Question Period Note: Antimicrobial Resistance

Antimicrobial-resistant infections are becoming more frequent and increasingly difficult to treat. The antibiotics we rely on for common infections, such as pneumonia and strep throat, are becoming less effective, resulting in serious illness and death.

The Council of Canadian Academies released a report on November 12th, commissioned by the Public Health Agency of Canada, that describes the serious threat of antibiotic resistance. Already,1 in 4 bacterial infections are resistant to the first line of antibiotic treatment and last year approximately 5,400 Canadians died from a resistant infection. Projections of growth to 40 percent resistance by 2050 and 400,000 deaths are plausible according to these experts.

• Our Government recognizes that antimicrobial resistance is a serious threat to human health and the economy.
• We are acting, both domestically and abroad, to preserve antibiotics and prevent the spread of drug resistant infections.
• Over the past 10 years, the Government has invested $203 million to support research, surveillance, awareness and education in Canada. More than $9 million has been provided to the World Health Organization to enhance global action in addressing this important issue.
• We are mobilizing Canada’s response with a pan-Canadian Action Plan on antimicrobial resistance so that action is coordinated for greatest impact. We know that federal leadership is essential to reduce antimicrobial resistance and protect the health of Canadians.

Antimicrobial Resistance (AMR) is characterized by a decline in the effectiveness of antimicrobial drugs in treating an infection. 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. It is estimated that in 2018, as a direct result of AMR, 5,400 Canadians died and there were an additional $1.4 billion in hospital costs.

Government of Canada Actions and Investments:
The Government of Canada outlined its commitment to addressing AMR in the Federal Framework on AMR and its supporting Action Plan. In July 2018, the first Progress Report on the Federal Action Plan was released and can be found at Canada.ca.

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 external stakeholders to develop the pan-Canadian AMR Framework, which was released in September 2017. Work is currently underway on a pan-Canadian AMR Action Plan that will identify concrete actions, to address this complex issue across the human, animal health, and agrifood sector. It is being developed in consultation and with input from all partners. Its release is planned for 2020.

The Government of Canada is taking action to address AMR by:
- Strengthening surveillance systems to help indentify new threats or changing patterns of AMR in humans and animals;
- Strengthening the stewardship of antimicrobials in human and veterinary medicine, as well as regulatory and policy changes governing human and veterinary drugs;
- Collaborating with national and international partners to advance policy, research and innovation in both Canada and abroad, including research on diagnostics, new antimicrobials and alternatives to the use of antimicrobials in human and veterinary medicine.

The Government of Canada has invested a total of $203 million in the past 10 years to support domestic action on AMR. More specifically,
- The Public Health Agency of Canada has invested approximately $50 million on AMR policy leadership, surveillance and stewardship over 10 years;
- The Canadian Institutes of Health Research has invested $115 million in AMR research over the past 5 years and participates in an international partnership under the Joint Programming Initiative on Antimicrobial Resistance;
- Agriculture and Agri-Food Canada has invested more than $37 million over the last 10 years to support industry-led research initiatives to accelerate the pace of innovation and address some of the AMR challenges in agriculture;
- Between 2014-15 and 2018-19, the Canadian Institutes of Health Research (CIHR) invested over $125 million to strengthen research in areas such as antimicrobial discovery, target identification, alternatives, diagnostics, surveillance, and stewardship.

Regulatory and Policy Changes:
In May 2017, amendments to the Food and Drug Regulations related to AMR in the veterinary drug context were published in Canada Gazette, Part II. These new regulations are aimed at increasing antimicrobial stewardship and promoting the prudent use of medically important antimicrobials (MIAs) in animals by:
• Collecting antimicrobial sales information;
o The data collection system has been implemented and the first year of data have been received and are being analyzed.
• Increasing the oversight of active pharmaceutical ingredients for veterinary use;
• Controlling the “own use” importation of veterinary drugs and;
• Facilitating access to low risk veterinary health products in order to increase animal health and welfare;
In support of these regulations, Health Canada has also undertaken complementary measures, which include:
• Removing growth promotion claims from MIA labels; and,
• Requiring all MIAs for animals be sold pursuant to a prescription from a veterinarian.

Health Canada requires AMR stewardship statements in the labelling of all antibiotics for human use to help increase awareness and encourage prudent use. Additionally, Health Canada released a Pathogens of Interest List that will help 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 $1M 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.

International Activities:
In May 2015, the World Health Organization’s (WHO) member states, including Canada, endorsed the WHO Global Action Plan on AMR, which calls on countries to develop multisectoral national action plans to address AMR. Canada supports the ongoing collaborative leadership of the WHO, the World Organization for Animal Health, and the Food and Agriculture Organization of the United Nations, via a One Health approach, to address AMR.

At the United Nations General Assembly high-level meeting on AMR in September 2016, world leaders endorsed a political declaration that recognized the need for stronger surveillance systems, strengthened regulation of antimicrobials, improved awareness, and innovative alternative treatments and diagnostics.

In 2017, the Government of Canada also made a one-time investment of more than $9 million to support the World Health Organization’s Global Action Plan on AMR. This initiative aims to ensure, for as long as possible, continuity of successful treatment and prevention of infectious diseases with effective and safe medicines that are quality-assured, used in a responsible way, and accessible to all who need them.

Parliamentary Business:
The Standing Committee on Health (HESA) tabled their 16th Report entitled: A Study on the Status of Antimicrobial Resistance in Canada and Related Recommendations on May 1, 2018. The Government Response to the Committee’s report was tabled on July 18, 2018 and is available on-line at the House of Commons website.

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