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.