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—