Evidence of meeting #18 for Health in the 45th Parliament, 1st session. (The original version is on Parliament’s site, as are the minutes.) The winning word was amr.
A video is available from Parliament.
Liberal
Doug Eyolfson Liberal Winnipeg West, MB
Okay. Thank you. That is good to know. That was an important part of the question.
To your knowledge, are there international bodies trying to get a global strategy on this? Is the World Health Organization working on this? Is the UN working on it?
Professor of Medicine, University of Toronto, As an Individual
Yes.
There is a program called GLASS—the global antimicrobial resistance and use surveillance system—that is run by the WHO, and the CDC runs a program called the global antimicrobial resistance laboratory and response network.
As we've seen over the last 12 months or so, the WHO have been significantly impacted when major funders have pulled out. They're just not able to run the same programs to the level that they were before. They're in a bit of a remodelling mode because of the significant funding crunch.
Certainly, in the United States, the CDC is having significant changes as well.
A lot of the global funders and global players, as well as these programs, aren't going to be running as effectively as they once were, despite this growing issue.
Liberal
Doug Eyolfson Liberal Winnipeg West, MB
Okay. Thank you.
Do you know what the change in funding was, particularly from the United States? Do you know what the proportion of their budget was on these programs when the United States was funding the World Health Organization, versus currently, when they have stopped?
Professor of Medicine, University of Toronto, As an Individual
It was announced that they pulled out of the WHO yesterday. I believe that was about $100 million a year of funding, which is pretty significant. The WHO budget is not that big, considering their enormous mandate.
Professor of Medicine, University of Toronto, As an Individual
They don't have enough money at the best of times. Having a major donor pull out is very problematic for global public health.
Liberal
Doug Eyolfson Liberal Winnipeg West, MB
Thank you.
Dr. Leung, I'll ask very quickly: You talked about vaccines. With viral illnesses such as flu, we can get secondary bacterial infections. Canada has a tremendous problem with decreased vaccine uptake. Given the setting that there are often secondary bacterial infections, would you say that Canada's decreased vaccine uptake is contributing to AMR?
Infectious Diseases Physician and Medical Microbiologist, As an Individual
Overall, when you have a decreased vaccine uptake, depending on the type of vaccine, that will definitely contribute to AMR. One specific example is the Streptococcus pneumoniae vaccine, which is for the bacterium that is the most common cause of bacterial pneumonia. It leads to invasive infections.
The reason the uptake is low is not necessarily issues related to vaccine hesitancy but rather how public health distributes the vaccine in each province. When you look at opportunities for vaccination when people interact with health care systems, that's not just in the community. The big gaps are in hospital-based vaccination opportunities and how they tie into the spectrum of care, as individuals have problems with access even if they want to get the vaccine. Improving access is one of the important things that need to be addressed when thinking about vaccines and AMR.
Liberal
The Chair Liberal Hedy Fry
Thank you, Dr. Leung.
I'm going to ask members to remember that when you have only 15 seconds left, please try not to ask a difficult, long-answer question.
I'm going to Mr. Blanchette-Joncas for six minutes, please.
Bloc
Maxime Blanchette-Joncas Bloc Rimouski—La Matapédia, QC
Thank you, Mr. Chair.
I'll turn to you, Dr. Weiss.
In its report entitled “Disruptions on the Horizon”, published in 2024, the government's Policy Horizons Canada centre pointed out that antimicrobial resistance is now the leading cause of death globally. So, as we know, this phenomenon is already disrupting food systems and increasing costs for the producers responsible for ensuring animal and plant health. Action is urgently needed.
I also liked what you said a bit earlier about fragmentation. According to my own data, in 2020, 82% of antimicrobials sold in Canada were for animal use. So, clearly, there isn't much left for humans.
I would like to hear your comments on this information. I would also appreciate your expertise and analysis.
Chief, Division of Infectious Diseases and Medical Microbiology, Jewish General Hospital, As an Individual
Antibiotics are used in the animal world first and foremost for economic reasons. The goal is to encourage animals to grow faster, so that they can reach a saleable weight more quickly. However, using these products also offers an advantage. We can think philosophically about the type of agriculture that we want, but I'll give you the following example. If you have a farm with a million chickens, but you don't give them antibiotics, there may be an outbreak, a very quick die‑off and economic losses. So the use of antibiotics also involves a balance of sorts.
In Canada, we do have good regulations. Animals are weaned before being sent to slaughter. People wonder whether they're going to eat antibiotics. I'm not a veterinarian. However, having spoken to some of my colleagues, the use of antibiotics is stopped some time before slaughter. Moreover, cooking will also denature antibiotics, which are often highly thermolabile molecules. So, when all is said and done, a certain structure does exist in Canada.
Countries such as Denmark, for example, tried to take further steps to reduce the use of antibiotics in agriculture, especially in pig farming. They have had mixed success, but there has been some progress nonetheless. So, yes, many more antibiotics are used in the animal world than in the human world. Obviously, the objectives are different. Antibiotics are used in humans for therapeutic reasons, but in animals for economic reasons. The exception is a very small portion of animals. Pets such as cats and dogs also receive antibiotics for therapeutic reasons, just as humans do.
So there's certainly room for improvement in the farming industry. Then again, we depend heavily on agricultural movements and flows around the world. We talk a great deal about animals. Remember that many antibiotics are also used in aquaculture. So, when you go to buy, for example, shrimp from certain parts of the world, a large number of antibiotics may have been used. I don't know how this is monitored in Canada, but is it? We should certainly try to meet with an expert in this field to find out whether and how much, for example, antibiotics have been used to feed shrimp farmed in other parts of the world. This could certainly affect our environment.
Bloc
Maxime Blanchette-Joncas Bloc Rimouski—La Matapédia, QC
Dr. Weiss, if you don't mind, I'll focus on matters no doubt familiar to you concerning the situation in our hospitals. You know, when a resistant infection no longer responds to standard treatment, you understand that hospital stays are longer and that more resources are required. In your opinion, is antimicrobial resistance already contributing to bed congestion and pressure on the hospital system, particularly in Quebec?
Chief, Division of Infectious Diseases and Medical Microbiology, Jewish General Hospital, As an Individual
Certainly. As you know, our population is getting older and older. We have people undergoing more and more procedures at increasingly advanced ages. This is the case in Canada and all over, in every province. I often say that, nowadays, people are kept on hemodialysis until the age of 90 or more, with all the potential complications of dialysis and the risks of infection by resistant bacteria in this group. However, the same applies to people undergoing complex surgery and to people receiving chemotherapy.
So, of course, the cost of antibiotic resistance lies in the increased length of hospital stays. We know this. Canadian and Quebec studies have shown this. We know that this will increase the cost of using antibiotics and that it will then cost more to treat these people. Obviously, we know that this can also affect mortality.
So all the risks of antibiotic resistance for the system's most vulnerable patients arise in the very places where the impact takes its greatest toll. Take antibiotic resistance for ear infections, for example. If you look at young and healthy children, the impact is mainly that they'll be taking other antibiotics. However, the impact will be relatively limited. If you look at a dialysis patient who needs antibiotics and who has developed antimicrobial resistance, the impact may be sepsis or death.
Bloc
Maxime Blanchette-Joncas Bloc Rimouski—La Matapédia, QC
Dr. Weiss, the important word that you used in your first remarks, following my initial questions, was “prevention”. It seems that prevention is currently being sacrificed with the required financial choices. So, from a clinical perspective, do you feel that prevention and monitoring are still the poor cousins when it comes to funding, despite their recognized effectiveness in avoiding costly complications?
Chief, Division of Infectious Diseases and Medical Microbiology, Jewish General Hospital, As an Individual
Certainly. You know, in a system in constant deficit, it's always difficult to see prevention as a profitable investment from the outset. It's often seen as an expense rather than anything else.
The easiest example is the good pneumococcal vaccines. Fortunately, these vaccines are administered in pediatrics from birth. It took a long time to provide them free of charge to seniors given the high cost, even though pneumococcal septicemia is often fatal in seniors. So this is a concrete example of a double standard.
Yes, investments should be made in prevention and rapid diagnosis, absolutely.
Liberal
The Chair Liberal Hedy Fry
Thank you; that's time.
I'll now go to Mr. Viersen for five minutes, please, for the Conservatives.
Conservative
Arnold Viersen Conservative Peace River—Westlock, AB
Thank you, Madam Chair.
Given that I was reading Mr. Wright's bio, my series of questions is directed towards him.
Mr. Wright, my questions are about not only prevention but also the treatment side of things. Our instincts have been, over the last number of years, to pursue hard surfaces such as plastic, stainless steel and the kinds of surfaces we are now discovering these bugs can actually live on for a very long time, but we've abandoned other products, such as wood, silver and brass, that we are discovering are very antibacterial. I would like some comments around the use of those materials in, say, the building of hospitals and things like that.
Also, I represent about a quarter of Canada's honey production, and my beekeepers say they have a solution to some of these superbugs, and that's bee propolis. I'm wondering if you have any comments on whether this is being used in medical settings. Are the beekeepers telling the truth when they tell me they have a solution for some of these superbugs?
Mr. Wright, the floor is yours.
Professor, McMaster University, As an Individual
Thank you for that.
Let me dodge the last question first and say your beekeepers are no doubt telling the truth, but I don't know a lot about those compounds. Bees are social animals, but they are highly susceptible to infection, so they very often produce a lot of interesting compounds, or they're associated with organisms that produce interesting antimicrobial compounds.
The area I know the most about is leafcutter ants, which actually harvest and embed in their skeletons antibiotic-producing bacteria so that they can protect themselves. I would not be surprised if your beekeepers are right. Whether it's a solution for non-bees, I couldn't comment.
With regard to your first question about surfaces, it's really important. We think of bacteria as just growing in a solution and then dividing, but a really important physiological lifestyle aspect of bacteria is something called biofilms. In fact, probably most bacteria in the world are found as biofilms. These are embedded in sugar matrices that form what you would almost think of as a slime. They bind to surfaces, and when they bind to these surfaces and enter these physiological states, they're highly resistant to antibiotics and very challenging to get rid of, and they can come off. This is why you often get chronic infections due to, for example, catheters that are inserted, because the bacteria grow biofilms around the plastics.
The challenge of using other materials, such as wood and metals like silver and brass, which have well-known antibiotic properties, is really one of practicality. It's hard to think of how you could implement that in a lot of indwelling devices that are used in humans. In many cases, it's much easier to pull them out and toss them, but I will make the point that, many times, important indwelling devices such as artificial joints are made out of heavy metals like titanium for the reason that they have inherent antimicrobial properties.
To wrap up the first part of your question, there are certainly different surfaces always being looked at as means to prevent infections, but balancing out the cost is a significant challenge.
Conservative
Arnold Viersen Conservative Peace River—Westlock, AB
I will go back to Mr. Wright and ask about public perception. We think about a wooden surface as probably being dirtier than a stainless steel surface. Maybe there needs to be some change to our thinking around those things. Do you have any comments around that?
Professor, McMaster University, As an Individual
I honestly have no expertise to be able to say that for sure. I used to work in a kitchen in a hospital as a high school student—
Conservative
Arnold Viersen Conservative Peace River—Westlock, AB
Could you point us towards somebody who would have some expertise in this?
Liberal
The Chair Liberal Hedy Fry
Given that you're out of time, Mr. Viersen, I think we could see if somebody wants to throw that into their question next time.
I'll now go to the Liberals.
Ms. Jaczek, you have five minutes, please.
Liberal
Helena Jaczek Liberal Markham—Stouffville, ON
Thank you so much, Madam Chair.
Thank you to all the witnesses.
Dr. Wright, I'd like to start with you. You have talked about push-pull incentives. Specifically, I would like to drill down a bit as to the role of the federal government.
One suggestion we've heard today was that CIHR form a specific stream related to AMR. Would you see this as a good recommendation on the push side in terms of advancing research?
Second, on the pull side, could you be more specific as to what the federal government should do as an incentive to encourage development of new antibiotics?
Professor, McMaster University, As an Individual
Thank you for that. That's something I actually know about.
An increase in the budget to the CIHR for fundamental upfront discoveries is a classic push mechanism. We're going to push the science. We're going to make this kind of science attractive to the best, youngest scientists available to us. This would have a huge impact.
On the pull side, we're trying to pull discoveries into patients, and usually the best people who know how to do this are with large pharmaceutical companies that know how to make drugs, can do this at scale and have the facilities to do it. We have to make it profitable for them to do it.
We do this in vaccines all the time. We promise vaccine developers that we're going to buy x number of doses, so there's no mystery for the vaccine developer about return on investment. We don't do that with antibiotics, but we should. Other countries—Norway, the United Kingdom—are doing this, and I hope Canada will too, going forward.
It's especially a challenge for us because we have such a small market. We need to get these drug companies excited about selling their products in Canada, because the market is so small, but if they had a guaranteed income, they would do it.