Health Committee on June 15th, 2017

[Dr. Andrew Morris]

I've tried to be clear as much as possible. Most of those things are covered in the framework. I would not underemphasize the issue of leadership. In the U.K., Dame Sally Davies—

[John Oliver, Liberal, Oakville, ON]

Just to be clear, how would that leadership manifest itself? Are you looking for a national point person on this?

[Dr. Andrew Morris]

I think that's probably what you need, to have somebody in Ottawa or anywhere else. You need that point person who is responsible, has ownership, has the mandate to ensure that the right thing is done, and who is also the vocal point.

I would just emphasize that in the U.K., their chief medical officer of health, Dr. Davies, issued a letter to all family physicians who were outliers in terms of their antimicrobial prescribing. It was actually a trial. Half got the letter, half didn't. There was a substantial reduction in antibiotic prescribing after she sent the letter, and it was because she was a recognizable point person. I think it would be very difficult for anyone in Canada to identify....

I know that this committee has been interested in opioids. My guess is that you'd be hard pressed to find a national leader or point person for opioids. I would say the same thing for antimicrobial resistance, which is, I would argue, more complex, because it goes outside of humans. There are so many other reasons why it's probably even more complex, and the opioids problem is already very, very complex.

You really do need a point person who will see the big picture and oversee and lead something like this.

[John Oliver, Liberal, Oakville, ON]

Does anyone else have any thoughts on recommendations or on that leadership point?

[Dr. Michael Routledge]

I would echo the leadership point.

I'll make another comment along the lines of what's been said before on this topic. I just want to take you back. In 2004 we had SARS, and we developed a lot of plans for SARS. Then SARS went away and we stopped thinking about it. Then a pandemic hit. People started pulling their SARS plans off the shelves. Nobody was really ready, because we'd kind of forgotten about it. It's easy to forget about, because all kinds of other things come up. We need to replace hips and knees and we need to get MRIs done and things like that.

We need to have ongoing eyes on this. I spent four years as the chief public health officer in Manitoba. I sat at the FPT tables. It's really critical for those tables, and in this case for the FPT steering committee, to have.... We talked about the Council of the Federation. The health ministers table and the deputy ministers tables need to be demanding action from that group and seeing it on a regular basis.

[John Oliver, Liberal, Oakville, ON]

Thank you.

[The Chair, Liberal, Bill Casey]

Mr. Davies, you have three minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Ms. Nakamachi, I didn't really give you an opportunity to answer the question about urgency. As a representative of front-line health care workers, nurses working in the wards of hospitals, can you give this committee a general sense of how important the issue of antimicrobial resistance is? Are you seeing patients to whom you're giving broad-spectrum antibiotics and then all of a sudden it's not working on them?

[Yoshiko Nakamachi]

Yes, absolutely. I know the question was what will our health care system look like 50 years from now, but we're already seeing patients who have multi drug-resistant organisms experiencing that.

Again, our most vulnerable population is the leukemia patients or transplant patients. When people think of vulnerable populations, they think of the very young and the very old, but that's not necessarily the case, so there certainly is an urgency.

With respect to nursing and the role that nursing can play, again, antimicrobial stewardship interventions can occur anywhere along the lifespan, from prenatal all the way to end of life. Nurses have a role and play a role in health care from prenatal to the end of life. Again, with the urgency here, there is definitely a role for nursing to play.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Dr. Morris, do you have an idea of the mortality rate? Canadians no doubt are dying from the inability to treat infections because of antimicrobial resistance. Is anybody tracking this?

[Dr. Andrew Morris]

No.

[Don Davies, NDP, Vancouver Kingsway, BC]

No? You talked about surveillance. You mentioned three reports issued in 13 years. You talked about the government eliminating or suspending money for the upcoming year in surveillance. You quoted the Auditor General—

[Dr. Andrew Morris]

Sorry, that was for stewardship.

[Don Davies, NDP, Vancouver Kingsway, BC]

It was for stewardship, sorry.

You referred to the AG report, I think from 2015, which said that Health Canada had failed to meet its key responsibilities.

I have two questions. Has this changed yet in the last year since the AG report? What resources are needed to increase surveillance and create the good data that we need to get a thorough handle on this issue?

[Dr. Andrew Morris]

I think things have somewhat changed in terms of intense change. We have this federal framework and there's been work in terms of developing policy and having FPT partners signing off on this. I consider that a move forward in terms of addressing AMR.

There's been increasing money to CIHR to address a variety of different research priorities that CIHR has around AMR. I think there's been some progress there, including through their participation in the joint programmatic initiative on AMR, which is an international effort.

In terms of what's needed for understanding and having better data, a better repository of information, it's going to have to be almost certainly something that's staged in nature, and there will have to be a ramp-up. To my mind, you start off with understanding existing datasets and validating them to make sure that what they're supposedly saying they really are saying. A lot of the data in these is actually from proprietary information that the Canadian government doesn't even own. On top of that, you need to start with probably the easiest systems to put in place, which would be understanding use in hospitals, and then you need to expand that to long-term care and then community practices in provinces. You need standards.

Shelita has already alluded to the need to have national standards for how statistics on antibiotics and resistance are collected and reported. Initial investment for that is probably going to require several million dollars, but over time it is going to be considerably larger than that because many provinces currently don't have that infrastructure. Some do; some provinces have an ability to track antimicrobial use in a much more granular way than most other provinces can, so we're talking about tens of millions of dollars.

[The Chair, Liberal, Bill Casey]

Time is up, and that completes our time for our witnesses.

I want to thank you all for your very impressive testimony.

I have a confession to make. When this committee first came together, we decided on the priority issues to deal with, and one of those issues was antimicrobial immunity. I didn't know what they were talking about, so that's how far we have to go with public awareness.

Ms. Nakamachi, you were talking about a kindergarten. Well, you need to educate the other end of the spectrum as well. That's how far we have to go, but this process will help. Things move very incrementally here, but they do work. The system does work, and you are part of it. I want to thank you very much for your contributions, because they were very effective.

That's it.

Dr. Carrie.

[Colin Carrie, Conservative, Oshawa, ON]

Just before you close the meeting, I notice that we will be going in camera, but as everybody is aware, the cannabis bill has been referred to our committee.

I would say this is one of the most important bills we've had the opportunity to review. There's a lot of interest in it, and I was just wondering if you could explain why we would be going in camera for that explanation and discussion.

[The Chair, Liberal, Bill Casey]

I can....

Mr. Davies.

[Don Davies, NDP, Vancouver Kingsway, BC]

I'd like to second that. In fact, I pulled the blues and the committee Hansard from Wednesday, February 17, 2016, when we first discussed in this committee when it would be appropriate to go in camera or not. Members may remember that I had a motion that would explicitly say that committee business was conducted in public at this committee other than when we were considering draft reports or when it was necessary to discuss witnesses' evidence or names in a free and open way, or for confidential or personnel matters. I said that the consideration of committee business should always be public.

At that time, Mr. Chair, you very generously reached out and stated your very clear position that this would be the general thrust of this committee. Now, obviously, the general description of the dates and subject of the study on the cannabis bill doesn't fall within any of those parameters where we discussed it would be appropriate to go in camera. I notice that there are members of the media here. The cannabis legislation was a major policy during the last federal election, and there should be no reason whatsoever that the public can't listen to our different views on how we choose to engage public input into this committee.

Of course, once we get into the study and discuss the witnesses and who they may be, that of course appropriately would be in camera, but at this point, it's not appropriate to go in camera, and I would ask that this portion of the meeting be public.

[The Chair, Liberal, Bill Casey]

Before we go any further, the issue is that my agenda for our committee business is the AMR budget first, then the cannabis study, and then the Lyme letter, if we ever get to it. The budget is always done in camera. I was supposed to do it last week, but I let the committee get ahead of me, and we didn't do the budget. We have to do it this week or the witnesses may not get—

[Don Davies, NDP, Vancouver Kingsway, BC]

Mr. Chair, that would be fine if we go in camera for that portion, but I'm suggesting and supporting Dr. Carrie—

[The Chair, Liberal, Bill Casey]

Mr. Oliver.

[John Oliver, Liberal, Oakville, ON]

I think it's a really important bill, and I think a lot of Canadians are interested in how the committee handles the bill. I would certainly recommend that we stay open for this piece. As I said, it's important, and Canadians want to see how we're handling it and how the committee will be discussing the bill. It's a major change in many parts of Canadian practice and norms, so I'd recommend as well that we stay open.

[The Chair, Liberal, Bill Casey]

You're all fighting for the same thing here. It's perfect.

[Don Davies, NDP, Vancouver Kingsway, BC]

Mr. Chairman, we're in violent agreement.