Health Committee on Nov. 9th, 2017

[The Chair, Liberal, Bill Casey]

We'll call meeting number 78 of the Standing Committee on Health to order.

We're very pleased to have you here as witnesses. We're looking forward to your testimony. Hopefully you can help us find our way through this antimicrobial study.

Our guests today include, from the Canadian Veterinary Medical Association, Dr. Duane Landals, chair of the prudent use guidelines expert advisory group. We have from the Chicken Farmers of Canada Mr. Steve Leech, national program manager, food safety and animal welfare. From the National Farmed Animal Health and Welfare Council we have Mr. Robert McNabb, co-chair. As an individual, we have Dr. Scott McEwen, professor at the Ontario Veterinary College, University of Guelph.

I welcome you all. We're going to ask each of you to make an opening statement of a maximum of 10 minutes. Then we'll go to questions from our members. Hopefully, we'll learn a lot from you today. I'm sure we will.

We'll start with Dr. Landals.

[Dr. Duane Landals, Chair, Prudent Use Guidelines Expert Advisory Group, Canadian Veterinary Medical Association]

Thank you very much, Mr. Chair and committee. Thank you for this opportunity to present to you today on this very important topic.

I am representing the Canadian Veterinary Medical Association. With your indulgence—I know the time is limited—I'm going to follow my speaking notes fairly closely, for two reasons: one, to keep me on track so that I don't digress, but also for the translators, because I have a tendency to speak rather rapidly. I'll try to avoid that for the translators; however, I want you to know for sure that I'm willing at any point in time to interrupt to answer questions or elaborate on some of the points of my presentation.

As a short introduction, I am a member of the Canadian Veterinary Medical Association's pharmaceutical stewardship advisory group. I also chair the multi-sectoral antimicrobial surveillance expert advisory group for that organization. I am a past president of the CVMA and a past president of the Alberta Veterinary Medical Association. I have also served two terms as vice-president of the World Veterinary Association, so antimicrobial use has been quite a bit in my blood.

I am a veterinarian. I owned and worked in a rural mixed practice in Alberta for 35 years. I practised as a clinical veterinarian for 25 years and spent 14 years working for the Alberta Veterinary Medical Association, which is the professional regulatory organization responsible for the practice of veterinary medicine under provincial statute. Some of my views are thus from both a regulator's point of view as well as a practitioner's perspective.

Our association, the CVMA, provides a national and international forum for 7,200 veterinarians working in all of Canada's provinces and territories in private, generalist, and specialist practices, in research, as educators, and as public servants. In addition, we count 7,300 veterinarian technicians as affiliate members. Our members, as practitioners, provide services to pets, livestock, and all other animals and make our interests rather broad—into all species of animals. In addition to their contribution to public health and food safety, healthy and humanely raised animals are vital to Canada's reputation as a producer and exporter of billions of dollars in animals and products of animal origin.

In this industry, veterinarians provide unique expertise on the health and welfare of all types of animals, not just food-producing animals. We have expertise in areas of animal health and disease; an understanding of the biology of domesticated and wild animals; practical experience and understanding of the care and management of animals of all species; and practical experience in the recognition of signs of suffering in animals. Those are very important things, when we talk about the way we use pharmaceuticals in our industry.

The Canadian Veterinary Medical Association strongly supports the responsible use of antimicrobials by veterinary professionals to protect both animal and human health and welfare. Veterinarians are best positioned to assess the benefits and risks of antimicrobial use in animals and have a professional responsibility to explain to their clients the importance of judicious use of antimicrobials.

To conserve the efficacy of antimicrobial drugs, veterinarians strive to achieve a balance between maximizing animal health and welfare and minimizing antimicrobial resistance. There is the constant balance between what is the very best for the patient and what is best for the population in general, and those may be in conflict, not necessarily the same. It's the veterinarian's professional responsibility to look at both sides when making clinical judgments.

For over 20 years, the CVMA has been an advocate for federal regulatory and policy changes to enhance the responsible use of antimicrobials. In this regard, our association participates in national organizations, such as the National Farmed Animal Health and Welfare Council, who are here today, and Antimicrobial Stewardship Canada. These organizations have developed, in collaboration, antimicrobial resistance and antimicrobial use strategies. The key focus is antimicrobial resistance, but our efforts are around antimicrobial use so that we can mitigate antimicrobial resistance.

AMR, antimicrobial resistance, is an international issue. It does not know boundaries and it doesn't respect borders. On an international scale, our association is part of the Government of Canada's delegation to the OIE, the World Organisation for Animal Health. Both the OIE and the World Health Organization have stressed the importance of raising awareness of health risks posed by antibiotic resistance and promoting good practice in how we use these drugs to limit the emergence of antimicrobial resistance. We've also been involved in writing joint papers with the American Veterinary Medical Association and the Federation of Veterinarians of Europe, understanding that responsible use is not unique to one country or one jurisdiction.

We are strong supporters of One Health and we know the One Health model. International One Health Day was last week, and World Antibiotic Awareness Week is this upcoming week, from the 13th to the 19th. The CVMA supports these as great opportunities to help showcase the One Health approach to this important problem.

The One Health approach is an approach to medicine that recognizes that human health, animal health, and environment health are inextricably linked, that we all need to work together to resolve some of the major problems we have.

We believe that veterinarians and registered veterinary technologists have key roles to play in the health and welfare of animals and that they treat them in a manner that supports One Health. While our patients are animals, we're very concerned about the health of the human population as well.

We collaborate in recognizing that antimicrobial resistance is a growing threat in Canada, and I don't think we need to convince anybody in this room of that. It's in Canada and around the world. It's crucial that public health, veterinary, agricultural, and regulatory communities work together to minimize the emergence and continued spread of antimicrobial resistance. It's time we break down silos between our various departments and segments to get to a common goal. Our goal, and everyone's, is to mitigate any impact of resistance that antibiotics have on human health.

In some of our actions, the CVMA works with international and national partners to urge action on eliminating unnecessary antimicrobial use and improving stewardship in humans and animals; improving surveillance of antimicrobial resistance and antimicrobial use; preventing and controlling the spread of all infections, including those that are drug-resistant; and stimulating research and innovation.

We have developed a number of activities. In 2017 we facilitated a workshop on the foundational work to build a national system of surveillance of antimicrobial use in animals by the veterinary community. This was funded by the Canadian Food Inspection Agency with in-kind support from our association. Key partners in animal health, including producer groups and human health practitioners, were involved in looking at how we can collect data to get a better understanding of the existing state of antimicrobial surveillance so that we can understand what the uses are in the veterinary or animal health context.

I chaired that workshop. We felt and hoped that the workshop was a phase one of a multi-year project to get to a point at which we can have a better understanding of the level of use, the reasons, and the use in different species of these products, which is information that is not readily available in Canada right now.

In a separate project funded by Agriculture and Agri-Food Canada, we started to review our prudent use guidelines. These were published by the CVMA in 2008 to help practitioners do an appropriate job when they decided to use an antimicrobial—when they should use them and how they should them. We're updating these and extending them to six sectors across the industry: swine, poultry, beef, dairy, small ruminants, and companion animals. We hope to have a pilot prototype toolset to review the effectiveness of the guidelines before we move forward in expanding that project. The participants in that workshop were Canadian veterinarians, veterinary researchers, educators, and government officials.

I have personally been working on a separate project with the CVMA looking at the use of antimicrobials and providing guidelines for veterinary care of honeybees. When we expand our control of antimicrobial use there may be many unintended consequences and things we haven't thought of in honeybees, aquarium fish, and some of these other species. Obviously the ones we capture with a net are very important to deal with, but may not have been on the table with the mainstream commodity groups that we think of regularly.

In following up on the Canadian government's platform for a pan-Canadian framework, the CVMA worked hard developing a doctrine that we call the “Veterinary Oversight of Antimicrobial Use—A Pan-Canadian Framework for Professional Standards for Veterinarians”. In 2016, we developed this document in partnership with the Canadian Council of Veterinary Registrars.

Again recognizing that veterinary medicine is regulated provincially, we have different practice standards among provinces and need to get to a national goal. These need to be brought together and harmonized. We spent a lot of time working on this doctrine and helped provide some guidance for the provincial regulatory bodies so that, when they put standards of practice in place for veterinarians on how they prescribe, dispense, or use pharmaceuticals—and antimicrobials particularly—we have some commonality among the provinces and territories.

We believe that of all of these initiatives together the CVMA will be part and will support or guide the evolution of veterinary oversight of antimicrobial use in Canada over the next several years. The Canadian Animal Health Products Regulatory Advisory Committee, of which the CVMA is a member, participates with the drug industry, food industry, feed producers, Health Canada, and the Canadian Food Inspection Agency in addressing the planning, implementation, and the potential impacts of the regulatory changes as we move medically important antimicrobials to the Prescription Drug List in 2018.

It's a very significant change for the animal health and veterinary industry. It's important that we have strategies in place, and communication strategies, to ensure that we can do this properly and get to the goal we want, which is ultimately eliminating the unnecessary use of antimicrobials and evaluating when we use them, why we use them, and making sure we're doing it properly.

Communication is going to be a very important part of that, and the veterinary drug directorate of Health Canada has agreed to develop a landing page for information and to give us updates and time frames on what the changes are and keep individual sectors current. As well, the Canadian Veterinary Medical Association is committed to ensuring that veterinarians are up to date on all the changes as they come in place and what implementations they need to do.

Through the One Health approach, the CVMA feels that we can really help Canada achieve its goals in our “Federal Action Plan on Antimicrobial Resistance and Use in Canada: Building on the Federal Framework for Action.” CVMA is a national organization, but we work with provincial veterinary groups. It's very important as we move forward to make sure we get those collaborations together.

In closing, we're encouraged by the Canadian government's involvement in this. We're very happy to present to the committee today. Thank you very much.

We really look forward to further federal government leadership in areas about enhancing partnerships with stakeholders, coordination amongst stakeholders, and coordination between provinces and territories as we move forward with a very important national initiative. We won't get to our common goals without that help and support, so thank you for your attendance and your time.

[The Chair, Liberal, Bill Casey]

Thank you very much.

Now we go to the Chicken Farmers of Canada and Mr. Leech.

[Steve Leech, National Program Manager, Food Safety and Animal Welfare, Chicken Farmers of Canada]

Thank you very much.

Chicken Farmers of Canada appreciates the opportunity to speak to the Standing Committee on Health regarding antimicrobial resistance. Canada’s 2,800 chicken farmers are engaged on the issues of antimicrobial resistance and use, and we take that responsibility quite seriously.

For years, Chicken Farmers of Canada has actively engaged with stakeholders to implement initiatives with respect to antimicrobial use, to be able to demonstrate the responsible use of antimicrobials within the Canadian chicken sector. Our commitment to antimicrobial resistance is demonstrated by our actions, including taking the steps to eliminate the preventive use of antibiotics of importance to humans.

CFC has implemented an AMU strategy in conjunction with our industry partners, and the four guiding principles to that are reduction, surveillance, stewardship, and research. I'll touch on each of those over the next few minutes. This strategy, covering all chicken raised in Canada, works in collaboration with the pan-Canadian framework on antimicrobial resistance and use in order to achieve common objectives held by the government and by industry. Our farmers are proud of the work they're doing and the fact that this helps to achieve the government objectives as well.

While we have established a reduction strategy, it's important to note that antimicrobials are and will continue to be essential tools to protect the health of animals and the safety of our food supply. If our birds and our flocks get sick, we need an ability to be able to treat those birds. Our strategy provides a sustainable means of meeting expectations while at the same time meeting animal health objectives.

Our reduction strategy is a phased strategy with three steps. The first step was to eliminate the preventive use of category I antibiotics, those that are most important to humans. That was done in May 2014, and through surveillance from the Public Health Agency of Canada we have been able to demonstrate that it has been an effective ban.

The second step to our strategy is to eliminate the preventive use of category II antibiotics by the end of 2018. It will be followed by the third step, which is an intention to eliminate the preventive use of category III antibiotics by the end of 2020.

This strategy will continue to allow for the use of antibiotics to treat disease, and in fact that is a cornerstone of our strategy. There are markets for “raised without the use of antibiotics” products, but it's our opinion that this is not sustainable for the entire industry. Antibiotics will continue to play an important role, and that's why our strategy focuses on prevention rather than full elimination.

The second part of our strategy is stewardship, which is a key and important aspect on the farm and involves a number of different aspects, from responsible use through to infection control.

On the infection control side, CFC's raised by a Canadian farmer on-farm food safety program, which is a program recognized by the federal, provincial, and territorial governments, is a complete set of biosecurity, cleaning, disinfection, and pathogen reduction standards that are mandatory for all chicken farmers across Canada. This is a compulsory program that is enforced using the authorities provided under supply management.

From a federal government regulatory perspective, CFC is collaborating with and supporting Health Canada as it moves forward to implement some of the initiatives that you have heard about, which promote greater oversight of antimicrobial use within agriculture.

Of most importance from a stewardship perspective, Canadian farmers need access to the same tools that our international competitors have. Unfortunately, that's not the case right now. When we look at putting in place reduction strategies, we look at using different tools, feed alternatives, and these types of things. Unfortunately, Canadian farmers don't have access to the products that are available in Europe or even in the United States. An example of this would be probiotics.

While these products that we're talking about are not alternatives—they're not full replacements; there is no silver bullet—they are an important tool in our tool box as we move forward, because we have seen them be successful in other jurisdictions. That is why Chicken Farmers of Canada strongly recommends that there be an expedited priority to the current government initiative between the Canadian Food Inspection Agency and Health Canada to help rectify this problem. Providing the solution by allowing more products onto the market would bring us more in line with international competitors, and it would help meet our common objectives of antimicrobial use and resistance.

To turn our attention to surveillance for a moment, surveillance of antimicrobial resistance and use is integral to increasing our knowledge and understanding the impacts of use, and to help guide both industry and government policy initiatives.

CFC has been collaborating with the Public Health Agency of Canada on surveillance initiatives for a number of years, both on antimicrobial use and resistance levels. As I mentioned, some of that research was able to demonstrate the effectiveness of the industry ban on the preventive use of category I antibiotics.

The work that CIPARS is doing through the Public Health Agency of Canada is critical to Canadian agriculture, but we would recommend even more attention be placed on surveillance in order to better track trends in antimicrobial use and resistance, and the reasons for these trends. Increasing the number of samples and the number of sample sites will provide greater validity and credibility to the results coming from CIPARS, and will also provide greater insight into the trends that are being observed and the potential reasons for those trends. AMR can be a very confusing puzzle, and proper surveillance will help Canada develop appropriate stewardship policies. That's needed at an increasing level as we move forward through our reduction strategy, but also the pan-Canadian framework.

On the research and innovation side, going forward, research and the commercialization of those results will become increasingly important. CFC contributes research funding through the Canadian Poultry Research Council. From an antimicrobial use perspective, we've focused our attention on feed alternatives, vaccine development, biosecurity, chick quality, management practices, and these types of things, which have an integral part to play in our strategy. Over half of our funding that we put towards research goes to issues of antimicrobial use and resistance.

Right now, the industry is actively participating in Agriculture and Agri-Food Canada's Canadian agricultural partnership research cluster, which is a five-year research program starting in 2018. For our part, we'll be contributing $500,000, with a priority being placed on antimicrobial use, resistance, and vaccine development, as I indicated.

As Canada progresses through this strategy, continued involvement from the federal government in conjunction with industry—both through grant programs and Ag Canada researchers—will be required to foster the innovation that's needed to get us to our end point. As a recommendation, we ask the committee to stay on top of the partners to ensure that funding and support for this progress and innovative research continues.

Lastly, as we focus on Canada's use and reduction strategy, we must always enter the open lines of communication and dialogue with our most important audience: Canadian consumers. It's a very important piece of the puzzle as we move through. From an agricultural standpoint, an important core message for consumers is not to confuse the issues of antimicrobial resistance with that of antimicrobial residues. Often, that is a confusion, and it's really important to make sure that doesn't happen in order to ensure continued confidence in our food supply.

Through various social and traditional communication outlets, Chicken Farmers of Canada has been reaching consumers with important messages about our food and the food supply. Antimicrobial use and resistance has been an important part of that, explaining how antimicrobials are used in agriculture and getting that out through different venues. We need support from government and those outside the food production industry to support those messages and continue that trust in the Canadian food supply that I spoke about.

In conclusion, the CFC has established a responsible antimicrobial use strategy and reduction timelines to give assurances about the sustainability of the Canadian chicken sector. We're confident in the actions that we've put in place to focus our attention on the elimination of the preventive use of antibiotics of human importance while maintaining the use of antibiotics to treat diseases. CFC’s leadership in antimicrobial resistance and use will continue to evolve as we commit to working with industry stakeholders and the government on this file as it moves forward.

Thank you. I look forward to your questions.

[The Chair, Liberal, Bill Casey]

Thank you very much.

Now we'll go to the National Farmed Animal Health and Welfare Council.

Mr. McNabb.

[Robert McNabb, Co-Chair, National Farmed Animal Health and Welfare Council]

Thank you very much for the opportunity to appear before this committee. I am the industry co-chair of the National Farmed Animal Health and Welfare Council.

The council was formed in 2010 out of an action item from the strategy by the same name that was developed in 2009. Subsequently it was designated as a subcommittee of the FPT Regulatory ADMs of Agriculture Committee.

The council is made up of three primary partner groups from different departments within the federal government, representatives from the provincial governments, and non-government organizations such as CVMA and a number of commodity groups, as well as academic institutions.

The council considers issues in a One Health context. In the agriculture community, that also includes the economic health of our constituents, but its primary focus, of course, is public health, animal health, and environmental health. The council supports a collaborative approach to issues of importance to animal agriculture, recognizing the roles and authorities of the respective organizations; the federal, provincial, and territorial governments; and the industry itself.

We provide advice to our constituents, primarily reporting through the FPT regulatory ADMs and identifying where we can organizations or individuals that could perhaps lead in some of the actions we recommend.

On antimicrobial resistance specifically, the council has completed three reports between 2012 and 2016. This reflects, we believe, the council's recognition that AMR is a global and urgent issue.

The first report was “Antimicrobial Resistance and Antimicrobial Use Initiatives in Humans and Animals in Canada”. It was published in 2012, and it's a collection and categorization of antimicrobial resistance initiatives in Canada in both human and animal medicine.

The second study was “Antimicrobial Use and Antimicrobial Resistance—Strategies for Animal Agriculture”, in 2014. It provided eight recommendations, many of which have been achieved, including a meeting of both human medicine and animal agriculture, which was hosted by the Public Health Agency of Canada in 2015.

Our last and most recent publication was “Antimicrobial Stewardship in Food Animals in Canada”, in 2016. That report focuses primarily on stewardship, which in animal agriculture includes infection prevention and control. It also recognizes the importance of surveillance and innovation in successful AMR intervention.

How do we define antimicrobial stewardship? There are a number of definitions, but the one we've captured in our documents is that antimicrobial stewardship is an active, dynamic process of continuous improvement. It involves coordinated interventions designed to promote, improve, monitor, and evaluate the judicious use of antimicrobials so as to preserve their future effectiveness and promote and protect human and animal health. It includes a 5R approach of responsibility, reduction, refinement, replacement, and review.

The concept and practice of antimicrobial stewardship continues to evolve in human and veterinary medicine. It is generally accepted that it will be the cumulative impact of numerous interventions or actions that will have a positive impact on reducing antimicrobial resistance.

Antimicrobials are important in animal agriculture. Modern medicine for both humans and animals is based on the availability of effective antimicrobials. The continuing efficacy of antimicrobials is important in animal agriculture, both in disease control and related animal welfare considerations.

There is growing concern about resistance of bacteria to antimicrobials, and the impact of such resistance to human and animal health. This is of particular concern in the case of those antimicrobials, as has already been outlined, that are important in human medicine.

We strongly believe the cornerstone of our stewardship efforts is that they should be used judiciously and prudently. Animal agriculture provides safe food for Canadians, as well as exporting both live animals and animal products around the world. Animal agriculture creates employment in rural communities and supports a number of sectors.

Throughout its history, Canadian animal agriculture has demonstrated that it can and will progressively adapt and change practices with changing knowledge and technology. We respond actively to societal imperatives. Canada has a strong network of veterinary practitioners—as was recently evaluated by the OIE, the global organization for animal health—with a profound knowledge of animal agriculture.

We believe that stewardship is a shared responsibility in national producer organizations. Sustainability and on-farm food safety programs are the cornerstone of delivering the message and the wherewithal to producers on how to implement judicious and prudent use of antimicrobials.

Producers, individually, can do a number of things in reducing the use and the need for antimicrobials, namely biosecurity, genetic selection for disease resistance, nutrition, housing, various management practices, and some of the alternatives that my colleague mentioned earlier.

For veterinarians, we've heard from the CVMA, as well as their respective provincial licensing bodies. They have a very significant role in the oversight of the use of antimicrobials.

As we move forward, there are other leadership opportunities that we recognize and that we will undertake to review. There's opportunity for all stakeholders to demonstrate their leadership in their various sectors. There are a great many activities on many fronts. It's framed by the pan-Canadian framework for antimicrobial use and resistance, and the action plan is currently under development. The council is demonstrating, through its own leadership, and ensuring that antimicrobial resistance is the centre stage at our annual forum—and has been since 2013. We did actively participate in the development of the pan-Canadian framework. We take any opportunity that we can.

Communication, as was mentioned, is going to be key—communication to build awareness and some of the extension and education and training for producers, veterinarians, and others in this sector—to the stewardship of antimicrobials.

Partnership is a big part of that, which is primarily led by the Public Health Agency, in developing that pan-Canadian action plan.

Research and innovation has been mentioned and alternatives to antimicrobials and risk mitigation tools are going to be needed. Reducing the need for antimicrobials in an investigation of those alternative production systems will be important. Research is a cornerstone of that.

Surveillance was mentioned, and we, too, support the enhancement of surveillance on the use and the resistance of antimicrobials.

There's an organization called the Canadian Global Food Animal Residue Avoidance Databank, which has a tool that veterinarians can access, and we believe that it can play a key role in providing advice beyond the current mandate that it has right now.

Finally, there is assessing regulatory needs required to create a change in the production environment and other activities that we have partnered with through the CAHPRAC organization that Dr. Landals mentioned.

In conclusion, I'd like to say that the council has taken this responsibility very seriously, and our ultimate objective is to ensure that antimicrobials that are available for the treatment of disease in both animals and humans remain effective.

Thank you.

[The Chair, Liberal, Bill Casey]

Thank you very much.

Now we'll go to Dr. McEwen, representing the Ontario Veterinary College.

[Dr. Scott McEwen, Professor, Ontario Veterinary College, University of Guelph, As an Individual]

Good afternoon, and thank you for the invitation to appear before you to discuss antimicrobial resistance.

I'm a veterinarian by training, and an academic by occupation. I've worked on AMR for many years as a researcher and consultant with several public health organizations in Canada and abroad, particularly over the last 20 years with the World Health Organization, but I don't represent any organization or group today.

Antimicrobials are used in animals for the treatment, prevention, and control of bacterial infections and in some species for growth promotion. The majority of antimicrobials used in animals are medically important, that is, they are members of drug classes that are also used in humans.

The AMR threat is perceived to be most acute in human medicine, but it does affect all sectors. Concerns about antimicrobial use in animals are not new. Since the early 1960s there have been numerous expert reports calling for restrictions in order to protect human health, particularly regarding the widespread use of medically important antimicrobials in livestock feed for growth promotion and disease prevention. The need to avert a public health crisis is the main driver for calls to action on AMR. While there are some important pathogens of animals for which AMR is a growing problem, generally speaking, there's not been a sense of impending AMR crisis in veterinary medicine.

Twenty years ago, I detected a perception among some in the veterinary and farming communities that AMR, particularly as it impacted human health, was not their problem. This is changing, I'm pleased to say. There's a growing awareness, particularly, but not exclusively, in the scientific arena that antimicrobial use in any sector—veterinary medicine, human medicine, plant and animal agriculture—can select for resistance in any other sector, given the ease with which resistance spreads.

Decades of research and surveillance have helped us to better understand the human health impact of antimicrobial use in animals. While we probably will never fully understand the overall magnitude of the impact, the available evidence shows that such use contributes to the selection and spread of AMR among food-borne pathogens of humans for which there is an animal reservoir, for example, the salmonella and campylobacter species. It also selects for resistance in many other bacterial species that may either be opportunistic pathogens of humans, such as E. coli and enterococcus, or donors of resistance genes for other bacteria.

While antimicrobial use in both food-producing and companion animals contributes to AMR, concerns are greatest for food-producing animals due to the much larger volumes of drugs used in that sector and the efficiency with which bacteria are transmitted through the food chain, despite our best efforts to control them.

I think it's important to recognize that the Government of Canada has already made some significant accomplishments in addressing the problem of AMR from animals. When as a researcher I began to study AMR in the late 1980s, Canada, like most other countries, was doing very little in the veterinary and agriculture sectors to address AMR problems, even though they were known to exist. Regulatory, food safety, and animal production quality assurance efforts focused almost entirely on the prevention of harmful veterinary drug residues in foods from animals and not on resistance.

In the 1990s and early 2000s, as resistance concerns came to the fore internationally, Health Canada, including what is now the Public Health Agency of Canada, responded by including AMR in the human safety evaluation of new veterinary antimicrobials, and by creating the Canadian integrated program for antimicrobial resistance surveillance, or CIPARS.

In 1999, Health Canada formed an advisory committee on animal uses of antimicrobials and impact on resistance and human health. In 2002, this committee issued a report with 38 recommendations. I've gone over them, and by my estimation, 34 have been implemented over the last 15 years or are part of Health Canada's current strategy to improve stewardship. These address a wide range of matters, including AMR stewardship, antimicrobial stewardship surveillance, infection prevention and control, as well as research and innovation. I think this is significant progress.

In my opinion, the veterinary drugs directorate within Health Canada performs its challenging mandate quite well, especially considering the constraints placed by our federal system of government. VDD should be commended for the progress it has made in improving the regulation of antimicrobial drugs as it pertains to resistance.

Secondly, CIPARS performs critically important AMR and antimicrobial use surveillance functions for Canada. As you've heard, surveillance provides information that is absolutely essential for identifying where the resistance problems are, what actions need to be taken to address these problems, and what effects these actions are having on resistance outcomes. CIPARS is performing these functions very well.

It should be pointed out as well that scientists within CIPARS and VDD make very important contributions to international efforts to address AMR by working with their sister organizations in Europe, the United States, and elsewhere, and through key international organizations like WHO, OIE, and Codex Alimentarius.

Notwithstanding these accomplishments, I believe much more can be done by our federal government to address the problem of AMR. Most importantly, the government should provide strong national leadership that recognizes that AMR is a very serious global public health problem for which action is needed in both public and private sectors. The federal government should ensure that appropriate national-level public sector actions are taken to address this problem and that there is overall coordination with partners in provinces and territories, and with industry and the health professions.

In August of this year, the pan-Canadian framework for action was published. The framework recognizes the One Health dimensions of AMR, and was developed with input from a wide range of stakeholders and experts. I think it's comprehensive and thorough. It addresses the most important pillars of stewardship, surveillance, infection prevention, and research. But there is urgent need for an accompanying plan of action with deliverables, outcomes, and time frames. In my opinion, it's most urgent to preserve the effectiveness of medically important antimicrobials. This requires improved stewardship in all sectors, including veterinary medicine and agriculture. There are numerous approaches to achieving this, but there are two that I would draw special attention to—namely, setting national targets for reduction in overall consumption of medically important antimicrobials in animals, and establishing additional restrictions on the use of these antimicrobials in animals.

Some European countries, such as France, the Netherlands, and the United Kingdom, have made up to 50% reductions in consumption of these antimicrobials in animals by setting national targets and, in the case of the Netherlands and Denmark, by measuring antimicrobial consumption at the farm and veterinary clinic levels and implementing strategies to encourage veterinarians and farmers to do their part to meet these targets.

The recently developed evidence-based WHO guidelines on the use of medically important antimicrobials in food-producing animals—the guidelines were released just a couple of days ago—identify several important restrictions on the use of these antimicrobials in animals, restrictions that should be implemented in all countries, including Canada. There is clear evidence that reducing antimicrobial use reduces antimicrobial resistance. Several European countries with strong surveillance systems have shown that restrictions on the use of antimicrobials for growth promotion, disease prevention, and treatment are effective, and have relatively minor negative effects on therapeutic antibiotic use, food-producing animal productivity, animal health and welfare, food safety, the environment, and the economy.

Thank you very much.

[The Chair, Liberal, Bill Casey]

Thank you.

I have to tell you that from a layman's point of view, I am impressed with the length and depth of the knowledge and with how much you've been involved with this subject for so long.

We'll go to questions now. We'll start our seven-minute round with Mr. McKinnon.

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

Thank you, Chair.

In our discussions with witnesses speaking to us in regard to medical uses, what came up over and over was the need for a national coordinating organization establishing national standards, national protocols, and so forth for testing and surveillance. It sounds to me like you're all recommending the same sort of approach for animal medicine as well. Is that true?

[Dr. Duane Landals]

Yes, absolutely. There's surveillance of resistance and surveillance of use. They are slightly different. We tend to lump them together. I think there is a need for both. Certainly in our workshop we were in agreement that we would like to see surveillance for a better understanding of what antimicrobials are used, where they're used, and why they're used, as opposed to the primary data we now have, which is what is being sold at the wholesale level. You don't know the specific implications of that. I think better data needs to be there so that we can measure what's being used. If we target reductions, we'll know we're making reductions, for what reasons, and where they're at.

There absolutely is a need for improved surveillance of use at some level on the chain beyond the wholesale level, such as at the veterinary use or end-user level.

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

Would anybody else like to comment?

[Steve Leech]

I think the good news here is that there is already a lot in place. We spoke about the Canadian integrated program for antimicrobial resistance surveillance, which is a surveillance program out of the Public Health Agency of Canada that has been in place for over a decade. It started out just looking at resistance levels, but they are also looking at on-farm use levels of antibiotics. There has been a lot developed there. A relationship has been built in terms of how this surveillance can be done and how the data can be analyzed. I think that has been an important vehicle for both industry and government to understand from a credible data source.

From our perspective, we would like to see that expanded. It is in a small number of sites. We are looking at the need to increase the amount of surveillance that's done, especially as we move through the pan-Canadian framework, and really try to understand some of the resistance trends that we see out there and why we see differences in some provinces and regions. That's an integral part of the strategy moving forward, and we need to continue that support for surveillance.

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

Excellent.

Is there anybody else?

[Robert McNabb]

I would simply concur with what has been stated. We have been advocating for both expanding the mandate and increasing the capacity for CIPARS under the Public Health Agency for a number of years now.

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

Would you see this surveillance and coordination system as a separate system, or should it be part of the same system that one might envision for medical use as well?

[Dr. Duane Landals]

I think there are enough differences in the systems and in the activities of the sectors that it would be difficult to coordinate them. The human medical side has standard prescriptions that go to pharmacists, and it has a number of data collection points that are already in place. That's different from how antimicrobials are prescribed, dispensed, distributed, and used in animal health. I don't know if it could be the same system, although there is obviously a need for some parallels.

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

Do they not need to be tracking the same kind of information, what antibiotics are in use for what purpose?

[Dr. Duane Landals]

You are tracking for some of the same purposes. I don't know if it's a difference in.... Maybe some of the other panellists can comment, too.

One of the challenges we have in animal use is getting to a common basis of what the products are. If you are treating a chicken and a cow, there is a big difference in the mass of the animal and the amount of antibiotic. First, you need to come to some system of standardized daily dosing, or something, so you get levels that are realistically comparative. I don't think that's as big a challenge on the human side; it's a little different.

The outcome is that you want to know what drugs are being used, why they are being used, and at what points you might intervene to implement a reduction.

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

Mr. Leech, it seems to me that you are suggesting—and Dr. Landals as well—that you need data captured at the producer level as well. Would that be true?

[Steve Leech]

Definitely.

I think the methods of data collection would be different between animals and humans. On the animal side, we have focused on collecting that information right on the farm level. That's where the most credible data occurs. There are a couple of different reasons for collecting the information on the agriculture side. One is, obviously, to figure out use and use trends, but also, now that we are at the stage of implementing reduction strategies, to determine the impact of those strategies.

As I indicated, the Public Health Agency of Canada reports have helped monitor the success of our ban on category I for preventive use. That will be needed going forward. That's one reason why we need to expand the surveillance, to make sure that we are covering the whole country and to understand what's going on in the domestic market.

I think there is also a comparison that needs to be made between animal and human use to understand the differences. From the CIPARS studies, we know that the types of antibiotics used in poultry production are different from those used in humans. The most frequently used antibiotics on the human side, the fluoroquinolones and the cephalosporins, are not being used in poultry production. Those are very important aspects to understand when you are looking at resistance patterns, the impact of agriculture, and the interaction with humans.

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

I wonder, Dr. Landals—and perhaps Dr. McEwen—if you could comment more on the interaction between animals and humans in terms of antimicrobial resistance and how one affects the other.

[Dr. Duane Landals]

I'll let Scott start with that. He's the expert.

[Dr. Scott McEwen]

As I said in my opening remarks, the scientific evidence suggests the major contributions to antimicrobial resistance problems in people, which arise from animals and animal uses of these drugs, are the food-borne enteric bacteria. They're common food-borne pathogens like salmonella and E. coli, which have campylobacter, which tend to have an animal reservoir. That's the best documented set of organisms for which we identify the resistance flowing through the animal production and food chain system, but there are others that are there.

Recently, over the past eight to 10 years, there has been an emergence of methicillin-resistant Staphylococcus aureus, which is a common human pathogen, but there is an animal-adapted strain that's spread around the world and is becoming more prevalent in production animal species as well as in horses and sometimes in pets.

There is recent data that just came out from Europe this week that indicates it's increasing its presence in human disease in Europe. So there are some other pathogens that flow from farm animals and from pets and horses, but there is a large component of resistance, which is a bit of a black box. It includes an environmental reservoir, as well as organisms that we don't monitor in our surveillance programs that well, which harbour resistance genes, and which act as donors of those genes for pathogens of animals and people.

As I said, I don't think we'll ever find out what the actual magnitude of the impact is from the animal sector on people, but it contributes through those various ways.

[The Chair, Liberal, Bill Casey]

Thanks very much.

Ms. Gladu, go ahead.