Health Committee on Nov. 21st, 2017

[Prof. Gerard D. Wright]

It's a big question. You're absolutely right. We know this really well. We dealt with SARS. We saw exactly what happened. We're only a plane ride away from these issues, and our laboratory and our group is in southern Ontario. We're 40 minutes away from Pearson, one of the biggest hubs in all of Canada, with lots of people visiting from all over the place, and people bring the bugs they have to Canada.

The practices in other countries are very challenging, as Dr. Evans said. Colistin, for example, is an antibiotic that was discovered in the 1950s. It's a terrible drug, but we've run out of all the other drugs so we needed to use it. They're using it by the tonne in China for pig production. As I said before, the bugs evolve resistance.

I think we heard a lot already about what we can do. Canada is in a unique position. We're part of the G7. We're part of the G20. We can help develop policies. We can help develop countermeasures here in Canada, export them to those countries, and share that information. There's no reason at all why we can't do a lot of really positive work here and then share it directly or work with these companies and steer these agencies that we have connections to already.

[Dr. Timothy G. Evans]

That's a very good question. I, too, will avoid making the members of the committee suffer. Indeed, my accent leaves something to be desired.

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

It's perfectly fine.

[Dr. Timothy G. Evans]

It's an excellent question. I think this was a little bit what we tried to do in this report. The cost of inaction is dear. It's huge. The cost of action is actually not that great, especially when you look at the return on investment.

Number one, you're looking at, from whatever economic perspective.... You take this to your Minister of Finance, and this competes with other places for high return on investment and therefore budget priority.

Number two, I think political advocacy is important. Professor Kramer made the point on how Canada is regarded from outside. As a Canadian in exile, I can tell you that Canada has a wonderful reputation, and particularly now, the leadership is being listened to. So work the top Canadian leadership to take this up, advocating that every country should have a universal system that entitles people to access to care without having to pay for it at the point of service. That's a fantastic political advocacy. It comes from what I deem to be our proud Canadian heritage, and it's a message that is absolutely fundamental in terms of value for money.

First, prepayment is more effective and equitable than paying when you're ill. It's a simple message, and governments need to be recognizing that responsibility the world over. There is no country that is too poor to move towards a universal system based on prepayment. That's a simple political advocacy statement, and I think Canada's leadership is perhaps in the best position in the world to make that very strong point.

Second is the value of smart multilateralism, recognizing that together we can achieve things in terms of preserving our global health security that alone we will be hopeless at. Look at the way in which not only the Canadian action plan on AMR but the WHO plan of action on AMR can actually come into focus and into action in the UN in 2018. There are lots of feet that can be marching and taking this agenda forward. It requires that commitment, and significant but not expensive resources to fuel those engines that are ready to go.

I think Willo Brock from the global TB Alliance has a massively cost-effective opportunity there. Five or ten million dollars from Canada, as part of a consortium of countries in the G20 and beyond—the OECD—that have said this is good value for money is going to allow this agenda to move forward without any single donor feeling like they're carrying too much of the weight.

I think those are opportunities in order to avoid those

scourges. They won't go away.

[The Chair, Liberal, Bill Casey]

Okay.

We have to move to Mr. Davies now for the final question.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Ms. Kramer, I feel, in some ways, that as I get to the end of the study I'm back to the beginning. I find myself unsure of the extent of the problem of antimicrobial resistance and what the causes are.

I'm going to ask whether you can quantify the problem for us and also identify the leading causes of antimicrobial resistance, and antibacterial resistance too.

[Jane A. Kramer]

At this point, we think it's clearly overuse for growth promotion in animals. It's that, because the food we eat is transferred to your hands and to your cooking. For the longest time, it was overuse in over-prescribing. The doctors can weigh in, but I think with the guidelines for physician use, the physicians are more careful in their use these days.

However, it's definitely in our food production.

[Don Davies, NDP, Vancouver Kingsway, BC]

How serious a problem is it? Should we be panicking about this? Is it urgent that we deal with this? I have people who express concern that they could get an infection for which there is no successful antibiotic. If that develops, we could be left with an extremely serious, widespread health problem. Is that a reasonable fear?

[Jane A. Kramer]

It is a reasonable fear. Let's bear in mind that the UN held a meeting about this, about a year and a half ago now, and it was only the fourth time in the history of the UN that they had a meeting about a health issue. The time before that was about Ebola. They would not take up a health issue unless it was that consequential. HIV was one of those issues. So yes, and I think that's why it's made your agenda.

[Don Davies, NDP, Vancouver Kingsway, BC]

Willo, I'll give you my last question. I'll start with a negative and a positive. For the negative, former UN special envoy for HIV/AIDS, Stephen Lewis, has been highly critical of international response to the resurgent threat of tuberculosis. He has, in particular, criticized developed countries for making and then breaking promises on international aid and global public health.

On a more positive note, global momentum seems to have been building in the fight against TB and AMR, including the G20 declaration last July and the recent ministerial declaration on TB in Moscow, both of which made commitments to addressing TB as a component of the global fight against AMR. How can Canada best help build on this global momentum as we move into the G7 and UN high-level meeting on TB next year?

[Willo Brock]

I'd mention a couple of points.

First of all, Canada has traditionally done a lot globally. I think its current level of funding global development is at an all-time low. A growth in global solidarity could be combined with an investment in this area, which I think is important. First of all, I think Canada has room to step up. I know there's been a little bit of a declaration of love towards Canada, but let me just point out a little criticism. There are places where I think there's an additional piece of work to be done.

Canada, next year, hosts the G7. This year the G7 and the G20 both committed, with Canada in there, to increase their work against AMR and against tuberculosis and to find more global coordination, more investment for the fight against AMR and TB. Canada will have that leadership and will be the one looked upon to create that momentum. If we let declarations like this sit....

As I'd mentioned in my introduction, in 1993 the WHO declared TB a global health emergency, similar to what happened to Ebola a couple of years ago. We've lost 50 million people to this disease because of inaction, because of everyone coming up with lofty political declarations with no action plans behind them, with no monitoring, and by not keeping ourselves responsible. I think Canada can create that environment of accountability by taking its leadership position and setting an example in this area by putting some money where its mouth is.

As you mentioned, we do have new drugs in TB. We have a new treatment. We can now treat XDR patients, hopefully, in the next couple of years, with six months of treatment, with a 90% success rate, as we have for current first-line treatments. The solutions are there. We just need to act.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

[The Chair, Liberal, Bill Casey]

Time's up.

That concludes our day. Once again, on behalf of the committee—

[John Oliver, Liberal, Oakville, ON]

Sorry, Mr. Chair, but I don't think the World Bank Group's 2017 report has been submitted as evidence. Could we receive a copy of it so we have it for our report?

[Dr. Timothy G. Evans]

Certainly.

[The Chair, Liberal, Bill Casey]

Thanks very much.

I want to commend the members of the committee. You proposed we do this study. When we started the study, I didn't even know what it was about. You've raised such an important issue. A little while ago Ms. Kramer referred to it as a crisis, but it's almost an unknown crisis. Our challenge as a committee is to write a report that raises awareness and puts it at the level our witnesses have described.

The drafting for this report is next Thursday, so everybody bring your ideas for the drafting. I do hope it reflects the seriousness of what witness after witness after witness has testified.

I want to thank the witnesses very much. You bring so much to this committee. We get the best witnesses of any committee on Parliament Hill, and today is a perfect example.

I have one final note to the members. Tomorrow is the last day for witnesses for the food guide study. If you have witnesses who want to come to that, we have to have the names tomorrow.

Again, thank you very much to the witnesses. You've provided us with a great deal of valuable and understandable information, which is very good.

The meeting is adjourned.