Thank you very much.
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 Philpott 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.