Dear members of the committee, good morning and thank you for the invitation to speak to you regarding antimicrobial resistance, or AMR. Let me begin with a quick summary of the issue.
AMR is one of the most serious global health threats facing the world today. It is a complex issue that impacts health, agriculture, trade, and the environment.
Antimicrobial resistance is the decline in the effectiveness of antimicrobial drugs such as antibiotics in treating an infection. Resistance can occur naturally, and any antimicrobial use can potentially promote AMR, but the inappropriate use of antimicrobials in health care, sanitation, animal health, and food production increases its emergence and spread.
Resistant infections are more difficult to treat and can lead to long-term illness, increased health care costs, and death. The Organisation for Economic Co-operation and Development estimates that up to 50% of human infections in G7 countries may be resistant to routinely used antibiotics.
If drug-resistant bacteria become widespread, treatments such as organ transplantation, cancer chemotherapy, and major surgeries such as Caesarean delivery could become so risky that they may not be readily available.
To provide a sense of the scale of this threat, in his review of antimicrobial resistance, or AMR, for the United Kingdom, Lord Jim O’Neill estimated that annual worldwide human deaths attributable to AMR could reach 10 million by 2050. This figure would overtake the number of deaths resulting from diabetes and cancer combined.
In its May 2017 report, the World Bank projected that, if no action is taken, the global GDP could fall between 1.1% and 3.8% annually by 2050. This shortfall amounts to a deficit of between US$2 trillion and US$6.1 trillion.
The costs of inaction are enormous. However, addressing the threat of AMR is extraordinarily complex, given that antimicrobials are used in so many sectors. To effectively move forward, we must use an integrated approach to coordinate efforts across the human health, animal health and agri-food sectors, among others, to help prevent and control AMR.
For many years, public and private sector organizations have been working to address AMR across Canada. Their actions, however, have not occurred in a coordinated or strategic manner. The first step towards a cohesive approach to AMR in Canada was the release of the federal framework for antimicrobial resistance and use in 2014. The framework outlines an integrated approach to AMR for key federal departments and agencies under three pillars: surveillance, stewardship, and innovation.
The federal action plan followed in March 2015, building on the framework by outlining the activities that federal departments and agencies agreed to undertake under each pillar. We have made some significant achievements under the action plan and have coordinated and integrated our AMR efforts. My colleagues at the Canadian Institutes of Health Research, Health Canada, and the Canadian Food Inspection Agency who are here with me today will provide details about the work they have under way and how we are working together to address this complex issue.
Today I will outline some of the Public Health Agency of Canada's achievements and I will defer to my portfolio colleagues here with me today to speak to their respective efforts.
Several commitments under the federal action plan focused on the establishment of a robust and integrated AMR surveillance system. The Canadian antimicrobial resistance surveillance system, also known as CARSS, compiles and synthesizes data from the Public Health Agency of Canada's surveillance systems to provide an integrated, national picture of AMR in antimicrobial use, or AMU, in Canada. Since its inception, CARSS' two annual reports have provided an increasingly better understanding of the AMR and AMU situation in Canada.
Working with our partners, we have a clear understanding of the gaps in information that need to be addressed. Key among these is the lack of human health data in the community setting. We have taken steps to assess the feasibility of collecting more and better information from community settings so that we can talk about the complete human health AMR and AMU situation.
The Public Health Agency of Canada continues to engage in education and awareness activities to improve knowledge and awareness of AMR among Canadian families, and to reinforce messages on the importance of personal infection prevention and control measures, including hand washing.
We’re also focused on understanding why antibiotics are prescribed and why they aren't always necessary, such as for viral infections. The prescription of antibiotics for viral infections is a key contributor to the development of antimicrobial resistance.
We’re working with our partners to give prescribers and pharmacists tools to help them talk to patients about the appropriate use of antimicrobials. We're supporting evaluation activities to measure the impact of initiatives and share best practices.
Research and development related to AMR is a global priority. We’re continuing to assess how Canada can best support the many initiatives underway.
Within Canada, the Public Health Agency of Canada has worked with our federal partners to develop a list of vaccine research priorities. We're also part of the project under the genomics research and development initiative launched to better understand the critical activities that contribute to the development of AMR and the critical exposure pathways by which resistant bacteria reach humans.
While the federal framework and action plan are a step forward for Canada's AMR response, we recognize that the federal government alone cannot address the AMR challenge and that many other players must be part of the solution. To move toward coordinated and consistent action across the country and meet our international commitments, Canada requires a truly national approach.
This approach is currently being developed by federal, provincial, and territorial governments, as well as professional organizations, non-government organizations, academic institutions, industry, and experts from across the human and animal health sectors. Given the multiple stakeholders and sectors that need to be engaged, a dedicated AMR governance structure bringing together federal, provincial, and territorial government representatives, key stakeholders in the medical and veterinary communities, industry, and academia was established to provide direction and input to the pan-Canadian framework.
The framework, which is in its final stages of development, is underpinned by four core components: surveillance, infection prevention and control, stewardship, and research and innovation. This high-level policy document outlines strategic objectives, opportunities for action, and outcomes to guide collective action in each of these areas, setting the stage for the pan-Canadian action plan, which will be developed following the release of the framework.
Development of the framework required unprecedented multi-sectoral collaboration. Stakeholders exhibited great willingness to come to the table to discuss crosscutting issues. Going forward, it will be critical to maintain this momentum and develop concrete actions, measurable outcomes, and time frames through the action plan to flesh out our collaborative, pan-Canadian approach to AMR.
Canada is well regarded by international partners for our inclusive, multi-sectoral, one-health approach to AMR that involves the human health, animal health, and agriculture sectors, and for our success in fostering collaboration among stakeholders across a range of public and private sector interests. The multi-jurisdictional and multi-sectoral governance structures we have established are applauded by international peers as a strong example of the one-health approach in action. In a practical demonstration of our commitment to international action on AMR, in November 2016 Canada announced $9 million to support the implementation of the World Health Organization's global action plan on AMR.
More recently, in 2017, Canada financially supported the World Organisation for Animal Health's participation in the United Nations' lnteragency Coordination Group on Antimicrobial Resistance, once again championing a global one-health approach.
At the World Health Assembly held just last month, Minister joined the Alliance of Champions, a group of health ministers committed to increasing awareness, engagement, and leadership on AMR among national and global leaders and strengthening high-level political momentum for action on AMR.
In September 2017, Canada will take on a new leadership role as the chair of the global health security agenda’s AMR action package. As chair, Canada will work with other leading countries to support the implementation of, and to accelerate progress on, the World Health Organization’s global action plan for AMR. This will be done in close cooperation with the World Health Organization, the Food and Agriculture Organization of the United Nations, and the World Organisation for Animal Health.
Canada will continue to advocate for the inclusion of AMR in high-level discussions at the United Nations and other key international venues. Canada recognizes that timely action to address AMR will serve to maintain global health gains made in past decades and support the achievement of the 2030 sustainable development goals.
We have made great strides, but we still have a long way to go. We will continue to develop the federal contribution both to the pan-Canadian action plan and to global efforts to address AMR, to ensure that Canadians and people around the world are protected from this significant threat.
Thank you for inviting me to speak today. I would be happy to take questions later on.
I’d like to thank the committee for inviting me to speak to you about how the Government of Canada is supporting the federal framework on antimicrobial resistance, or AMR.
As you know, the Canadian Institutes of Health Research, or CIHR, is the Government of Canada's health research funding agency, with a mandate to support the creation of new knowledge and its translation for more effective health services and products, and a strengthened Canadian health care system.
Within CIHR, the Institute of Infection and Immunity, of which I am currently the scientific director, supports research in the field of antimicrobial resistance. Outside of CIHR, I am also a researcher at Université Laval here in Quebec City, and my primary research interest is antimicrobial resistance. Since 2003, I have had the honour to hold a Canada research chair on antimicrobial resistance.
Between 2011 and 2016, CIHR invested more than $96 million in antimicrobial resistance research, including an investment of over $20 million in the last fiscal year. These investments have supported world-class research towards the investigation of novel antibiotics and alternative therapies, new or improved diagnostics, antimicrobial stewardship strategies, surveillance of resistant organisms, and methods to improve infection prevention and control.
I would like to give you a concrete example that profoundly illustrates the importance of research in tackling this global issue. Dr. Andrew Morris, a physician and researcher at Toronto's Mount Sinai Hospital, and the University Health Network developed a program focused on reducing antibiotic over-prescription for patients in the intensive care unit. This stewardship program led to a 33% decrease in antibiotic prescription. This has led to improved outcomes for patients and a lower incidence of AMR infections. This program has been so successful that it is being adopted as the gold standard in care by Accreditation Canada. CIHR is proud to support research that will contribute to the expansion of this program into other hospital settings.
As my colleague Dr. Njoo just described, the Canadian Institutes of Health Research, or CIHR, is a key player in the implementation of the Government of Canada’s framework entitled “antimicrobial resistance and use in Canada: a federal framework for action.” This framework outlines three pillars for action, which are surveillance, antimicrobial stewardship and innovation. While contributing to the research components of the surveillance and stewardship pillars, CIHR's primary role is to lead and support the innovation pillar.
The framework's implementation was followed, in March 2015, by the federal action plan on antimicrobial resistance and use in Canada. CIHR has already contributed to all three pillars of the plan through various strategic investments.
In Budget 2015, CIHR was given $1.8 million a year “to support additional research to better understand and address the health challenges posed by antimicrobial resistant infections.” Through this ongoing investment, CIHR is able to fund the development of new point of care diagnostic tools. The Honourable announced the first phase of this funding a few weeks ago. The funding will help support five teams through a $1.39 million contribution from CIHR.
These teams, which are working with industrial partners, will develop tests to rapidly and accurately diagnose antimicrobial resistance at the point of care. The intent of this funding is to create commercially viable diagnostic tools that could be scale-up and, when appropriate, commercialized and implemented.
CIHR is also collaborating with its international counterparts to address the antimicrobial resistance issue at a global level. For example, we're participating in the joint programming initiative on antimicrobial resistance, or JPIAMR.
We're working with over 20 partner countries to address the knowledge gaps in antimicrobial resistance using a “one health” approach. This collaboration allows for the alignment of national and international investments in coordinated global research activities.
CIHR is currently one of the top funders in this major collaborative effort of JPIAMR, which represents, so far, a total investment of $6.7 million, with an additional $3 million in future commitments. CIHR participation in this program enables Canadian researchers to build partnerships with their international counterparts to address important issues related to the challenge of AMR and to develop meaningful solutions.
While CIHR's main role is to fund research, we also often play the role of convenor as a means to better coordinate action and inform our activities in this space. For instance, in November 2016 CIHR co-hosted a forum on antimicrobial stewardship. Held during World Antibiotic Awareness Week, this meeting brought together more than 80 people from multiple disciplines and sectors to discuss the responsible use of antibiotics in clinical settings. This one-day workshop led to the development of five recommendations that were centred around innovation and knowledge mobilization. These recommendations will be used to inform on CIHR future investments in antimicrobial stewardship.
I would like also to point out that Canada has indeed cultivated some of the best experts in the field of AMR, not to mention that it has seen the emergence of a great number of hubs of excellence at a number of universities across Canada.
For example, Dr. Natalie Strynadka, from UBC, has been using an array of molecular imaging techniques to define the molecular blueprints of superbugs. Her team is focused on identifying novel targets for new antibiotics that can penetrate the bacterial cell wall while resisting the bacteria's attempts to eliminate the drug.
Similarly, at McMaster University, the work of Gerry Wright focuses on both the discovery of novel antimicrobial strategies, as well as understanding the basis of antimicrobial resistance.
Here's another example. At the University of British Columbia, Dr. Robert Hancock has focused his efforts on designing new therapeutic strategies to address the growing threat of antimicrobial resistance. Dr. Hancock has demonstrated his ability to translate his laboratory innovations into the development of new enterprises. He co-founded the Centre for Drug Research and Development, and four spin-off companies. These include Sepset Biosciences Inc., which he co-founded in September 2016. Sepset Biosciences has developed a rapid diagnostic blood test that can identify sepsis, a type of infection that causes the hospitalization of over 30,000 Canadians each year.
I’ve hopefully demonstrated how CIHR is supporting the federal framework on antimicrobial resistance through its strategic funding of the research community and its ability to convene expertise from across the country and abroad. The types of new research I’ve just described underpin much of the framework.
In conclusion, Mr. Chair, rest assured that CIHR will continue building antimicrobial resistance research capacity in the country and promoting international research collaborations to limit the impact of this problem on the health of Canadians and the global population, and to ensure that we're able to address this growing threat.
Thank you for your attention. I would be pleased to answer any of your questions.
I'd like to thank the committee for inviting Health Canada to discuss the issue of antimicrobial resistance with a particular focus on our implementation efforts as part of the federal framework and action plan on AMR.
Thank you, Dr. Njoo, for the overview of the strategy in the first presentation.
I am pleased to be here today to discuss with you this global public health issue and the actions we are taking to address it from the veterinary drug, as well as human drug perspectives. The activities I will cover today are important and tangible deliverables under the stewardship, surveillance, and innovation pillars described in the previous presentation.
I'll begin by emphasizing the important role that Health Canada plays in protecting human and animal health and ensuring the safety of Canada's food supply.
Through the veterinary drugs directorate and therapeutic products directorate, we review and authorize all new antimicrobial drugs used in animals and humans. We monitor the safety of marketed products, and we require companies to amend product labelling with new information, including information related to AMR as it becomes available.
It is important to remember that Health Canada provides market authorization for the sale of drugs, while the use is regulated by the provinces and territories under the practice of medicine and veterinary medicine. There are also provincial and territorial rules pertaining to the distribution and dispensing of drugs.
As Dr. Njoo discussed, the inappropriate antimicrobial use and overuse in humans, animals, and plants is leading to increases in the emergence and spread of AMR. Health Canada's goal is to promote the responsible use of antimicrobials to reduce the development and spread of resistant bacteria, as well as help preserve the availability of effective antimicrobials for future generations.
I'll now focus on our efforts to address AMR in the animal context, as this is one of my key responsibilities within the veterinary drugs directorate and also because in Canada an estimated 70% of all medically important antimicrobials, which means those that impact human medicine, are sold for use in food-producing animals.
We have made significant progress in building an evidence-based approach to assessing the antimicrobial resistance risks from antimicrobials approved for sale in Canada. Since 2004, our ongoing actions include the implementation of specific requirements for the assessment of new veterinary antimicrobial drug submissions for antimicrobial resistance risks when used in food-producing animals.
The categorization of antimicrobials into four categories is based on their importance in human medicine. For example, category I antimicrobials are of very high importance in human medicine; category II are high importance, and category III are of medium importance. This categorization has helped us to better manage the risks. For example, all category I antimicrobials have specific warnings on the labels recommending against extra label drug use.
The surveillance data from the Public Health Agency of Canada's antimicrobial resistance surveillance program supports the veterinary drugs directorate's market and post-market safety assessments of veterinary antimicrobial drugs.
To encourage the prudent use of antimicrobials in animals, the veterinary drugs directorate works collaboratively with stakeholders, such as the provincial and territorial authorities, veterinarians, industry, and food animal producers.
In addition, we are also making significant progress on important regulatory and policy changes to increase the oversight and promote the responsible use of antimicrobials in animals.
Final regulatory changes to the food and drug regulations were published in the Canada Gazette, part II, on May 17 of this year. These changes focus on four key measures.
First, we are increasing oversight on the personal importation of unapproved veterinary drugs for food-producing animals. This means that, moving forward, only those drugs that Health Canada has determined do not pose a risk to public health or food safety may be imported and only in limited quantities. For example, our eligibility criteria do not allow for the importation of prescription drugs or medically important antimicrobials.
Second, we are increasing oversight on the importation and quality of active pharmaceutical ingredients for veterinary use by requiring compliance with good manufacturing practices and establishment licences to conduct these activities.
Third, we are requiring that manufacturers and importers report annual sales of medically important antimicrobials for veterinary use, to support our surveillance programs. This information will help provide a better understanding of the volume of antimicrobials available for use in animals in Canada and support the analysis of patterns and trends of antimicrobial resistance.
Fourth, we are introducing an alternative, less burdensome pathway for companies to import and sell low-risk veterinary health products, such as vitamins, minerals, and botanicals, as additional health management tools. We know that promoting the health and welfare of animals can help reduce the need for antimicrobials down the road.
These regulatory changes will come into force through a phased approach, starting in November of this year, and we will continue to work with stakeholders to help prepare everyone so that we have a smooth transition.
To complement the regulatory changes, we are also working with provincial and territorial authorities and other stakeholders to make important policy changes to promote the responsible use of antimicrobials in animals. These include two key measures.
First, we are proposing to move all medically important antimicrobials from over-the-counter to prescription status. This means that a prescription will be needed from a veterinarian before one is able to purchase the drug.
Veterinarians who prescribe for animals under their care possess the scientific and clinical training to assess the health of animals, diagnose disease conditions, determine the need for antimicrobial drug treatment, and choose the most appropriate course of treatment. Consequently, involving the veterinarians in antimicrobial treatment decisions is a very important component of enhancing antimicrobial stewardship. This is also an internationally recognized best practice. Already, since 2004, new medically important antimicrobials approved by Health Canada are required to be sold pursuant to a prescription. With this proposal, we will establish the same level of oversight for those remaining medically important antimicrobials that, in some cases, were approved decades ago.
Second, we are removing growth promotion claims from the labels of medically important antimicrobials. This is in line with international best practices or principles that these important drugs should not be used to promote weight gain in animals and should be reserved only for treating and preventing diseases.
These two measures will be rolled out concurrently, since they will both require changes to labelling. For example, companies that need to add the “Pr” symbol to labels to identify them as a prescription drug as well as remove growth promotion claims will be able to do so at the same time.
We are proposing to roll out these changes between now and 2018 so that, for example, provinces and territories, which have oversight on the distribution and dispensing of the drugs, will have enough time to make needed changes and also so that end users, such as farmers, are aware and prepared. These changes require extensive consultation and collaboration, and we are making significant progress on this.
Both the regulatory and policy measures are important elements of the federal antimicrobial resistance action plan and have been developed over many years of collaboration with stakeholders and experts in Canada. We all have a role to play, and the prudent use of antimicrobials in animals is a shared responsibility across governments, industry, veterinarians, and the agriculture sectors. We continue to collaborate with all stakeholders to ensure an effective and smooth implementation of these measures that I've just described.
Switching now to the human drug context, I'd like to share with you an update on the progress being made for human use antimicrobials. Under the stewardship pillar, work began in 2015 and will wrap up in late 2018 to include standard antimicrobial stewardship statements to all currently marketed antibiotics to encourage the prudent prescribing and use of these drugs.
Specifically, we are adding text to remind physicians to check for susceptibility of bacterial infections prior to prescribing an antibiotic. We are also adding text to the patient medication information leaflet to inform patients that they should take their antibiotic exactly as directed by their doctor and should not share their medication.
In order to manage the large number of antibiotics on the market, the prudent use statements are being added in a phased approach, starting with antibiotics that have the highest prescribing in adults and children, as well as those of last resort. This is being followed by antibiotics important for treating resistant pathogens in the community, and then all remaining antibiotics.
Beyond labelling changes, we're working with the Public Health Agency of Canada on awareness and education materials about the responsible use and exploring how best to reach physicians and patients.
In conclusion, Health Canada is continuing to take concrete steps to address AMR risks related to the use of antimicrobial drugs with a “one health” approach. Our main goal is to ensure that safe and effective antimicrobials remain available on the market for treating infections for generations to come.
The department is committed to both ongoing collaboration with its partners and stakeholders on limiting and controlling the emergence and spread of antimicrobial resistance and ensuring the continued protection of the health and safety of Canadians and their food supply.
I thank you for your time, and I would be pleased to answer any questions you may have.
Thank you very much, Chair.
Good morning, everyone.
First, thank you for giving me the opportunity to participate in this study.
I want to explain what the Canadian Food Inspection Agency, or CFIA, is doing to support the plan entitled federal action plan on antimicrobial resistance and use in Canada: building on the federal framework for action.
The CFIA is a science-based regulatory agency dedicated to safeguarding plants, animals and food.
The CFIA reports to the Minister of Health. Its first priority is the health and safety of Canadians.
The CFIA also supports the Minister of Agriculture and Agri-Food.
We thank the committee for inviting the CFIA to speak to this important subject. Antimicrobial resistance, or AMR as you've already heard, is a complex issue that impacts health, agriculture, trade, and the environment, as our portfolio partners have already expressed.
The international community recognizes the need for a high level of collaboration between countries and their industrial partners, to confront the growing public health problem of AMR. Canada has committed to collaborate with other G7 and G20 countries to support the WHO global action plan on AMR, which was adopted at the World Health Assembly in May 2015.
As you've heard, the CFIA and other federal departments and agencies developed the federal framework in 2014 and the federal action plan in 2015 to deliver coordinated federal actions to combat AMR. The CFIA is in the unique position of having existing and well-established collaborative working relationships with agrifood stakeholders, including producers, growers, feed mill operators, processors, veterinary associations, and our provincial and territorial colleagues.
We are actively taking advantage of these relationships to deliver on actions resulting from the federal action plan. The CFIA has been working with our federal, provincial, and territorial partners in human and animal health, along with industry and academia to develop the pan-Canadian framework, and we plan to develop the pan-Canadian action plan to better integrate action across Canada.
Specifically, I would like to talk about how the CFIA supports the four pillars that have already been mentioned. They are surveillance, stewardship, infection prevention and control, and research and innovation.
Let me talk first about surveillance. The CFIA supports monitoring levels of antimicrobial resistance in Canada by contributing to the Canadian antimicrobial resistance surveillance system, CARSS. We do so through our contribution to a specialized program called the Canadian integrated program for antimicrobial resistance surveillance, known as CIPARS, which is led by our PHAC colleagues.
Still, the reality is that medical professionals are the true stewards of antibiotic use. They are the front line in making sure these agents are used prudently. This includes animal health. For this reason, the veterinary community is a key partner in combatting the threat of AMR while safeguarding animal health.
To improve the surveillance of the use of antimicrobials in agricultural settings, the CFIA, along with Agriculture and Agri-Food Canada, and our health portfolio, are working closely with animal producers and veterinarians. We are doing this through the convening of workshops by the Canadian Veterinary Medical Association and the Canadian Animal Health Surveillance System. These workshops are intended to facilitate the articulation of a clear path forward and the encouragement of a coordinated approach within the different sectors.
Let me talk next about stewardship, along with infection prevention and control. The CFIA supports efforts by the Canadian Veterinary Medical Association to improve the stewardship of antimicrobials. The agency contributed to the development of the “Veterinary Oversight of Antimicrobial Use - A Pan-Canadian Framework for Professional Standards for Veterinarians” and is contributing to the revision of the guidelines for prudent use of veterinary antimicrobial medications.
As a science-based regulatory agency, the CFIA enforces regulations involving the judicious use of antimicrobials in feed to further support the antimicrobial stewardship. Our role is to verify that the compendium of medicated ingredient brochures is followed and that any feed prescribed by a veterinarian is in line with the requirements of the food and drug regulations. As I said earlier, veterinarians are on the front line safeguarding animal health and promoting the prudent use of antimicrobials. We work closely with animal producers and these veterinarians.
Finally, let me talk about research and innovation. Tracking the emergence of new microbes that can harbour antibiotic resistance requires innovative research and development, as you heard from our colleague Marc Ouellette. Indeed, the federal action plan commits to promoting such innovation through funding collaborative research. CFIA laboratories have answered this call, and in collaboration with other partners, we are developing novel techniques and methods to improve the surveillance of antimicrobial resistance in food-borne bacteria, such as through the genomics research and development initiative.
Mr. Chair, progress is being made through our collaborative approach with our partners in government, industry, and academia. Still, there is more work to be done.
I hope this sheds some light on how the CFIA is working to implement the action plan on antimicrobial resistance and use in Canada.
I'll be pleased to answer your questions.
I'll start, and maybe my colleagues would like to complement what I'm saying.
The problem is rising. Twenty years ago we were talking about this, but the rates of resistance that we are encountering now are frightening, and I'm talking worldwide, especially in the outer regions of Asia, in India for instance. There are cases of resistance that are very high in human populations. Some of the bacteria that you just named are problematic.
In Canada you've talked about staphylococcus aureus or MRSA. This is a serious problem. It's not going down. I think we should put more effort into this. This is a serious infection and the drug of choice is methicillin, and then infections are MRSA, methicillin resistant, so it does not function. In Canada this is an issue that we have to look at.
For streptococcus pneumoniae, now we have a vaccine. We were talking about alternatives. I think the development of a vaccine has been very helpful in decreasing the rates of streptococcus pneumoniae infections, but unfortunately, the vaccine is effective against the subgroups that were the most frequent, and now there's a deplacement. When you remove something, something else is coming. Unfortunately, these are becoming resistant, and so we will have to look at this.
With the E. coli and the shigella, I mean the problem is more acute in other places of the world. For instance, if you look in agriculture, four or five years ago they were still using some of the class 1 drugs that were helpful also for human medicine. Some of the percentage that you're highlighting were from this equilibrium between the use of those antibiotics that are used both in human medicine and agriculture. Now they've banned those antibiotics and now the resistance rates are going down. It's showing that good stewardship can make a difference.
In a nutshell, I think it's very important that we work on it because—and I'm not sure how to translate that in English. I'll say it in French and hopefully it will be translated:
“Prevention is better than cure.”
I think we have to be aware of this. We are aware and it's politically quite clear. It's also scientifically quite clear and we have to take action.
Thank you for the question.
You're right. There's an economic aspect. However, we must also take into account that antibiotics are still saving lives. This is the case for people suffering from an infection.
Unfortunately, our collective unconscious leads us to believe that antibiotics are effective, that it isn't necessary to take them for a long time and that they're inexpensive. We have this equation in mind. That said, cancer drugs can cost from $20,000 to $25,000, and add only four months to a person's life expectancy. Everyone knows it's the price to pay. However, this isn't the case for an antibiotic, which will probably save the life of the person who takes it.
There are what we call
“push and pull incentives”.
If the market is small, the development of the drug costs billions of dollars and the period is short, this incentive can't be applied. Regarding antibiotics, major pharmaceutical companies no longer invest in innovation. However, they invest in innovation when it comes to diseases such as diabetes and cancer. Many organizations are concerned about this issue, which was raised at the Davos forum and on a number of other occasions.
How can these pharmaceutical companies develop antibiotics while making a profit? This involves an economic aspect. The discussions currently concern topics such as the possibility of extending the duration of the patent or granting a bit more protection to a pharmaceutical company for research on an anti-diabetes drug, for example, if the company agrees to develop an antibiotic that won't be economically profitable. Therefore, we're trying to establish push and pull incentives. It's very economically innovative. We're trying to encourage the development of new antibiotics.
Thank you very much for the presentations.
I'm reminded a bit of a story I heard about algae growing in a pond. In 20 days, if it doubles in size every day, it would cover the entire pond. You begin on day one with what looks like a very small problem, and on day 17 a quarter of the pond is filled. On the 19th day it's half filled, and on the 20th day it's filled. That's the logarithmic growth you can get in some of these spreads.
In our case, we're looking at 10 million people worldwide, or 50,000 Canadians, if we don't manage it.
I listened to your testimony and read through it. All of you are pretty much saying the same thing: in collaboration, Mr. Chair, CIHR will continue building research capacity, and we're going to work to fight this global threat; from CFIA: we're making progress through collaboration, and there's still work to be done, but we're working on it; at PHAC, we'll continue to develop the federal contribution in global efforts to make sure that AMR will be addressed.
The message you're giving to the health committee, then, is that you're on it, that it's being managed, that there's still work to be done, but you have the capacity, frameworks, and collective efforts to address this problem.
I wish we had the pan-Canadian framework done, so that we could see what's in and what's not in it. I'll ask each one of you, however, is there anything you would like this committee to say in the House and to the minister to further prevent this potential crisis from emerging? Is there anything more that any one of you feels we should be doing?
I'll start with Dr. Njoo.