Evidence of meeting #61 for Health in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was antimicrobial.
A recording is available from Parliament.
12:30 p.m.
Liberal
12:30 p.m.
Scientific Director, Infection and Immunity, Institute of Infection and Immunity, Canadian Institutes of Health Research
Just taking the time to hear us, I think, showed the importance you're placing on this very important issue. It is recognized now to be worthwhile. We're very thankful that Canada also believes this is an important issue that we have to move forward on.
Thank you for all your support.
12:30 p.m.
Executive Director, Food Safety Science and Deputy Chief Food Safety Officer, Canadian Food Inspection Agency
Let me add that what's really important is to also remember that it's a complex issue. It's not something we will be able to turn on a dime. There's a lot of effort that has to go into it. While we may be able to have results immediately in the systems we have put in place, it may take us a while to see, let's say, a decline in the resistance or a complete change in the pattern.
I think, then, that the attention span around this particular file is not a two-year attention span. It is really something that's much longer, and people have to become sensitive to that.
12:30 p.m.
Liberal
John Oliver Liberal Oakville, ON
Okay, thank you.
I noticed that the CARSS report, under surveillance data gaps, said that there are significant data gaps “for rural and northern healthcare settings and First Nations and Inuit communities....”
I'm assuming that some of the burden of AMR is going to fall on third world and underdeveloped areas more than on others. I worry that we already have some difficult health indicators in our indigenous communities.
Will the new framework deal with those surveillance gaps?
12:30 p.m.
Deputy Chief Public Health Officer, Acting Assistant Deputy Minister, Infectious Disease Prevention and Control Branch, Public Health Agency of Canada
As I mentioned earlier, in the new framework, one of the key pillars is surveillance. I think once we get past the framework, into a concrete action plan, yes, it will.
12:30 p.m.
Liberal
John Oliver Liberal Oakville, ON
Will it deal specifically with rural and northern health care settings?
12:30 p.m.
Deputy Chief Public Health Officer, Acting Assistant Deputy Minister, Infectious Disease Prevention and Control Branch, Public Health Agency of Canada
Yes.
We'll look at all the gaps, for example, at indigenous communities, rural settings, also at strengthening surveillance for antimicrobial use in addition to the resistance in the outcomes.
12:30 p.m.
Liberal
John Oliver Liberal Oakville, ON
On the animal husbandry side, there's the use of metaphylaxis, whereby you treat an entire herd because a few are ill, and the use of AMU for growth and to improve feed efficiency. When I looked at the stuff from CARSS, we seemed to be low on usage of antibiotics in humans, but we looked to be very high in the use of antibiotics on our food side.
Do we need to make more substantive changes than what I've heard today from you, Mary-Jane?
12:30 p.m.
Director General, Veterinary Drugs Directorate, Health Products and Food Branch, Department of Health
That's a great question.
I think we're making substantive changes already through the suite of regulatory changes and the policy changes, which will place a veterinarian in the decision-making process for medically important antimicrobials, which will avoid the use of these important antimicrobials for the promotion of growth, for which there is no modern scientific evidence that it is effective to do so. This is good.
In terms of the amount of antimicrobials, as I said in my introductory remarks, more than 70% of medically important antimicrobials are used in animals.
There are some very good reasons for that. Number one, animals are much bigger than we are. A 600-kilogram cow, and there are many of them in this country.... When we look at the amount that is used, we need to remember those two key important facts.
12:30 p.m.
Liberal
John Oliver Liberal Oakville, ON
I have a quick question on that.
Do you need any stronger legislative authorities? Right now the antibiotics are in feed. Do you have sufficient legislative authority to prevent the use of those feeds without a veterinarian authorizing them? I don't know enough about the animal side of it.
12:30 p.m.
Director General, Veterinary Drugs Directorate, Health Products and Food Branch, Department of Health
There are a couple of things. In prescribing and the practice of prescribing there's some provincial oversight to that under the practice of medicine and veterinary medicine. There's this division of the sale of drugs and the use of drugs that occurs across this country, which is unique.
In terms of the drugs that go in feed, yes, you're right. Antimicrobials and other drugs go in feed because that is the most logical way to treat a large number of animals, either in feed or in water. We have rules around drugs in animal feed. We also authorize drugs to be used in feed, so we have rules within the food and drug regulations to address that. We also have rules in the feed regulations to address that. I think we have coverage on that from a regulatory perspective for feed, which is quite unique, in terms of the use.
12:35 p.m.
NDP
Don Davies NDP Vancouver Kingsway, BC
Thank you.
Ms. Ireland, I want to pick up on my colleague's questions on that.
Mr. Webber talked about the issue of having a sick animal and getting a prescription to treat that animal, but I think what's of more concern to Canadians are large-scale commercial producers using antibiotics in feed as a prophylactic measure, which seems to me to be something that I think is a leading cause of antimicrobial resistance.
Is that allowed in Canada? Can they put antibiotics in feed, and feed it to a large-scale commercial operation when individual animals are not sick, but as a prophylactic measure? Is that allowed?
12:35 p.m.
Director General, Veterinary Drugs Directorate, Health Products and Food Branch, Department of Health
It is allowed. I would consider that preventing disease in a particular herd for which it's known there's a disease pattern, as well as treating a disease, is important. Preventing disease, and the snowball effect of many more animals becoming much more sick, and having to use more antimicrobials, and maybe second line and third line treatments, is a reasonable practice. Yes, prophylactic drugs are approved for use in food animals in both prevention and treatment. They are permitted and considered reasonable.
12:35 p.m.
NDP
Don Davies NDP Vancouver Kingsway, BC
Help me situate that. Those are the positive benefits of it. I'm going to assume there's a negative aspect, which is that it's a contributor to antimicrobial resistance or is it not?
12:35 p.m.
Director General, Veterinary Drugs Directorate, Health Products and Food Branch, Department of Health
I don't know that I'd want to say that prophylactic treatment is a major driver of antimicrobial resistance. I think what I'd like to say is the misuse, overuse, of antimicrobials is a driver for antimicrobial resistance.
Making sure that a drug is used only when needed, at the right dose, and for the right duration of treatment, is what we're trying to achieve. It's why we are for, one, asking them not to use these things for growth promotion, medically important antimicrobials, and two, ensuring that a veterinarian is involved to make those decisions in collaboration with their client, the farmer.
12:35 p.m.
NDP
Don Davies NDP Vancouver Kingsway, BC
I see.
Dr. Njoo, I don't know if we tracked this, but is it possible for us to have a mortality figure? For instance, how many Canadians would we estimate die every year because of antimicrobial resistance? Do we have a feeling for that number?
12:35 p.m.
Deputy Chief Public Health Officer, Acting Assistant Deputy Minister, Infectious Disease Prevention and Control Branch, Public Health Agency of Canada
I wouldn't venture to put out a number. Dr. Ouellette with some of his research colleagues may have a more accurate figure. That's certainly one of the things that moving forward is the type of information we'd look to gather. But I don't have a specific figure right now.
12:35 p.m.
NDP
Don Davies NDP Vancouver Kingsway, BC
Maybe I'll end with you, Dr. Ouellette. I'll ask you that question, but I'll give you a second question, and then I'll probably run out of time.
Could you answer that question, and also, could you explain what the difference between antimicrobial and antibacterial resistance is? I'm led to believe there is a distinction.
12:35 p.m.
Scientific Director, Infection and Immunity, Institute of Infection and Immunity, Canadian Institutes of Health Research
Yes, the second one is much easier, so I'll start with the second one.
With antimicrobials there are four classes of microbes. You have bacteria, viruses, parasites, and fungus. All four need drugs. They are usually called antiparasitics, antivirals, antibacterials, and antifungals. The term that is used within Canada, but also accepted throughout the world, is antimicrobial. It's global. But mostly what we are discussing right now is about antibacterials. This is where most of the problem is.
Mind you, there are problems of resistance also with viruses, and with parasites, like malaria for instance, there's a lot of resistance. That's with antiparasitics. With HIV at one point, there was a lot of resistance, and that was with antivirals. Now they've combined drugs and it's a lesser problem.
Regarding your first question, the numbers that are highlighted are mostly from the U.S. and the EU. You could make a rule of 10, but then we're not sure if that's very accurate, for Canada.
12:35 p.m.
Scientific Director, Infection and Immunity, Institute of Infection and Immunity, Canadian Institutes of Health Research
In the multiple tens of thousands, so 40,000 in the EU and in the U.S., so is it 4,000, 2,000, or 1,000 in Canada? That's difficult to say.
12:35 p.m.
Liberal
The Chair Liberal Bill Casey
The time is up.
I want to thank all our witnesses today for attending, and Professor Ouellette for being so patient for two hours sitting there.
You did a great job.
I want to thank everybody for helping us to understand this issue a lot more.
I'm going to suspend the meeting, while we prepare to go in camera for some committee business.
Thanks very much.
[Proceedings continue in camera]