Health Committee on Nov. 2nd, 2017

[Dr. Wendy Levinson]

I think there are some communication skills that are really fundamental, too, because often physicians are trying to please the patient, but they don't ask the question, “What are you most fearful of? What are you most worried about? What do you think this antibiotic will do for you?” “Well, if I get that, my kid won't cry tonight, and I will be able to get back to work tomorrow.”

If you understand and ask those questions, then you can reassure them and educate them, “I understand why you're worried, but if I were you, I wouldn't want the risk of my kid having an antibiotic reaction, because the earache is going to get better anyhow.”

Some of it is the knowledge, and some of it is how we work with patients to simply explain things.

[Dave Van Kesteren, Conservative, Chatham-Kent—Leamington, ON]

Mr. Morris, you're saying that you need $100 million basically to gather the information. I don't know how much time I have, but I served on the finance committee for years. I found, at least when we were in government, we used to like these little projects and stuff like this. The biggest problem we had, or the biggest problem the medical profession had, is that they really had poor representation. You don't have time to go out there, talk to politicians, and do the necessary work to get that support.

I think this is a marvellous suggestion. It just makes sense, because just in this short conversation, it's obvious that this is a very complicated and confusing issue, and there needs to be some gathering of information and education right across the board. If that can be done for $100 million, that's the best money.

I would suggest that you put together a lobby group of some sort and start to lobby the government, because, as I said, when we were in government, we used to love these little $50 million, $100 million jobs, or something along those lines. I know Sinai had a number of projects like that.

Are you doing that?

[Dr. Andrew Morris]

I'm putting together a group. We're not allowed to ask for as much as $100 million, which is the problem, but we have no other opportunity. We have a broad-based group. IPAC Canada, NCCID, and Choosing Wisely are all involved in it. The most we're going to ask for is somewhere around $30 million, and we're competing for that money.

This committee needs to come to us and say, “Give us your best shot. Tell us how you're going to do this,” and we will tell you. As Dr. Levinson said, this needs to be at least guided by groups, organizations, and individuals who know about this but have access to money. There isn't that money available, and we're not politicians.

[Dave Van Kesteren, Conservative, Chatham-Kent—Leamington, ON]

Can you do that? Can this committee ask you to put something together that—

[Dr. Andrew Morris]

Absolutely.

[Dave Van Kesteren, Conservative, Chatham-Kent—Leamington, ON]

I'm sure this is something we could all agree on.

[Dr. Andrew Morris]

You follow up with me. Somebody send something to me, Mr. Gagnon, and we will get it to you.

[The Chair, Liberal, Bill Casey]

Thanks very much.

Mr. McKinnon.

[Ron McKinnon, Liberal, Coquitlam—Port Coquitlam, BC]

Thank you, Chair.

I'm going to take refuge in information systems. A lot of what I'm hearing is that we need this overarching coordination mechanism. We need data standards, and we need process standards. I'm going to touch on what Ms. Gladu mentioned as well, international experience.

This is not a problem local to Canada. It's a problem that exists around the world in all countries to some degree or other. Is there a country or some supernational or subnational group that does this really well, that has an organization that has processes and definitions in place that we could use here as best practices that would be a good starting point for us?

[Suzanne Rhodenizer Rose]

I think just coming from the perspective of surveillance, we already have some of that in Canada. I talked a little bit about the Canadian nosocomial infection surveillance program. They develop standardized case definitions that are used in a small pocket of tertiary care facilities across the country. There's an opportunity there to use those well-vetted, evidence-informed case definitions right across the country so all the provinces and territories in Canada are using the same definitions, and we're able to monitor and trend with a high degree of reliability what's going on in the various areas across the country.

[Dr. Andrew Morris]

I can add to that. The challenge in most jurisdictions is that there's a divide between research and public health. In most jurisdictions, whether it's in the European Union or in the U.S., there's no coordination between research and public health. This requires research, and it requires public health, and it requires them to be integrated.

There are many jurisdictions that do great surveillance in epidemiology, and there are some that do excellent research. Canada could be a leader here by integrating the research with infection prevention and control, antimicrobial stewardship and surveillance, and putting all those things together.

Scandinavian countries by far and away lead the rest of the world, but there are pockets of excellence in stewardship. In Australia, they have a National Centre for Antimicrobial Stewardship. The European CDC and the U.S. CDC are excellent for surveillance. The Dutch are amazing for stewardship. Research still remains the domain of Americans especially, but it's increasing in the U.K., and in the rest of Europe.

[Ron McKinnon, Liberal, Coquitlam—Port Coquitlam, BC]

So we could go to these various organizations and synthesize a new system based on their respective best practices, and that would be a world-leading standard.

Carrying on to what you said, Ms. Rose, with the existing system you talked about in Canada, if we were to build on that—I'm interested in the international perspective—is there interoperability between European systems in terms of exchanging data? In fact, is there any need, any value, in exchanging data with European or other systems?

[Suzanne Rhodenizer Rose]

From my perspective, yes, I think there is. I would defer to my clinician colleagues on looking at that.

I think there is opportunity in looking at antimicrobial-resistant trending across the country and also globally so that you can see what's happening in other areas and there is ability to have some predictability about what may come to our borders.

However, that's not exactly my area of expertise.

[Dr. Wendy Levinson]

The OECD quality effort that Canada is very involved in could be a source of information too. As I said, they do comparisons across the countries. They have consistent information, yearly, in their “Health at a Glance” report—Canada is part of that—looking at rates of antibiotic use and, among other things, a comparison. As I said, the Netherlands is a half of the use of antibiotics per capita to Canada.

[Ron McKinnon, Liberal, Coquitlam—Port Coquitlam, BC]

Does the World Health Organization provide any overarching definitions or support? It is a global organization.

[Dr. Andrew Morris]

They do provide definitions.

[Ron McKinnon, Liberal, Coquitlam—Port Coquitlam, BC]

Are they useful?

[Dr. Andrew Morris]

Well, that's a different question altogether. I think that the challenges of AMR differ, and the hurdles that countries need to overcome.

The WHO, as Dr. Tedros mentioned just yesterday, involves all countries. There are many countries around the world where access to antibiotics is a greater issue than choosing which one you're going to get.

We face different challenges than many other countries, so to rely on an internationally accepted definition for surveillance and other purposes may not be the best approach.

[Ron McKinnon, Liberal, Coquitlam—Port Coquitlam, BC]

Okay.

[The Chair, Liberal, Bill Casey]

Your time is up. Thank you very much.

Ms. Sansoucy.

[Brigitte Sansoucy, NDP, Saint-Hyacinthe—Bagot, QC]

Thank you.

Mr. Morris, you mentioned earlier that antimicrobial resistance was currently costing the system several hundred million dollars.

Do we really have data on the potential savings that could be made in the health care system with adequate intervention and the development of new methods compared with the current costs?

[Dr. Andrew Morris]

The challenge is a complex one.

I don't know how much you spend on your insurance, but the battle we're all dealing with on AMR is primarily one of insurance, because we know there has been a growth of resistance over time that is going unabated. What we're looking to do is try to stem that tide and invest for cost avoidance, I will say, because the expenditures of dealing with antibiotic resistance are going to be much greater down the road than they are today, especially if we don't do anything.

If we just estimate and we don't have reliable data.... Let's just say we're using $1 billion of antibiotics a year. Our best estimates are that 50% of antibiotics are unnecessary. Those are the best reliable estimates, somewhere between 30% and 50%. Even if you reduce it by 30%, we're talking about a $300-million savings. To be honest, $100 million is a relatively insignificant investment. That's only antibiotic costs. That has nothing to do with all the other investments or risks.

One of the hospitals I work in deals with cancer patients. Often, we now only have one antibiotic with which to treat them. We have patients with transplants and we're giving them novel antibiotics, or ones we really have no experience with, because we have no other choices for them. If we pass that stage, and often we do, we have no other choice.

You may be familiar with the case this past year where doctors at Toronto General had to remove a patient's lungs because there was no antibiotic solution for her. They had to take out the lungs, wait, put her on some other support until lungs were available, and then give her new hope for life.

On that reality that people are thinking about down the road, we're there today. This is not something that Canadians can afford to delay investing in. This committee and the government need to take action now to invest in this.

[Brigitte Sansoucy, NDP, Saint-Hyacinthe—Bagot, QC]

Earlier, you talked about the importance of funding research and said that developing a new drug costs $2 billion, but that it may not be the solution.

Is there development potential? You are in a better position than me to talk about that. Are there any ideas that could be developed, innovations to be made, other than the ones we are currently using?

[Dr. Andrew Morris]

You're from Quebec?

[Brigitte Sansoucy, NDP, Saint-Hyacinthe—Bagot, QC]

Yes.