Thank you, Chair and honourable members of the committee, for the opportunity to present here.
My name is Yoav Keynan and I'm the scientific director of the National Collaborating Centre for Infectious Diseases, or NCCID. The six national collaborating centres for public health were set up after the SARS epidemic. At that time they were fed by the experiences of perceived weaknesses in the public health system in Canada. Compared to that epidemic, AMR is a far deeper and more serious problem.
The NCCID is currently hosted by the University of Manitoba in Winnipeg under a contribution agreement with the Public Health Agency of Canada. Our mandate at NCCID is for knowledge translation and brokering to provide evidence and other information to inform public health practice and policy across Canada at all levels of authority. The centre fosters connections among public health practitioners, decision-makers, researchers, and clinicians, with a shared goal of improving control of infectious diseases in Canada.
Since its inception in 2005 under the early leadership of Dr. Ronald and Dr. Plummer, as well as others, the NCCID has played a role in bringing attention to antimicrobial resistance and the importance of appropriate antimicrobial surveillance, use, and stewardship. For example, the NCCID has been involved with hosting antimicrobial awareness week in Canada since 2010.
Since then, NCCID's involvement has grown, and the centre plays a role in AMR in public health, particularly supporting collaborative efforts to improve coordination and equitable delivery of stewardship initiatives across sectors, disciplines, and settings. Here I emphasize what Dr. Morris already mentioned, the area of inequity with the distribution of antimicrobial stewardship resources. There are fantastic centres of excellence within Canada, but it is not broadly available across all jurisdictions.
Working closely with the Public Health Agency and other partners and colleagues, the NCCID is able to convene and host in-person meetings across federal, provincial, and territorial jurisdictions and ensures the involvement of other agencies within the health portfolio.
Last year, in June 2016, NCCID co-hosted a national round table of antimicrobial stewardship leading to the development of a national action plan, “Putting the Pieces Together”, and to the establishment of AMS Canada, a national network of key stewardship experts and stakeholders co-chaired by NCCID.
Within two months of the round table and before AMS Canada formally released the action plan, we embarked on new work to bring evidence and other knowledge about stewardship to public health. The work is predicated on the critical role that public health has to play in controlling the emergence and spread of AMR. Public health partners with health care providers and facilities to promote education, surveillance, and prevention strategies. Public health has a strong role in planning infection prevention programs and strategies and is positioned to promote AMS across health care settings, particularly addressing known gaps in the deployment of community antimicrobial stewardship programs, rural settings, and in redressing inequities for structurally disadvantaged populations inadequately served by health systems.
I will highlight some examples of NCCID activities to inform and engage public health in addressing AMR. We have contributed to advancing public health professional knowledge of the burdens and drivers of AMR and to articulating the role in contributing to efforts to control AMR. In 2016 we commissioned two new reviews. One examines the role of animal and human health care in growing resistance globally and in Canada. The other provides a glossary to encourage shared understanding of the terminology.
Earlier this year we hosted a series of presentations at Public Health 2017 and brought antimicrobial resistance and stewardship to the forefront of this annual conference. The two documents will be circulated for those who are interested.
The NCCID models the public health sector's role in convening interdisciplinary knowledge exchange on sound and evidence-based AMS programs by providing opportunities for practitioners, researchers, and program planners to inform one another on successes and challenges in the regions or institutions specific to antimicrobial stewardship programs. For example, during the meeting in 2017, we hosted an Atlantic region stakeholder meeting, including a live webinar broadcast to exchange knowledge. Later this month we will be co-hosting accredited continuing education and training sessions for physicians, pharmacists, and nurses to open a dialogue on ways forward to improve the appropriate use of prescribing antimicrobials.
As another knowledge strategy, we have documented strategies that have been useful and have worked in Alberta to develop a provincial stewardship program, in an easy to read case study that is shared with other jurisdictions. The projects have helped to document challenges, gaps, and capacities for stewardship at national, provincial, and regional levels. These have included helping to convene exchanges in the Atlantic region, and we have worked with a proof of concept in a regional health authority in Manitoba, trying to use tools developed in other jurisdictions to implement an antimicrobial stewardship program.
As already mentioned, similar themes and challenges are emerging. There's a need for IT infrastructure, and there's inadequate capacity for developing metrics and analytics for antimicrobial use and resistance. There's an interest in obtaining readily available materials for practitioners and for patients...appropriate leadership to allow physicians and pharmacy partnerships. The lack of guidelines and access to existing guidelines was already mentioned.
We intend to analyze the distribution of stewardship programs, including how well stewardship is understood and implemented in rural and first nation communities, as well as the availability of materials and resources for francophone users.
Part of our role for the AMS stewardship program is fostering development in a community setting, including long-term care and continuing care, leveraging existing strengths and expertise from acute care settings such the Sinai Health System and University Health Network in Toronto, as was described.
We engage senior leaders and public health professionals to help situate information for use in a public health setting. An example is a webinar planned for later this month to feature the business case model for a stewardship program in acute care developed by the Association of Medical Microbiology and Infectious Disease Canada. This webinar will clarify the essential elements of a quality program with resources that are needed for effective stewardship. A senior public health physician will discuss helping public health physicians and trainees to understand the public health role, and applications for planning similar programs in the community.
In the past year, in partnership with Do Bugs Need Drugs? and Alberta Health Services, we are fostering a growing community of practice, or a network of practitioners and decision-makers who are keenly interested in understanding how to develop and implement AMS programs tailored to distinct contexts of long-term care and nursing homes—a huge gap. A series of webinars provides a platform to build relationships and foster dialogue. The first webinar was a testament to the acuity of the need, with an overwhelming response and 350 registrants.
NCCID has supported the development and dissemination of public education tools, particularly to primary care physicians, educating patients about necessary antibiotic use. We've revised and actively promoted our popular non-prescribing prescription pads, adding one that is for parents of young children. Working with regional health in Manitoba, we've helped adapt their own viral prescription pad and entered it into their electronic medical system.
Other collaborative efforts for awareness building include a national social media campaign and efforts for public health prescribers to coordinate and share consistent messaging. These efforts can lead to a more systematic, coordinated effort of awareness building, leveraging partners' positions to reach the various audiences.
This requires alignment through a proactive Canada-led plan. We see a need to get beyond Antibiotic Awareness Week to arrive at a more integrated strategy to build knowledge for changing prescribing habits.
Currently NCCID is assessing how well public health personnel can obtain and understand data of antimicrobial resistance surveillance in Canada. It is our intention to work with partners and to connect public health to data managers, perhaps ultimately leading to versions that public health can use for planning responses. Currently the surveillance data, as mentioned by Dr. Morris, is siloed and barely comprehensible.
Last, as a result of the activities across Canada fostering public health involvement and stewardship and reducing resistance, we're working with colleagues on applications for a national centre of excellence that can continue to sustain the efforts to combat antimicrobial resistance.
In summary, we see a continued need for strong leadership at the federal level. As mentioned earlier, this leadership needs to come with funding to adequately resource development implementation and the scaling up of programs. We need support for the national coordination of stewardship, to make sure that the endeavours that have already begun are continued, and public health leadership in planning, to improve the breadth of the initiatives, including ongoing recognition of the importance of public health and population health interests beyond the involvement with just their clinical and acute care settings.
Thank you.