Welcome, ladies and gentlemen, to the Standing Committee on Health, meeting number 54.
Pursuant to Standing Order 108(2), we are studying antibiotics and livestock.
We have witnesses here today. The witnesses from the Canadian Animal Health Institute are Jean Szkotnicki, president, and Dr. John Prescott. From the Canadian Cattlemen's Association we have John Masswohl, director, and Dr. Reynold Bergen. From the Canadian Pork Council we have Dawn Lawrence, national coordinator. From the Chicken Farmers of Canada we have Mike Dungate and Dr. Leigh Rosengren. From Environmental Defence we have Rick Smith, executive director. And from Pew Charitable Trusts we have Dr. Gail Hansen.
We will allow each organization about a five-minute opening session before the questions.
We will begin with the Canadian Animal Health Institute.
Chair, committee members, and guests, I am pleased to be here today representing the companies that manufacture and distribute animal medications.
Animal medications are intended to keep animals healthy, and they have a secondary role in limiting human exposure to zoonotic diseases, diseases that can be transferred from animals to humans. Many of the companies I represent have a human side to their business, so it goes without question that while our members want the medications they develop to remain effective for a long time, they also do not want to develop antimicrobials that would compromise or jeopardize the effectiveness of the animal medications that they develop for the human side of the industry.
Joining me here today is Dr. John Prescott, a professor of pathobiology at the Ontario Veterinary College in Guelph, Ontario. He joins me since he's an expert in the area of bacteriology and will address any technical questions arising from the committee members. He certainly has had a long-term interest in this area, and he has been a part of many of the discussions that have occurred here in Canada and internationally for many years.
Topics that I will be discussing include the role of the veterinary drugs directorate, a division of Health Canada, in doing pre-market assessment of our products; and post-marketing controls by veterinarians in the veterinary drugs directorate of the Canadian Public Health Agency as well as by the Canadian Food Inspection Agency. I will also talk about the size of the animal health industry and about agriculture's contribution to resistance.
One control I won't be talking about is producer quality assurance programs, the farm-to-fork programs, because I know my colleagues around the table will be discussing those.
VDD, within Health Canada, has pre-marketing controls over the antimicrobials sold in Canada for use in companion and production animals. The VDD review process involves examination of every aspect of a drug from human and animal safety to trials demonstrating a drug's quality and efficacy.
In my formal brief you can see a diagram that briefly outlines the review process. I want to draw your attention to the fact that it's thorough and stringent, and the important part of the review is the human safety component, which ensures that no harmful residues of drugs enter the food chain. There is also an assessment of the potential impact of resistant bacteria being ingested by humans from animal products because of the use of antimicrobials in food-animal production. There is a difference between residues and residue avoidance in antimicrobial resistance.
VDD approves drugs for four uses: the treatment of animals infected with disease, the prevention of disease within herds and flocks, the control of diseases in the case of outbreaks within a herd or flock, and, lastly, the enhancement of growth and feed efficiency.
Many think that in-feed use is equivalent to growth promotion. That is really not the case. It confuses a drug's use with its route of administration. All four uses, including therapeutic use, can be administered via feed or water, and this in many cases is the only practical way to administer medication to large herds and flocks.
The VDD regulates every aspect of labelling, including the species it is intended for, the use, the dosage, and the warnings and cautions. Extra label provisions do exist for the use of antimicrobials whereby the veterinarian directs the use of a medication under the situation of having a valid veterinary client-patient relationship.
Post-marketing controls also exist beyond the VDD. Veterinarian-directed use of antimicrobials is a fact of life, and most new antimicrobials are prescription. Due to concerns about antimicrobial resistance, I would point out that the Canadian Veterinary Medical Association has developed prudent-use guidelines for the use of antimicrobials in food-animal medicine. It is very much a concern of the veterinary profession. The monitoring for adverse events is an ongoing effort of the veterinary drugs directorate within Health Canada.
The public health agency looks toward evaluating trends on the use of medication and for resistance trends in food, animals, and humans. Last, CFIA tests to ensure no harmful residues enter the food chain.
I just wanted to point out that we have limited growth in the animal health industry. There was a 1.1% increase in the total kilograms of active antimicrobials distributed from 2008 to 2009 by our members. Total sales of medications in 2009 amounted to $590 million, and that compares to $21 billion on the human side. Meanwhile, growth on the human side has doubled from 2000 to 2009. That's in sales.
There's no question that antimicrobial resistance is a serious public health threat. It is a complex matter, with no one solution. A 2000 survey published by a group of medical experts estimated that the animal contribution to overall human resistance problems is less than 4%. That small proportion was attributed to the transfer of resistant bacteria from food to humans following use of antimicrobials in food animal production. In my presentation I outlined the chain of events that would have to be traversed by bacteria to move from animals to humans.
In closing, the animal health industry and animal agriculture, along with the veterinary profession, take the issue of antimicrobial resistance very seriously. Discussions on the issue have been occurring within the sector for decades, and measures have been taken to drive prudent and judicious use of antimicrobials.
I won't say too much, but I will draw the attention of the committee to the 2002 Health Canada report called Uses of Antimicrobials in Food Animals in Canada: Impact on Resistance and Human Health. This was an absolutely outstanding report, which involved considerable work and effort from many people across the country. It made 38 recommendations, including the establishment of CCARs, Canadian Committee on Antimicrobial Resistance. Most of the recommendations have not been acted on. These recommendations included key things like making antibiotics veterinary prescription only, getting rid of own-use and active pharmaceutical ingredient importation issues, prohibiting extra-label use of antibiotics for certain important public health issues, and so on.
I certainly think it would be of great interest to look again at those recommendations, because I think we can improve how we use antibiotics in animals to try to establish national priorities and put one person in charge of the issue of antibiotic resistance in animals and its relationship to humans, as well as antibiotic resistance in human pathogens generally.
Currently, I think nobody in the federal government is in charge, just the resistant bacteria.
Thank you, Mr. Chairman, and thank you for that accommodation.
Thank you, members of the committee, for allowing Chicken Farmers of Canada to present before you today on judicious use of antibiotics in livestock production.
Chicken Farmers of Canada is a national organization that represents the 2,800 chicken farmers in Canada and the Canadian chicken industry. I'm joined today by Dr. Leigh Rosengren. She is an independent veterinary epidemiologist with ten years of experience. She has worked for governments and industry on these issues of research and issues of antibiotic resistance.
I'm going to focus my comments today. You have our submission, but I'm going to focus down on five key points: some misconceptions that are out there with antibiotic use; CFC's support for government regulation and monitoring; CFC's support for judicious use of antibiotics; an outline of the five-point plan we follow in terms of addressing antimicrobial use and resistance; and finally a couple of recommendations, if I might, for the committee.
Before I move on to our policies, I think it's important that we address the elephant in the room, as it were: a CBC Marketplace episode that aired recently, which was designed by its nature to be sensationalistic. However, as such it painted an inaccurate and incomplete picture of the Canadian chicken industry, production, and antibiotic use and resistance. It certainly did not provide a factual or a scientific basis from which government can or should derive policy or options.
I just want to give you a couple of examples. While it was not expressly stated, viewers were left with the impression that the cases presented in the show of human antibiotic resistance were the result of eating chicken. No connection was made, and there is no connection there.
Second, viewers were left with the impression that all antibiotic resistance found in chickens is because of antibiotic use at the farm. As was stated by my colleagues, this is a complex area. Bacteria are endemic, and there are numerous sources. The CBC test results found resistance to antibiotics that are not used in poultry production in Canada. They found resistance to more antibiotics than would be given to a chicken flock. They reported on resistances to antibiotics that have nothing to do with drug use. For example, salmonella and e.coli have a natural resistance with erythromycin, when that drug was never designed for that use, and would never be prescribed for that use.
Third, contrary to what was repeated on the show, the government does have control over antibiotic approvals, it does have control over monitoring and use, and the chicken industry does report on the use of antibiotics.
These examples, and there are more, describe how the episode was misleading and shouldn't be the basis for government policy going forward.
In terms of government regulations, my colleagues here have already outlined the approval processes of Health Canada, the veterinary drugs directorate, and CFIA, so I won't go into that further. It's important, however, to note that all chicken farmers are required by federal regulation to report on the use of antibiotics before the flock is sent to a processing plant. CFIA veterinarians verify these reports and determine that antibiotics are used properly. Any chicken failing this investigation is not allowed to enter the food system.
Taking a further step, Canada has a leading edge surveillance program in the Public Health Agency of Canada's CIPARS, which is internationally respected and is an important component in government oversight and in developing public policy.
On judicious use, CFC has a clear policy. We approve judicious use of antibiotics that have been approved by Health Canada. Antibiotic use in chicken is for the treatment of birds to prevent disease and to prevent potential food safety problems. Antibiotics play a key role in ensuring that only healthy birds enter the food chain for consumption.
Antibiotics are a critical issue for us in terms of consumer trust. Without consumer trust, we don't have an industry. So anything but judicious use would be unacceptable.
I think it's also important to note that a significant amount of the drugs we use on a preventative basis are what are called class 4 drugs, or ionophores, and they are the types of drugs that are of little importance for human medicine. They are the preferred antibiotics we want to move to in terms of ensuring we are keeping those antibiotics that are of importance for human medicine and their efficacy in place.
In terms of the five-point plan that CFC has put in place, we have an on-farm food safety program where all farms have to report mandatory recording and reporting. This is in addition to what they have to provide to the CFIA veterinarian. They are audited on an annual basis. We have 97% of the farms in Canada certified on this program.
Second, we are working with CIPARS on surveillance. We've designed an on-farm surveillance program. Right now there's only on-farm surveillance in hogs and in cattle. We would like to see that extended to the farm level on poultry and we would look for that to be done. We're not waiting for that to be done. We've done some research with the University of Guelph in order to do a pre-pilot project.
Third, we are actively funding research. We've spent almost $5.1 million over the last several years in terms of research into probiotics, developing vaccines, and alternatives.
Thank you again for the accommodation earlier, and thank you for the invitation to appear and present before the committee. The Canadian Cattlemen's Association is always willing to appear before members and provide information on various things that are going on in our industry.
I'm going to make a few brief comments, but since I'm not a scientist myself, to the extent that we can keep the subject matter today focused on science, our comments will come primarily from our science director, Dr. Reynold Bergen.
While I'm not a scientist, like members of Parliament, I spent a lot of my time trying to distill various pieces of technical information into good policy. I hope that is the spirit of what we're trying to do here today.
As we do that, I think we can all be assured that food safety is something that cattle producers take very seriously. We're keenly aware that consumers insist that the food they eat be safe. They're purchasing it to feed to their families, to their children, and they have every right to expect that it be safe.
Canadian cattle producers are committed to ensuring that the beef they produce is safe for all consumers, and indeed we are feeding our own families. I have a 14-year-old daughter and a 12-year-old son of my own. You can believe that we eat our share of beef in our house. I have complete confidence in the safety of the beef that I put on my own dining room table.
It's also important to recognize that beef production in Canada operates in a competitive environment. Beef purchasers in both the Canadian and the export markets make buying decisions based on a number of factors. Our daily challenge is to ensure that those consumers have confidence that what we produce is safe and that we produce it at a competitive price.
Over-regulation is a disservice to both the consuming public and to the hard-working people who produce the food. Having the right policies and regulatory operating environment in place is the first step. Ensuring that cattle producers are well trained to follow those policies and adopt good practices is the next step. For that reason, we've developed an extensive on-farm food safety program. We call it verified beef production. Under that program we provide training to producers so that they have all the latest knowledge to produce wholesome and healthy beef.
I'm going to turn it over to Dr. Bergen to speak specifically to the anti-microbial issues, but I would also note that we have Ms. Terry Grajczyk in the room as well. Terry is our national manager for the verified beef production program that I mentioned.
Thank for the invitation to come here today.
I couldn't agree more with John's introductory comments and those of the previous speakers that producing safe and nutritious food is the most important thing that Canada's cattle producers do.
It was pointed out earlier, but I'll repeat it: livestock producers and cattle producers use antimicrobial products very strategically.
Ionophores are the main antimicrobial that the beef industry uses. Ionophores are not used in human medicine at all. As a result of that, eliminating the use of ionophores in beef production would not halt or slow the development of antimicrobial resistance and would not contribute to our goal of producing safe and nutritious food.
With this in mind, the CCA developed the verified beef production program to uphold consumer confidence in Canadian beef. This is a HACCP-based on-farm food safety program, and it has received technical approval from the Canadian Food Inspection Agency.
VBP promotes prudent use of veterinary products so that the right product is used to treat the right disease or condition at the right dose, following the right administration route, following the right course of treatment and the correct withdrawal times, and ensuring that leftover product, containers, and what not are disposed of properly.
Finally, one of the most important steps is documenting that all of these steps were actually followed for every animal that was treated. Following label or veterinary instructions regarding the use of these antimicrobials is an important safeguard against the development of antimicrobial resistance.
Preventing antimicrobial resistance is also important to Canada's cattle producers, simply because we want to make sure that these antimicrobials continue to be effective. When antimicrobial resistance develops, the product isn't effective any more. Losing the effectiveness of those tools is something we can't afford to have happen.
Producers use these antimicrobials in a targeted manner because they're costly and also because they need these products to be effective. Cattle feeders use sophisticated and quite often computerized animal health management software systems under the direction of, or in conjunction with, specialized veterinarians.
The dosing systems that are used are accurate to the millimetre and dosages are based on individual animal weight, so the individual animal is getting the right dose of antimicrobial that it needs to address the situation.
I would like to thank you for the invitation to appear this afternoon.
The Canadian Pork Council is a national association representing the interests of Canada's 7,000 hog producers. The Canadian pork industry recognizes the vital importance of using practices that promote the health and well-being of the animals under its care and, through this, the safety of pork.
To support this commitment to food safety, the Canadian Pork Council launched the CQA program in 1998, an on-farm food safety program based upon the principles of HACCP and designed to assist producers in the development of production protocols to address potential food safety risks that could be introduced at the farm.
The use of medications is an important area of potential risk at the farm level. As such, a significant part of the CQA program addresses the use of these products. The program also includes a specific drug use policy requiring that only products approved for use in food-producing animals in Canada may be used.
Producers are required to have a veterinary prescription for all schedule F, part 1 prescription drugs, for extra-label use of any product used in that manner, and they are encouraged to consult with a veterinarian for all other medication use. Any other medication use would fall under the over-the-counter products. These requirements are to ensure that medications are being used effectively to manage herd health.
Additionally, producers are required to develop a medication and vaccine usage plan and maintain treatment records. Each of these items is included in the audit of the on-farm food safety program.
Canadian livestock producers have available to them a toolbox of items that allow them to care for the animals they raise. Like other skilled tradesmen, producers are committed to proper use and maintenance of their tools, thus ensuring that they continue to be useful for years to come.
Producers are responsible for growing a healthy pig destined for the food chain, but they also rely on the expertise of veterinarians for support and education and upon the veterinary drugs directorate and Canadian Food Inspection Agency to ensure correct approval and oversight procedures for medications included in their toolbox.
On-farm food safety programs, like CQA and the others mentioned here this afternoon, provide producers with support in the form of educational tools. They require consultation with a veterinarian on the use of medications and require a regular audit process. The CQA program requires an annual on-farm audit, during which the producer's on-farm food safety system is evaluated by an outside party. The program itself has been reviewed for technical soundness by the Canadian Food Inspection Agency, and the Canadian Pork Council works with the CFIA and Health Canada on many issues, including the use of antibiotics.
Antimicrobials are an invaluable tool in the maintenance of animal health. At the same time, they are a concern in that they can contribute to the development of antimicrobial resistance. The focus of our industry is on using these products prudently.
As of 2009, approximately 94% of Canadian market hogs were sourced from CQA-registered farms. The high participation rate is a result of Canadian processors making it a requirement for producers shipping to their facilities to be on the CQA program. The program has become a condition of sale to most processing plants and an integral part of the industry commitment to quality and safety.
I will be speaking in English, but I will be happy to answer any questions in French.
Thank you not only for inviting me but for taking the time to study this important issue.
My name is Rick Smith. I'm the executive director of Environmental Defence. I have a PhD in biology.
We're a non-partisan environmental organization that focuses on human health. It's been our pleasure to work with all parties in this Parliament to move forward some highly significant decisions to protect Canadian consumers, decisions like the ban on bisphenol A in baby bottles, an international best practice now emulated by the European Union; the recent announcements that Canada would be matching U.S. and European standards to get toxic phthalates out of kids' toys and to get toxic flame retardants out of consumer electronics; and of course, in the last couple of months, the unanimous adoption by the House of Commons of a modernized Consumer Product Safety Act, finally making Canadian consumer product standards comparable to those in the European Union and in other jurisdictions.
All these were positive steps forward. I would submit that they were no-brainers in terms of good public policy. They were certainly squarely in the interests of Canadian consumers, and they were all supported by all parties in this Parliament.
I think the matter before you today is in this same vein. At least I hope it is.
I'd like to make two points today. The first is that the routine and unregulated use of antibiotics as a growth promotant in agriculture is harming human health and safety. The second is that, just as has happened in Canada over the past few years with respect to the decisions I just mentioned, Canadians surely have the right to expect improvements in the regulation of antibiotics similar to what has already occurred in Europe.
If we go back just a few years, of course routinely treated bacterial infections killed people until the 1950s, when modern antibiotics started to be used. They are an indispensable pillar of today's health system, but without action from the federal government we risk morphing today's annoying ailments back into yesterday's life-threatening risks. The reason is simple: we use too many antibiotics we don't need. This overuse of antibiotics is making bacteria stronger and giving rise to superbugs that our antibiotics can't kill.
When people use antibiotics, a physician must prescribe them, but this is not the case when used on animals, which consume most of the antibiotics in meat- and poultry-producing countries like ours. I want to be really clear here. What we object to, and what I think Canadians have a right to expect their federal government to get a better handle on, is not the use of antibiotics to treat sick animals. We don't object to this. Clearly, this is a reasonable thing to do. What needs to change is the widespread and unregulated use of antibiotics on healthy animals to promote their growth. Canada urgently needs stricter regulations around this practice, especially when some of these same antibiotics are so crucial for use in human medicine.
Environmental Defence has been tracking the issue of superbugs for some time. Most recently our concern was piqued after the CBC TV 's Marketplace tested chicken from supermarkets in Montreal, Toronto, and Vancouver. Alarmingly, CBC found antibiotic-resistant bacteria in two-thirds of the chicken it sampled.
Since the 1960s we've known that the overuse of common medicines can create uncommon bacteria. For example, the Canadian Medical Association Journal called antibiotic-resistant superbugs "one of the most significant public health issues facing Canada and the world today". So this fact is not in dispute. Governments of all political stripes throughout the world agree, and around the world researchers are developing newer, more expensive, and more powerful antibiotics to fight the superbugs.
Yet as governments, including Canada's, continue to educate doctors and patients about the dire risks that overusing antibiotics creates, the biggest users of antibiotics—animals—are largely let off the hook. Here is an astonishing statistic I want to leave with you. In the United States, it is estimated that 75% of all antibiotics used are not used on people; they're used on animals. In Australia, this statistic is 56%.
It's disturbing that the Canadian public doesn't know with any precision what the similar statistic would be for Canada. And the reason for this is you don't need a prescription and you don't need oversight by veterinarians. The industry is largely free to shovel as many antibiotics as it likes into animal feed.
And this is not a small industry. About 20 animals are slaughtered each year--
Thank you, Mr. Chair and members of the committee.
Good afternoon, and thank you for inviting me.
My name is Gail Hansen. I'm a public health veterinarian and I'm a senior officer with The Pew Charitable Trusts.
I have worked on antimicrobial resistance issues from a lot of different perspectives for over 30 years. I was a state public health veterinarian and epidemiologist with the Kansas Department of Health and Environment, and with a local health department. Before that, I was in private veterinary practice. And before that--actually before I got into veterinary school--I actually worked for the U.S. Food and Drug Administration for a short time when they were first looking at eliminating antibiotics from animal feeds as growth promotants.
The Pew human health and industrial farming section partners with public health leaders, with other veterinarians, with agricultural interests, and with consumer groups to preserve the effectiveness of antibiotics by phasing out the overuse of the drugs in food animal production.
Antibiotic resistance from feeding low levels of antibiotics to animals is real and is here, as you've heard. Antibiotics are legally available and they're readily available over the counter and are fed to healthy animals. These are the same drugs that are used in human medicine to fight disease. The antibiotic use in food animals in the United States and Canada is very similar, as is the lack of monitoring the use of other drugs and the reporting of the drugs.
It's also very similar that we are seeing an upward trend in antibiotic resistance in bacteria both in animals and in people, and we are seeing that all over the world. And there is an upward trend in the number of bacteria that are becoming resistant to the antibiotics we have on hand.
The CBC report from last month that found bacteria in about three-quarters of the tested chickens, and all the bacteria being resistant to at least one antibiotic and several of them being resistant to multiple antibiotics was not a surprise to me. In the United States, certainly in 2008, nearly all of the chicken that was tested was contaminated with at least one bacteria. And if one of the bacteria is a salmonella, which we find in about half of our chickens, 38% of those salmonellae are resistant to three or more antibiotics.
So it's not really an overstatement to say that antibiotics are overused in industrial farming to the detriment of human health. Animals are fed low levels of antibiotics for growth promotion and in the absence of disease. This is to compensate for some of the overcrowded and sometimes unsanitary conditions and is used as a fix for good practices. And when bacteria come in contact with low levels of antibiotics, it makes it easier for them to become resistant to antibiotics, the “what doesn't kill you makes you stronger” kind of thing. That resistance gets transferred to people. Ultimately, then, the antibiotics we've used to treat disease don't work for animals or for people.
The CIPARS, the Canadian Integrated Program for Antimicrobial Resistance Surveillance, published in 2010, in a peer-reviewed journal, that they found a rise in ceftiofur resistance in a common salmonella in both chickens and people. Ceftiofur is an antibiotic that's routinely injected into chicken eggs just before they're hatched. That drug, ceftiofur, is nearly identical to ceftriaxone, a drug used to treat children and pregnant women.
In Quebec the hatcheries voluntarily stopped that practice, and when they stopped injecting the ceftiofur they saw a great drop in the resistance of salmonella to ceftiofur, both in chickens and in humans. When they lifted that ban a little bit, again they started to see a rise in the antibiotic resistance in people and in chickens.
The WHO has looked at fluoroquinolones, which is another antibiotic. You may know it as Cipro. When it was first licensed for human therapy, there was no immediate rise in salmonella resistance seen. But then when the Cipro, or fluoroquinolones, were licensed for use in food animals, the rates of fluoroquinolone-resistant salmonella went up both in animals and in humans.
The good news is that we do have effective alternatives to using a low level of antibiotics for farmers and ranchers. The EU has banned the use of antibiotics as growth promoters in meat and poultry since 2006. And the ban on the antibiotics as growth promoters was followed in subsequent years by substantial decreases in food-borne illness in Europe.
It would seem to me that Canadians deserve the same, and you can do it if you follow the EU's lead, it would seem.
In Denmark they have industrial farms that are very able to efficiently raise pork and poultry without the use of antibiotics except when the animals are sick. The farmers give antibiotics when they're prescribed by a veterinarian for a specific disease only. They found that if they just banned the use of antibiotics for these non-therapeutic uses, it wasn't enough. They had to really work with their veterinarians and others to find some other effective management strategies.
This is a very opportune time, because the WHO has declared April 7, 2011, as World Health Day. The focus this year is on antimicrobial resistance, in an effort to safeguard antibiotics for future generations.
The U.S. Food and Drug Administration has announced that it will take two significant steps this year to curb the overuse of antibiotics in our food production. First, the FDA is preparing guidance that we're hoping will advise the industry to not use antibiotics for growth promotion and other non-therapeutic purposes, and to not feed antibiotics to healthy animals. Second, the agency is looking at implementing a ban on the off-label use of a drug called ceftiofur in animals. That drug is vital in treating pregnant women, children, and cancer patients. We can't lose the ability of antibiotics to treat us when we're sick, and certainly not because we're feeding them to healthy animals.
Thank you. I'm open for questions.
I'll attempt to address your questions as best as possible.
It's not a simple question to stop using antibiotics inappropriately, because it's a very grey and complex area.
Dr. Hansen raised two key issues. One was the use of ceftiofur, and the second was the use of growth-promoting drugs. Those are two opposite spectrum issues. One is the use of a class I drug that's classified as critically important for human medicine. It is used in the chicken industry strategically for one particular issue, which is omphalophlebitis in young day-old chicks. The other is an issue of using drugs that are unimportant to human medicine, or class IV drugs, to prevent subclinical disease from becoming clinical.
So your question is very complex, because it deals with a myriad of issues to stop using antimicrobials in these instances.
I apologize if I appeared to disagree with Dr. Hansen.
The EU model has been successful for the countries in the European Union, but we have had very different legislation on veterinary antimicrobials in our country, in North America, dating way back to the 1970s. It's not as if you can cut and paste the legislation that they have. We have a completely different system.
The reason we appear to disagree is that antimicrobial resistance is an extremely complex issue. We're talking about multiple commodities; and within each commodity, multiple bacteria species; and within each of those bacteria species, multiple resistance concerns driven by multiple drugs. It's easy to get lost in the details and draw on something that's a success, or dismiss something else as a failure.
Overall, it's a flawed experiment because there's no control to the situation. We don't know where the situation would have been without the withdrawal of the growth-promoting drugs, and we haven't done a very good job of measuring the farm-level drug use and correlating that all the way through to the clinical instance of disease in people.
I happen to have the Denmark map report for 2009. I'm reading right from the document, so this is the Danish experience. It says that for production animals in general, the consumption of antimicrobial agents has increased by 59% from 2000 to 2009, mainly because of an increase in consumption of antimicrobials in pork production.
That's the removal of the growth-promoters. It required that additional drugs be used to treat animals therapeutically, because they were getting sicknesses. It's a complex issue. By removing some of the products from production, you don't necessarily eliminate use—in fact you may increase it.
Time will tell, as Dr. Hansen was saying. Certainly the resistance in humans hasn't been affected in the Danish experience, from what I understand. Yes, there's been a reduction in the animal population, but one would expect that when the use has been reduced. But did it change in the human population? After all, that's what these bans have been about, to get outcomes relevant to the treatment of humans.
Thank you very much, Mr. Chair.
I want to thank everyone for coming.
I find the discussion we're having this afternoon quite interesting. I think everybody would like to see a reasonable use of antibiotics, but I think it's important, at least for me, not to confuse the issues. I think there is still a little confusion around the table, and I want to clear something up.
I have a question for Mr. Dungate. Madam Hansen had a comment that was concerning to me: it was like feeding children antibiotics in their cereal to prevent kids getting sick. I think the analogy is that this is what we're doing when we feed livestock preventative antibiotics.
I was listening to what you said in response to Mr. Dosanjh. My understanding is that if you use fewer preventative antibiotics, what you call ionophores, you could potentially get increased disease in the flock. Then you would have to use more of the antibiotics that you would use in humans, which may lead to an increased resistance.
Is that what you said earlier? Was I understanding it?
Disease in a flock—we're talking about population medicine, not individual animal medicine here—is like a scale, from white to black with every shade of grey. In these flocks we don't have healthy and unhealthy, we have every spectrum in between.
If we wait until birds are clinically ill, those birds are spreading pathogens into the barn and we get a cycling and an amplification. It's like an avalanche effect. By using antimicrobials prudently and early, on a flock basis we can prevent that disease from rising.
I'd like to go back to Ms. Hansen's point about the European Union experience. You're right that they were very successful in raising livestock without growth promotional antibiotics. I concur with that point. What they have not been successful in doing is raising livestock without antibiotics.
They have removed those growth promotional antibiotics, and they've had to go to the higher-powered therapeutic drugs that are important in humans. I guess that goes back to Mr. Smith's point, with which I completely concur. I don't think we should be willy-nilly using these very important antibiotics either. That's why it's very important to maintain our available repertoire of antibiotics for the judicious use by veterinarians.
Thank you to all the witnesses.
I'm going to begin by asking for a number of you to table some information with the committee, if you'd be so willing.
First, I would ask the various animal organizations to table the number of animals that have actually been removed from the system for inappropriate antibiotic use.
Second, I'd like to know how each of you defines “judicious”. That's a very loose term. I'd like to know what that actually means in terms of dosage, usage, etc.
Third, how many pounds of antibiotics are given to livestock? I know people didn't want to go into pounds, but I'm going to ask it anyhow. How many pounds are given to livestock per year, and what percentage of that is given to treat disease? In the U.S. I believe the figures are 25 million pounds of antibiotics given to livestock and three million pounds given to treat disease.
The last request is for Dr. Hansen and Dr. Prescott if they would be so willing. Dr. Prescott, you talked about the 2002 report. You thought it was a very good report, but you said a number of those recommendations had not been followed up on. So I would like to know which of those recommendations have been completed and which have not.
Now I will ask some questions, if I may.
I think it's been brought up that the U.S. FDA released draft guidelines in June on the judicious use of medically important antimicrobial drugs. Has Canada undertaken a similar study since 2002 or produced draft guidelines?
I thank everybody for coming here today. This is a great discussion.
I don't think there's one Canadian in Canada who isn't concerned about the improper use of any type of antibiotic or drugs in that case. This is a good discussion to have.
At first glance, when you look at it you think, “Oh my God, this is horrible”, but when you actually start to dig down and see exactly what's going on, it's an example of there being a lot more to the story than just the headline.
I'll start with you, Mr. Dungate.
The chicken industry is using antibiotics that are not being used in the human chain. I'll use that expression—maybe it's not correct, but as a farmer from Saskatchewan, I'll use those words. In the process of putting the antibiotics in the feed, you are actually using antibiotics that would not normally be used in a hospital or that type of situation. Is that fair to say?
Thank you for your questions, Mr. Malo.
We have invested $5.1 million in the poultry industry, with all of this money going to research into antibiotic resistance and alternative solutions. Real discussions are underway.
I'm going to switch to the other language, because this is too technical.
It's gut microbiology, and to understand what is going on inside the bird so we can create healthy bacteria alternatives and treat it that way. Those are called probiotics. So there's a lot of investigation there.
In our submission we have included a list of the projects that have been funded with that $5.1 million, and it's ongoing. We're just starting to see the results of that research coming in. Many of them are three- or five-year projects.
Thank you all for being here this afternoon.
I certainly listened with interest to each of your presentations and found them very interesting. I was glad to hear you confirm that the CBC Marketplace episode was in great proportion misleading and sensational. I happened to watch that, and after I watched it I thought, is this really true, or is this just something we're kind of pretending?
I do have some questions. We know that when antibiotics are used in humans, it's solely for the treatment of a bacterial infection, while antibiotics are often included in animal feed to promote growth. Health Canada has approved a number of antibiotics for growth improvement in livestock. I'm wondering how long this practice has been in place.
I'll start answering your question by taking a shot at the first one that was addressed to me 15 minutes ago, and hopefully my response to yours won't take as long to formulate.
Part of the reason it took me so long to come up with an answer is that I'm still wracking my brain trying to figure out what sort of disease my five-year-old or seven-year-old daughter would get that I would use ionophores to treat. The drugs that are used in beef cattle for the promotion of growth and feed efficiency are ionophores and they are not used in human medicine at all.
I think that's a really important point to keep in mind, that removing this tool from the livestock industry, whether it's cattle or dairy or chickens or pigs, is not going to benefit human health at all, and it will negatively impact producers and it will impact society as a whole. Because when you're improving feed efficiency, what it means is that you're using less feed to produce the same amount of meat. So it's resource efficiency.
Now, what was your question? How long have ionophores been used? Decades.
But there was another question that I thought I'd have a go at.
How do they help the industry? I'll speak to the ionophores.
There are really the two points that have been brought up, and one is that if we keep animals healthier by using drugs like ionophores, we're using drugs that are of zero importance or very low importance in human medicine. If we can use those tools to keep animals from getting sick to begin with, that means fewer animals get sick, fewer animals get really sick, and fewer animals get really, really sick, which means we don't need to use the high-powered drugs to fix them. That's one benefit to the industry.
The other benefit is in terms of the growth promotion and feed efficiency. It allows us to use our feed resources more efficiently. We can get more pounds of beef out of the same clump of hay and grain than we could without using it. In terms of the ionophores, there is a health benefit there in terms of preventing coccidiosis, which is a good disease issue for cattle and all livestock, I believe.
But then one of the real interesting ones with the ionophores--I hope I don't get too nerdy here--is that the way these things work is they promote the growth of bacteria that produce a molecule called propionate, which is used more efficiently in the animal's metabolism. So I'm not going to go any further into that.
One of the classes of bacteria that the ionophores inhibit is a group called methanogens, which is really interesting, because they're the ones that produce methane. So by feeding ionophores, we are improving feed efficiency. We're having absolutely zero impact on human health and there's actually the side environmental benefit in terms of greenhouse gas, in addition to the fact that we're using fewer resources to produce beef.
I'll be brief. Just to point out the obvious, the implication of my industry colleague's comments is that the situation is terribly complicated but that largely it's working.
I would just point out ways in which it's clearly not working. The first is simple transparency. If none of this is a problem, then why isn't the amount of antibiotic used in the livestock industry in Canada clearly available to the Canadian public? It is not, at the moment.
Second, if the situation is working, then how do you explain the situation of specific drugs, such as ceftiofur, which is administered willy-nilly to chicken eggs, which is important to human moms and kids? We have a study from Quebec showing a very tight correlation between ceftiofur use and bacterial resistance in people--not in food but in people.
This is kind of topical and timely in terms of our discussion of it, because since that CBC documentary, our office has actually been flooded with a number of e-mails from concerned Canadians and constituents.
I know that when Mr. Dungate started off his presentation, he wanted to talk about the elephant in the room that no one wanted to discuss, but I can tell you that people are alarmed. They are horrified, to an extent, and they are scared.
I have a science background, but someone who doesn't have the background, which is probably the average Canadian who is going out to the grocery store and buying chicken, really wouldn't know who to believe. When they watch a documentary the CBC puts on, let me tell you, they are alarmed and they are concerned.
We not only have the report done by the CBC. There was a report written in the Canadian Medical Association Journal in 2009. We had the Auditor General in Ontario in December 2008, I believe. We had a director of procurement at Maple Leaf Foods. Each and every one of those individuals, or those particular media, have raised the issue of the use of antibiotics in chickens and its correlation with human health.
I find it ironic that Dr. Bergen was talking about the fact that there's no correlation, when I believe that Dr. Smith stated that in the studies that have been done they have found a direct correlation between cephalosporin used in chickens and its impact on human health.
I know that Dr. Rosengren was speaking about the fact that there are protocols between veterinarians and the producers in terms of the industry. But you also mentioned in the beginning part of your presentation that there are over-the-counter drugs.
Who's monitoring what is being used over the counter by these producers?
With respect to ceftiofur, it is not used willy-nilly. Ceftiofur is used in ova to prevent a sickness in day-old chicks that come from a susceptible breeder flock. It's not used across the country. It's not used all the time. It is used when there is a specific issue. It's used once in the egg, and that's it. It is not in the feed. Let's be clear when we're talking about something like ceftiofur. It's important how it's used. I appreciate the opportunity there.
As for disclosing levels, we report to CFIA all the antibiotic usage that is put on a flock.
The other thing that comes out, in reference Ms. Dhalla's question, is that there is a small percentage of use in chickens that is not done by a veterinarian. If you have a flock issue and it goes through a flock, you're going to use a whole flock. You're going to put trust in a veterinarian to figure out what you need to do, because we have six weeks to market in a chicken flock. We don't have time to test one out, see if it works, go back to the drug store, see if Advil works better than Tylenol. We're going to go to the vet, and the vet is going to prescribe. That's how it gets done. The percentage of over-the-counter in our industry is small.
It's an interesting question, and I'm not sure. I'm a scientist, so I'm trying to imagine how you'd graph those two things.
But certainly you're right. The creation of new antibiotics is a very difficult enterprise, there's no question. The World Health Organization, the Canadian Medical Association, the American Medical Association, and any doctors group you want to talk to are extremely concerned about the rapid general increase in antibiotic resistance.
I'm delighted that the health committee is hearing this issue—examining and considering it—because first and foremost this is a public health issue. Yes, it's about livestock production, but first and foremost this is a public health issue. Other jurisdictions are showing the way in terms of protecting public health.
I have a 2009 document from the Danish government with very strong conclusions. Because of the Danish and EU policies, total antibiotic consumption in food-producing animals has been reduced by 50%—in excess of 50%—since the early 1990s. Animal health has not been compromised. Agricultural productivity has continued to improve. Denmark continues to be a monstrous exporter of food animals. We haven't talked about it very much here, but consumer prices have not been affected.
Again, if there's the possibility that the Government of Canada can do better in this area, can make some contribution to bringing down rates of antimicrobial resistance.... The Danish and the EU examples have shown that it's no big deal, frankly, for livestock producers. Why wouldn't we do it?
Great topic today, and thank you for your presentations.
I don't pretend to be an expert, certainly, on the science or medicine side of things, so I tried to follow along as best I could.
Ms. Szkotnicki, the presentation you handed out here today is quite illuminating. I just want to go over a couple of things so the committee understands. There have been a lot of comments made that I think might lead our viewers to be considerably alarmed, and perhaps not for the right reasons.
You made a distinction between the types of antibiotics in use in the veterinary realm. Mr. Dungate and some of the representatives of industry made reference to those used for therapeutic treatment. Are those the types used when bacterial infections require this kind of intervention? Is it this type of antibiotic use that might pose a potential risk to human antimicrobial resistance?
We've heard here today that the use of the therapeutic type, the stronger type, is limited. Yet we've heard, and there seems to be evidence, that somehow this is increasing microbial resistance in humans. So I'm trying to isolate the source. You say here that none of these pose any kind of risk to human health, so I wonder if you could help us there.
I'll just qualify your ending statement. Everything poses a risk, but the question becomes can we manage the risk? There's lots of effort put into managing the risk.
On your other question, about use of antimicrobials and the impact on resistance--I think that's what it boils down to--the different uses are treatment, prevention, control, and growth promotion. Across any of those applications, the use of any microbials--and I'll eliminate the ionophores from that equation--have the potential to create resistance. The question is, how do we manage that situation?
We manage it through different methods. There is the labelling of the product. We go through the review process. I talked about that as a control. Also is the fact that a lot of the newer products critically important to humans are prescription-only, under veterinary prescription. There has to be a veterinary client-patient relationship. There are prudent-use guidelines that they're following. We also have the producer groups with quality assurance programs that look at maintaining the quality of the product at the farm level right through to the table.
Members, I'm going to ask you to stay. We're going to have to do a little bit of committee business.
Thank you, witnesses, for coming and contributing to our study on antibiotics in livestock. We will be going in camera right away to discuss a little bit of committee business, so I have to ask you to leave the room as soon as possible, but thank you for coming.
Members, please stay for a few minutes.
[Proceedings continue in camera]