Health Committee on Dec. 2nd, 2025

[The Chair, Liberal, Hedy Fry]

Good morning, everyone.

I call this meeting to order.

Welcome.

Welcome to meeting number 15 of the House of Commons Standing Committee on Health.

We recognize that we meet on the unceded territory of the Algonquin Anishinabe peoples.

This meeting is taking place in a hybrid format, pursuant to the Standing Orders.

I want to remind participants of the following points. Please wait until I recognize you by name before speaking. For those participating by video conference, please click on the microphone icon in front of you to activate your mic. Please mute your mic when you're not speaking. Also, at the bottom of your screen, you will see a little globe icon. If you press that, you can get English, French or the floor, whichever you choose.

I remind you that all comments should be addressed through the chair.

When you wish to speak, if you're on Zoom, there's a little hand icon on your computer screen. Please use the "raise hand” function. We don't have any of our committee on Zoom today, so the clerk and I will try to make sure we see your hand and put you in order.

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Chair, I would like to raise a point of order before the meeting begins.

[The Chair, Liberal, Hedy Fry]

I'm sorry. I can't hear her at all.

[Andréanne Larouche, Bloc, Shefford, QC]

May I read my point of order?

[The Chair, Liberal, Hedy Fry]

Excuse me, Madam. I'm putting up my volume. I cannot hear you. I'm sorry.

What are you saying?

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Chair, I have a point of order.

The study we are working on was undertaken following the adoption, on September 23, 2025, of the motion by my colleague, the member for Montcalm.

While I was substituting for the member for Montcalm at the meeting of October 21, 2025, the committee adopted the following motion to govern the operation of witness testimony for this study: “It was agreed, — That committee meetings be divided into two blocks of one hour each and that a maximum of three witnesses per hour be allowed to testify during meetings.”

However, a change was made to the notice of meeting for today's meeting. The five guests will testify in a single two-hour block, from 11 a.m. to 1 p.m. I have a point of order, because the five guests will testify in a single two-hour block, instead of two one-hour blocks each, which is not consistent with the motion adopted on October 21. Since you made this decision without consulting us, I would like you to reset the clock for the second hour of the meeting, which would allow everyone to have another six-minute round of questions.

[The Chair, Liberal, Hedy Fry]

I would like to explain that the chair tries to run the meeting so that it is on time and fills the time slot when it's meant to be held. We have been going over time every single meeting we've had so far. I've had complaints from some members that they—knowing that the meeting is supposed to end at one o'clock, or in cases if there are IT problems, maybe a little later—have appointments they cannot keep because the meeting goes on.

It takes time when you have two separate hours to put people on again. We have everybody on now. There is no need to stop at the middle of an hour. I think you're concerned about getting six minutes in the two hours. We could ask the committee if they would be happy to give you another six-minute round without having to do this, because it takes up a lot of time and is very inefficient.

Would the committee agree to allow the Bloc to have another six-minute round?

[Some hon. members]

Agreed.

[The Chair, Liberal, Hedy Fry]

Thank you very much, Madam Larouche.

Pursuant to the motion of Tuesday, September 23, 2025, the committee will begin the study of antimicrobial resistance.

I would like to welcome our witnesses.

We have with us Scot Magnish, director of communications and public affairs of ATMIS.

From the Canadian Society of Healthcare-Systems Pharmacy, we have Dr. Rita Dhami. I think she's online.

We have Dr. Kevin Stinson, program manager, Infection Prevention and Control Canada.

From Western University, we have Dr. Sameer Elsayed.

From the Winnipeg Regional Health Authority, we have Dr. Terry Wuerz.

I'd like to explain the process here. Each of you has five minutes to present. I will give you a one-minute shout-out—and I mean shout-out—and a 30-second shout-out so you can know to wrap up. If you don't finish in time, I'm sure you'll get an opportunity during the period for questions and answers to say or expand on what you want to say.

We will begin with Scot Magnish for five minutes, please.

[Scot Magnish, Director of Communications and Public Affairs, ATMIS]

Thank you, Madam Chair, and committee members, for this opportunity.

I'd like to begin by talking about the role infection prevention and control play when it comes to antimicrobial stewardship. I'm sure there are people presenting today who know a lot more about infection prevention and control. I'm approaching this as a manufacturer, and I hope I'll be able to bring some new information to the table.

Our premise is that helping people not get sick is probably one of the best tools we have when it comes to slowing antimicrobial resistance. Our frontline health care workers try to do this in a number of ways. I've worked in hospitals in infection prevention and control. I'm sure you are all aware that there are campaigns across the country about washing your hands. You're also familiar with the role PPE plays in protecting frontline health care workers and the patients they care for simultaneously.

I'm going to focus today on single-use isolation gowns, which play an important part in our system's overall infection prevention and control strategy. Typically, these gowns are made from man-made fabrics like polypropylene. Polypropylene is layered during manufacturing to create spunbonded surfaces with a meltblown centre. Then they're sold in bulk to companies that cut the gowns out of the material and weld the seams together using ultrasonics, and then fold, bag and box them and send them out for shipment. This is what my company does. We have a facility in Chatham, Ontario, of 38,000 square feet, and we use robots to manufacture.

Here's a bit of science. The level of protection an isolation gown offers is determined by how it stands up to fluid penetration in testing, as decided upon by the Association for the Advancement of Medical Instrumentation, or AAMI. The AAMI tells us that we need to test both the gown's material and its seams, and how to conduct these tests, which are typically done by an accredited laboratory.

How a gown performs is determined by several factors, including the quality of the polypropylene, the density of the material and the integrity of the welded seams. A level one gown offers the lowest level of protection, while a level four gown offers the highest. Health care professionals are trained to know which level of gown they need to wear for effective protection. This is where the rubber hits the road. Their decision is based on information the gown manufacturers have provided to the buyers at the institution in question. I'm here to tell you today that that information is frequently untrue.

Here's a series of facts. Number one is that, according to the National Research Council, our country goes through 8.7 million isolation gowns a month.

Number two is that the vast majority of these gowns are made in Southeast Asia, mostly in China. They're imported into America by a handful of companies, which then ship them to Canada and sell them to our health care institutions. These are the same companies that were on deck to provide Canada with emergency PPE when the pandemic hit in 2020, and we all know how that story ended.

Number three is that although these importers have valid Health Canada medical device establishment licences for their warehouses here, the factories making the gowns—many of which are in the Uyghur Autonomous Region of China, in violation of Bill S-211—do not.

Number four is that any company can run multiple tests for compliance with AAMI standards and cherry-pick their results. Nobody needs to know how many times your gowns fail before they finally pass.

Number five is that once you have a lab result, there's no follow-up. If a company changes its material supplier or its place of manufacture, nobody is watching. Nobody is going to know.

Last but not least, number six is that no one is even checking to see whether these labs are authentic. During the pandemic, my company encountered multiple organizations and other companies using falsified lab reports to sell their gowns to hospitals, shared services organizations and even the federal government.

As a result, frontline health care workers were being given substandard gowns to wear, some of which were highly flammable, and Canada has over 100 million dollars' worth of isolation gowns in the national emergency strategic stockpile, NESS, right now that were made by companies that provided false lab reports. Fortunately, these gowns were procured by the government and are unlikely to be used. The last of the NESS gowns were delivered in March 2022 with a two-year shelf life, meaning they've long since expired and have not been replaced.

What's the take-away from all of this? If we're going to practise good antimicrobial stewardship, we need to start buying PPE that actually meets AAMI standards. It's a failure that lives at the intersection of our health care procurement policies and procedures, and I think it's having an effect not only on antimicrobial resistance, but on everybody in the country, from hospitals to the federal government.

[The Chair, Liberal, Hedy Fry]

I did not give you a 30-second warning. You have 14 seconds left.

I'm sorry.

[Scot Magnish]

The solution is to buy PPE from manufacturing plants with MDE licences and ISO 9001 quality, tracking and traceability. I think making these standards mandatory would advance your work on an antimicrobial strategy or stewardship faster and with broader results than a lot of the other initiatives you could take.

Thank you.

[The Chair, Liberal, Hedy Fry]

Thank you very much.

I'll go to the next witness, Dr. Rita Dhami from the Canadian Society of Healthcare-Systems Pharmacy.

Dr. Dhami, you have five minutes.

[Rita Dhami, Chief Pharmacy Officer, Canadian Society of Healthcare-Systems Pharmacy]

Thank you, honourable Chair, and members of the committee.

I am the chief pharmacy officer at CSHP and a clinical professor at the University of Waterloo. I regret that I can't be with you in person today, but I appreciate the opportunity to appear once again to speak about AMR.

When I last presented on AMR, it was for the science and research committee. I focused on evidence; I focused on research. Today, I want to share with you a more personal day-to-day reality and the opportunities I believe we have to act on.

I've been a pharmacist for over 20 years, with nearly half of that time spent as an antimicrobial stewardship infectious disease specialist. I can tell you with confidence that every day, pharmacists across this country confront the consequences of antimicrobial resistance, which include patients who don't respond to first-line treatments; infections requiring more toxic or less effective options; longer hospital stays and preventable complications; and families who are devastated to learn that their loved ones have deteriorated from an infection that became life-threatening.

AMR is not a theoretical risk. It's a present-day reality.

The pan-Canadian action plan on antimicrobial resistance offers a strong foundation. It offers us pillars that we can action. However, it needs some dedicated resources, timelines and sustained federal leadership to meet the urgency of this threat.

First, we have an opportunity to strengthen national surveillance of resistant organisms and antimicrobial use. Canada already has a strong surveillance program through the Canadian nosocomial infection surveillance program, CNISP, which offers both pathogen and antimicrobial-use surveillance in both adult and pediatric in-patient populations.

Work that I've been involved in, the CLEAR registry, further complements the CNISP work by monitoring real-world use of newer antimicrobials. Together, these databases offer a powerful and efficient national surveillance model. CNISP tells us how much antimicrobials are being used, and the CLEAR registry tells us why they are being used. Canada should continue to support scaling these data platforms so that AMR and AMU surveillance can be expanded outside of hospitals into long-term care and community care settings.

Second, we have the opportunity to build sustainable antimicrobial stewardship programs. Accreditation Canada requires that antimicrobial stewardship and infection control be organizational practices for all hospitals. However, we know that the expertise, the data access, and the staffing and infrastructure behind these programs varies widely across the different provinces. We also know that hospital prescribing of antimicrobials is only one part of the picture.

Provinces and territories need support to build sustainable, high-quality stewardship programs across the health care continuum. That includes long-term care, primary care and also the outreach to rural and remote communities. Surveillance data informs stewardship programs and allows clinicians to detect and address the emerging risks sooner.

Third, we have an opportunity to improve access for antimicrobial therapies. Antimicrobial development has not kept pace with the need. We know that since 2010, 18 antibiotics have been introduced globally, but only three of them have had market access in Canada. The Public Health Agency of Canada has done a lot of work on push-and-pull incentives, and that has formed a good foundation for improving access to the antimicrobial pipeline. We now need to move from that sort of exploration phase of the push-and-pull incentives to implementation if we want timely—

[The Chair, Liberal, Hedy Fry]

You have one minute.

[Rita Dhami]

—and equitable access to next-generation therapies.

In closing, the next steps are clear: Strengthen surveillance, sustain stewardship, and secure access to effective treatments.

As a pharmacist, I've seen first-hand what can happen when those systems fail and what is possible when they are supported. Canada has the infrastructure and the expertise. What we need now are sustained federal leadership and stable funding to turn those plans into action.

Thank you again for the opportunity.

[The Chair, Liberal, Hedy Fry]

Thank you very much.

Now I'll go to Dr. Kevin Stinson, program manager, Infection Prevention and Control Canada.

[Kevin Stinson, Program Manager, Infection Prevention and Control, Waterloo Regional Health Network, Infection Prevention and Control Canada]

Thank you, Madam Chair, and members of the committee, for the opportunity to appear today.

I would like to thank the members of the committee for giving me the opportunity to make my presentation today.

I do apologize that I'm unable to attend in person.

In October, I had the opportunity to appear before the science and research committee. I'm quite encouraged to see that this challenge of AMR is being picked up and looked at by so many different aspects of our government. AMR is, after all, a very complex and cross-sectoral threat that truly does require a whole-of-government response.

My background is a microbiologist and an infection control professional. While I work in the acute care sector in Kitchener, Ontario, I'm here today really representing infection prevention and control professionals from across Canada and across the spectrum of health care on behalf of our professional association, IPAC Canada.

AMR has been described as a silent pandemic. What this really means is that a significant aspect of cases and transmission largely goes undetected. We already see significant socio-economic and direct health impacts of AMR, both in Canada and abroad.

Contrary to typical pandemics or epidemics that we think of, especially in recent memory, there's a bit of a unique challenge with AMR as antimicrobial resistant organisms, AROs, have this unique ability to transfer their resistance gene from one bacterium to another, including into the bacteria that occupy our human microbiome, which are the bacteria on our bodies.

This creates a real challenge of persistent colonization, where someone can be persistently colonized, which increases their risk of downstream resistant infections and also of transmission from one person to another. We see today that nearly one in 10 Canadians in acute care hospitals are colonized with at least one ARO. This number increases significantly when we look at low- and middle-income countries abroad.

AMR is, after all, a global threat that really does not know any borders. Effectively controlling and responding to this threat requires coordinated efforts along the lines of surveillance, infection prevention and control, IPAC, as well as antimicrobial stewardship.

In health care settings, infection control professionals, ICPs, form a backbone of the core personnel required and responsible for implementing these strategies. However, we see inconsistencies across Canada in how IPAC programs are implemented as well as in access to trained and certified ICPs in all health care settings.

From a surveillance lens, Canada's surveillance program broadly acts to give large-scale, generalized AMR trends, but it lacks the depth and the breadth to be able to actually map transmission, and it lacks the granularity to be able to take that data and apply it to influence practice at a local level.

Infection control professionals rely on good, solid evidence and good, solid surveillance data to optimize our AMR control and surveillance strategies within our facilities to both meet the needs of our communities and balance clinical operations and financial stewardship. Without this data, we're left trying to take generalized data and are unable to apply it directly. These disparities are especially prominent in rural settings or sectors outside of acute care.

To address these problems, we need to look at building our infection control capacities in the health care workforce through training and capacity development initiatives, such as what we see with the IPAC hub program that is currently operating across the province of Ontario.

When we look at longer-term strategies, Canada really needs to look at improving its overall AMR surveillance program.

[The Chair, Liberal, Hedy Fry]

You have one minute.

[Kevin Stinson]

What we need is an integrated multi-sector approach with a specific focus on understanding transmission dynamics and using that to find control measures both in and out of the health care setting.

We also must continue to look at how Canada can support broad public health initiatives, such as backing vaccination campaigns, which are aimed at preventing infectious diseases and which indirectly do support antimicrobial stewardship efforts.

With that, I would again like to thank you all for the opportunity to present today. I will be submitting a written brief as a follow-up to this session, outlining these points in greater detail. I certainly welcome your questions.

Thank you very much.

[The Chair, Liberal, Hedy Fry]

Thank you, Dr. Stinson.

I now go to Dr. Elsayed from Western University.

You have five minutes.

[Sameer Elsayed, Infectious Diseases Physician, Western University]

Good morning, Madam Chair, and honourable members. Thank you very much for the invitation. It's an honour and a privilege to appear before this committee to answer your questions and to speak about antimicrobial resistance and its impact on the health of Canadians.

My name is Dr. Sameer Elsayed. I'm an infectious diseases physician and medical microbiologist at London Health Sciences Centre, and a full professor at Western University. My educational credentials also include advanced degrees in public health and health care quality. I've been practising as a clinician, educator and researcher for over 25 years and have held several leadership positions throughout my professional career.

In 2009, I was appointed chair of the antimicrobial medication committee at London Health Sciences Centre and continue to serve in this capacity. Since 2013, I have served as the physician lead for the antimicrobial stewardship program at London Health Sciences Centre, and as the program's representative on the hospital's quality and patient safety committee. From 2017 to 2020, I served as the elected chair in infectious diseases at the Ontario Medical Association. In 2018, I was appointed director of the adult infectious diseases residency training program at Western University and continue to provide educational oversight of this program.

The topic under discussion today is near and dear to me, and one which all Canadians should take to heart, including policy-makers, researchers, health care administrators, regulated health professionals and members of the general public.

According to the World Health Organization, antimicrobial resistance, commonly referred to as AMR, is currently one of the top 10 global public health threats to humanity. In 2021, AMR was directly responsible for over 1.1 million deaths and contributed indirectly to an additional 4.7 million deaths.

Scientific modelling studies predict that by the year 2050, these numbers will double, and annual excess health care costs due to AMR will exceed $2 trillion U.S. without appropriate action by governments, the health care community at large and other global stakeholders.

Antimicrobial resistance affects all geographical regions, income levels and age groups. It compromises the ability of the health care community to provide safe and effective treatments to individuals suffering from infectious diseases. AMR is often referred to as a silent pandemic, because it typically spreads unnoticed. AMR is linked to several human behaviours. Misuse of antimicrobials involves selecting the wrong antimicrobial agent, dosage or duration of treatment due to diagnostic uncertainty, lack of knowledge or patient demands.

Overuse relates to antimicrobial use that is considered unnecessary, for instance, treating a viral infection with these medications. In some countries, there is unregulated access and minimal oversight of antimicrobial use in humans as well as in animal husbandry.

In Canada and many other high-income countries, approximately 50% of antimicrobial prescriptions in community settings are considered inappropriate—in other words, misuse or overuse. These numbers are slightly lower in hospital settings, at around 30%.

In 2013, antimicrobial stewardship, AMS, practices became an accreditation requirement for all Canadian acute health care facilities. In contrast, AMS became a mandatory practice for acute care hospitals and long-term care facilities in the United States in 2017. Currently, long-term care homes in Canada are exempt from this requirement, even though they bear a large burden of inappropriate antimicrobial use.

There is a natural cycle of antimicrobial use and its consequences that involves humans, animals and the environment. Agricultural use of medically important antimicrobials in Canada and the U.S. is more than twice that in humans. On a per capita basis, use of antimicrobials in Canadian livestock exceeds that of the U.S. and most European countries. Antimicrobial-resistant organisms can spread from animals to humans through food, contamination of waste water—

[The Chair, Liberal, Hedy Fry]

You have one minute.

[Sameer Elsayed]

—and crops, and even via transmission of animal wastes to birds, ticks, flies and rodents that may come into contact with humans. Human waste from hospital sewage systems contains AMR organisms due to heavy antimicrobial use, which eventually enters our water supply, the natural environment and food-producing animals, repeating this never-ending cycle. Approximately 75% of all infections caused by AMR pathogens are—

[The Chair, Liberal, Hedy Fry]

You have 30 seconds.