. The AMR Task Force will spearhead and coordinate federal actions to combat AMR, as well as mobilize and collaborate with domestic and international partners and stakeholder groups to optimize the effectiveness of AMR actions.

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 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.

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 over $138 million in AMR-related research, investing $28 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 participates in international forums, such as the G7, G20, World Health Organization and United Nations to advance AMR and other priorities with like-minded partners. At the G7 Health Ministers’ call on November 17, 2021, and the G7 Finance Ministers’ call on December 13, 2021, Canada supported statements calling for efforts to promote the appropriate valuation of antimicrobials and expand consideration of options to improve the antimicrobial pipeline. At the working level, the federal government participates on numerous technical groups to address AMR and antimicrobial use issues related to human health, animal health, and food production.

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 one of the top 10 global public health issues and Canada needs to be prepared to face this threat.
• 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.
• Antimicrobials have been instrumental in medical advances and saving lives. Without effective antimicrobials, our ability to fight infectious diseases will significantly decline. Routine medical procedures such as cesarean sections and joint replacements, and even chemotherapy for cancer patients that depend on antibiotics, will become riskier for Canadians.
• A 2022 study revealed that AMR is now a leading cause of death worldwide – estimated at causing over 1.2 million deaths in 2019. The study has garnered significant media attention, ringing the alarm on the next public health threat.
• There is growing international attention on the urgent need to combat AMR. The 2022 G7 Germany Presidency identified 3 health priorities of which controlling AMR was one. Canada is lagging behind its international partners who are taking aggressive and concrete steps to address AMR. Canada tied last among G7 countries in a 2021 study on AMR Preparedness.
• Domestically, the Canadian Antimicrobial Innovation Coalition and McMaster University recently released a new report entitled, “Antibiotic access and capacity: A grassroots solution to improving patient access to novel antibiotics in Canada.” The report underscores the seriousness of AMR, its impacts on the Canadian health care system, and the need for coordinated action across multiple disciplines and sectors to improve access to antimicrobials through incentivization and regulatory changes.
• In 2018, 26% of total infections in Canada were resistant to first-line antimicrobial treatment, and an estimated 15 deaths a day were directly attributable to AMR. The economic cost of AMR is currently estimated at $2 billion and is projected to grow to $20 billion by 2050.
• Concerted action through the One Health approach that takes into account the linkages between the health of people, animals, and the environment is necessary to combat AMR.