Health Committee on Nov. 9th, 2017

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Thank you to our witnesses for all of your work and your information.

I'm quite impressed with the way that you are far down the path in coming to a standardized approach. Specifically, Mr. Leech, you talked about the phased strategy of the category I antibiotics that were eliminated, the preventive category II and the date that will happen, and that you have these protocols and standards.

We heard testimony from people who were speaking about human antimicrobial resistance, and it was clear that globally there wasn't a protocol, it was very complicated, and then they weren't anywhere near where you are in terms of having a plan.

I wondered if you could comment, any of you who know, whether it is the same kind of thorough plan across all industries or whether it is just with the chicken industry.

[Robert McNabb]

I'll perhaps start, representing a number of the commodities. Of all the food-producing groups, they are all very conscious of the issue and, of course, have been part of the consultations on some of the regulatory changes that are upcoming, including the movement to prescription-only for categories I, II, and III.

As was alluded to, they've all had an on-farm food safety program for, I would suggest, the better part of 15 to 20 years. Those are evolving into much more comprehensive programs of sustainability. So it's consciousness of not only food safety, but environmental protection, and the community, which includes human health.

As information and tools are provided to them, they're adapting it to their production systems.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Very good.

We heard testimony from Dr. Neil Rau, who said that when he considers the antimicrobial situation in Canada and the deaths from resistance, he doesn't see that animal microbial resistance is a huge factor here, but he did say that in many countries across the world, it is of larger concern.

Innocently, I thought, if we import meats and products from those from other countries, is there a risk? Could you comment?

[Dr. Duane Landals]

I'll start, if I may. I believe there is a risk and, as he said, antimicrobial resistance doesn't know any boundaries. If one country in the world is producing a lot of resistant superbugs, they're going to get elsewhere in the world very rapidly. I think that Canada needs to do what Canada needs to do, because that's our jurisdiction, but we also need to interact with the international community and ensure that there's a global plan to address resistance.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Do we know where the areas of problem are?

[Dr. Scott McEwen]

I'm not aware of any data that indicates that there is a greater problem from the animal sector in other countries than there is in Canada, but I can understand where the impression would come from, because we've had some events and cases in which there has been global spread. The most recent of these involves resistance to a drug called colistin. This is a drug that is not used much in Canada. We have some data to indicate that comparatively little is used here. It was used in large quantities in animal agriculture in other parts of the world including Europe and China and some other regions.

There was a strain of bacteria, in the family Enterobacteriaceae, that had resistance to this drug, and it was on a transmissible element that made it highly mobile. There was a lot of concern about this, because this drug has become a treatment of last resort for a very important set of pathogenic organisms within this group, Enterobacteriaceae, which had become resistant to carbapenems and other important drugs of humans.

There are some parts of the world, such as Brazil and other areas, where colistin is the last drug they have for critically ill patients. Their evidence has demonstrated that this probably emerged in China—though nobody really knows— because it's a very large country; it has the biggest pig population in the world; and they're using very large quantities of colistin in poultry and swine production. That's where it was first reported, whether or not that's where it was generated.

Then quickly, because of the improvements we've had in surveillance so that we now can use rapid DNA testing of bacteria, it was shown to be present in collections of these bacteria in several parts of the world. That may be where that statement came from, but I'm not aware that there is any one country around the world that you would call a hotbed of resistance from animals that's been spreading to people.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Very good.

What should the federal government do to support you, and what should we not do so that we're not in your way?

[Steve Leech]

I think one aspect that's come up here is a leadership role. I think there's a strong leadership role for the federal government to play in bringing together the provinces as well as the industries in order to move forward. It requires a combined effort from the human side and from agriculture. We've seen some of that happen with the pan-Canadian framework. I think that needs to continue.

One of the aspects that I brought up is providing the tools for industry to be able to put in place these reduction strategies and to move forward with meeting our common objectives. From our side, it's the access to products.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Access to products available in Europe.

[Steve Leech]

Exactly.

The great news is that a lot of that research and a lot of that innovation has already been done; it's a case of getting them into the Canadian market to where they are already internationally.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Are there any other comments?

[Robert McNabb]

I personally don't think I could add much to what Steve said. I would just say we need to work collaboratively to reach the desired solutions with industry and through the federal-provincial approach. Agriculture is multi-jurisdictional in its undertaking, and it's going to require very much a collaborative approach.

[Dr. Scott McEwen]

It's my impression that it's your job to decide what's best for Canadians and to set the major direction and provide that leadership. A tangible way of doing that is, as I said, by setting those targets, because doing that focuses the attention of everyone on how we're going to get to that place. I realize that's not an easy thing to do in our current system but I'm sure you've had experience with that sort of thing before.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Thanks.

[The Chair, Liberal, Bill Casey]

Mr. Davies.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you to all the witnesses for some really excellent testimony.

Dr. McEwen, I want to put this question to you. I want to step far back to try to get an understanding of the scope and urgency of this issue. I think we all started off as lay people wondering, as a health committee, how serious a problem this is. We understand well the importance of antibiotics, and we're worried that overuse of antibiotics in both the animal and the human world may be getting us to a point where we are really running the risk of having antibiotic-resistant bacteria, so we're running the risk of having serious pathogens for which we have no effective antibiotic.

Can you help us understand how close we are to that situation? How urgent is the need to deal with this?

[Dr. Scott McEwen]

I think that question is probably better placed to medical experts when they're here, if they haven't been here yet and are coming. I speak from the veterinary side on the animal dimensions of the public health problem, so all I can do is quote figures that have been developed in the medical sector.

As I said in my opening comments, that's where the crisis is best described and most clearly articulated. It's clear in that sector that there is a major crisis in bacteria like those I already mentioned: the gram negative enterobacteriaceae, some of the gram positives like methicillin-resistant Staphylococcus aureus and enterococci, and some of the sexually transmitted diseases. There are serious possibilities of running out of effective antibiotics for those. The best evidence we have in terms of the animal contribution to that is through these food-borne enterics.

WHO put out a top 10 list earlier this year, and salmonella was on that list. Non-typhoidal salmonella nowadays in developed countries mainly has a food-animal reservoir, so there's an impact there for sure.

At the end of the day, we've tried for many years to come up with a quantitative estimate of the percentage of the impact that comes from animals. That's been very evasive, and I have my doubts we'll ever get to that point. I think now what we're settling to is what you've heard from us today, that all sectors have to do their part to reduce overuse wherever they can with the goal of bringing down resistance in all sectors. We can be strategic in terms of where the most important emphasis is and fine-tune it, but I think our approach needs to be that we take steps to reduce overuse to improve infection control and prevention, to improve surveillance, and all those other things as well.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Dr. Landals, it's my understanding that on December 1, 2018 all medically important antimicrobials for veterinary use will be sold by prescription only. In your view, what will be the impact of that change?

[Dr. Duane Landals]

There certainly will be an impact with that change. The objective of the change is to meet the goal of veterinary oversight of the use of antimicrobials in food-producing animals and to make a realistic expectation that veterinarians will be engaged. The drugs are made to be prescription only; that's how that's been implemented, so that will have an impact. I don't think it's an insurmountable impact. Most livestock producers and animal owners have a relationship with a veterinarian, and if they have a legitimate disease, they'll be able to get those pharmaceuticals prescribed and appropriately dispensed.

I think the biggest change is going to come in the antimicrobials that are used in animal feed, because veterinarians have not been involved in that. We have some work to do over the next short while to train veterinarians how to write those prescriptions properly and how to get the information to the feed mill that they need to safely mix the drugs appropriately to the required levels and whatnot.

There is some work to be done, but I don't think it's going to be a crisis impact, if that's your question. I think it's just something we'll manage, and we'll move forward. I think it will be a positive step forward.

[Don Davies, NDP, Vancouver Kingsway, BC]

Mr. Leech, I think you briefly touched on the issue of poultry probiotics. Can you maybe expand on that for us? What role should those probiotics play in reducing antibiotic use in poultry?

[Steve Leech]

When we look internationally at reduction efforts that have taken place, we see that a lot of alternative strategies have been put in place, whether they be management or other. Certainly vaccine alternatives and feed alternatives are part of that. It's a large tool.

Really, what we're looking at is maintaining the health of the gut of the chicken from day one all the way through and making sure we don't have disease incursions. That's really where these probiotic and prebiotic acids come into play that other countries have had some success with. It's different from farm to farm, and certainly one of the reasons we have an implementation period is to figure out exactly what works.

Quite frankly, I think one of reasons we've gone with the implementation period we have is to hopefully have access to those products. The industry has certainly gone out on a limb in terms of putting forward the reduction strategy that has been agreed upon, but part and parcel of that is having the products available in order to move forward. That's why it's such a crucial area, but it has a time significance to it now in order to meet our objectives.

[Don Davies, NDP, Vancouver Kingsway, BC]

Mr. McNabb, I want to get a question to you if I can.

To what degree do stressful, crowded, or unsanitary conditions necessitate the use of antibiotics in livestock? In other words, would improved animal welfare practices lead to a reduction in overall antibiotic use?

[Robert McNabb]

I have to first admit that I'm not an expert in that particular area, but in my experience, we know that proper accommodations will play a role in reducing the stress of animals. Whether or not that is directly impacted by the need or not for antimicrobials, I couldn't say.

[Don Davies, NDP, Vancouver Kingsway, BC]

Dr. McEwen or Dr. Landals, do either of you have an opinion?

[Dr. Scott McEwen]

It's well-known that antibiotic use is higher in conditions of intensive agriculture. However, it's also well-known that there are many excellent managers who are able to raise animals in confined conditions and intense conditions with minimal use of antibiotics through good husbandry practices, good hygiene, good health management, and good biosecurity. The techniques are available. There is the use of vaccines and other products that are available. I don't think we're going to get away from intensive agriculture, but we do need to encourage people to use good production practices.