Health Committee on Jan. 27th, 2026

[The Chair, Liberal, Hedy Fry]

I call this meeting to order.

Welcome to meeting number 18 of the House of Commons Standing Committee on Health.

We acknowledge that we're meeting on the unceded territory of the Algonquin Anishinabe nation.

Today's meeting is taking place in a hybrid format, pursuant to the Standing Orders.

I want to remind everyone, especially those of you who are new to the committee, about the following points.

Wait until I recognize you by name before speaking. For those of you who are on video conference, click on the microphone to activate your mic. Please mute it when you're not speaking, or we'll get feedback, and this is very damaging to the ears of the interpreters.

At the bottom of your screen, for those of you online, you can select the appropriate channel for interpretation: floor, English or French. It's the little round globe that you can press on.

This is a reminder that all comments should be addressed through the chair. Members in the room, you know how to raise your hands if you wish to speak. You also know that you have a little decal sitting next to you, where you should park your phone so that you don't cause a lot of feedback for the interpreters.

The clerk and I will try to manage the speaking order as we see you. Because you're on both sides of the room, sometimes we don't get to you first when you put your hand up. We're trying very hard to cover the room.

At the end of this meeting, we have two budgets to pass. We just need to say yes.

Pursuant to Standing Order 108(2) and the motion adopted by the committee on Tuesday, September 23, 2025, the committee will resume the study on antimicrobial resistance.

I want to welcome our witnesses. There's one in the room: Dr. Bogoch. Everyone else—Dr. Leung, Dr. Weiss and Dr. Wright—is online.

Here's how it works. You each have five minutes to speak. I will give you a literal shout-out at about one minute, and then you'll know you have time to wrap up. I'll then give you a 30-second shout-out. At the end of that, if you didn't get to finish everything you wanted to say, we have a question-and-answer period in which you can elaborate.

We will begin. I will start with Dr. Bogoch, professor of medicine at the University of Toronto.

Professor Bogoch, you have five minutes.

[Isaac Bogoch, Professor of Medicine, University of Toronto, As an Individual]

Thank you so much, and thank you for the invitation to be here today. It's wonderful to see everybody.

My name is Isaac Bogoch, and I’m an infectious diseases physician and scientist, as well as a professor of medicine based out of the University of Toronto. I recently spoke about antimicrobial resistance, or AMR, at the Standing Committee on Science and Research, and I'll be making many of the same points here. I regularly treat drug-resistant infections in my clinical practice, and my research focuses on how these organisms spread around the world, mainly through human mobility patterns. I’m grateful that you're studying this topic, because it has a tremendous negative impact in Canada and around the world.

As you've heard, AMR arises from the misuse and the overuse of antimicrobial drugs, rendering them ineffective and causing substantial morbidity and mortality. I see this at the bedside as a clinician; I appreciate that some of you in the room are physicians as well, and you have dealt with this too. AMR leads to the delayed initiation of appropriate antibiotics, and it results in predictable negative consequences.

Interestingly, although many people might not be aware of this, about 70% of the global antibiotic consumption is in agricultural animals, and only 30% of the use is in humans. This imbalance underscores the importance of what we call the “one health” concept, which basically recognizes the interconnectedness of human, animal and environmental health; because of this, we need to take a collaborative and—pardon the buzzwords—truly cross-sectoral approach to combatting AMR, because it's a massive problem.

A recent study published in The Lancet estimated that there are about 4.7 million deaths per year in which AMR plays some role. To put that into context and perspective, that's more deaths than from HIV, TB and malaria combined; every country is impacted, but of course, lower-resource settings are disproportionately impacted.

We're not going to invent our way out of this issue by developing new drugs. In an arms race between creating new drugs and microbes adapting to these drugs, the microbes are going to win every time, as they've done in the past.

Canada, relative to the rest of the world, is doing well, but—pardon the pun—we're not immune. We have national strategies and regulations for antibiotic use. We have infection prevention and control initiatives that mitigate the impact of AMR spread in health care settings, but the uncomfortable truth is that we can do everything right in Canada and still fail. We know that AMR, like just about every other pathogen, doesn't respect political borders. We can see the development of resistant organisms on one side of the planet, and they move to Canada and elsewhere around the world through travel and trade.

While AMR is appropriately framed, as I mentioned, as a one health issue, I would also urge you to consider this a health security concern. As we saw during COVID-19, our supply chains for diagnostics and therapeutics are fragile, and they might be further strained by growing geopolitical instability. There is an ongoing war in Ukraine, for example, that could spread to other NATO countries. We already had two allies invoke Article 4 in 2025. For an example, in this conflict, up to 80% of the combat wound infections are resistant to conventional antibiotics. This would pose a serious risk should Canada be drawn in. In addition, Russia’s past biological weapons program is well known to have developed drug-resistant pathogens. At a time when Canada has pledged to raise security spending to 5% of GDP, failing to integrate AMR research and preparedness into that investment would overlook a critical threat.

Do you know what? I can't say this with a straight face. I was going to say it's not all bad—but it actually is. There are large surveillance programs to study and track AMR. The WHO which leads a big program. The U.S. CDC leads a big program. Of course, as you are well aware, major partners are massively scaling back funding, and global health leadership is imploding. This leaves us more vulnerable, but it also presents a major opportunity for Canada to fill the vacuum as a global leader in health care, public health and health security, with a focus on combatting AMR.

What is a smart path forward? We can take a true intersectoral approach, with a national and global perspective.

We can strengthen antimicrobial stewardship programs and infection prevention and control programs in Canada and abroad. This means not just in health care but also in agriculture and veterinary sectors.

We can enhance AMR surveillance in Canada and abroad. We don’t need to reinvent the wheel. These programs exist. We can just help support funding them.

We can invest in research and innovation in Canada and abroad—supporting public-private partnerships, enabling Canada to be self-reliant, supporting R and D for new diagnostics and therapeutics.

We can raise public awareness campaigns for various sectors on the dangers of the overuse and misuse of antibiotics.

We can then leverage the security aspect of AMR to fund many of these initiatives.

AMR isn’t a distant threat—it’s already here, and it endangers both Canadian and global health. We can act now, or we can face far greater consequences in the future.

Thank you very much for your time.

[The Chair, Liberal, Hedy Fry]

Thank you very much, Dr. Bogoch. That was on the button, really good work.

I'll now go to Dr. Victor Leung, infectious diseases physician and medical microbiologist. He is here by video conference.

Hello, Victor. It's good to see you.

[Victor Leung, Infectious Diseases Physician and Medical Microbiologist, As an Individual]

Good afternoon.

I work as an infectious disease physician and microbiologist in Vancouver, British Columbia. Today I want to highlight aspects that I see on a daily basis and that are important to emphasize because they highlight the problems we face when dealing with infections. I'm going to divide them into three categories.

The first is treating infections that have multidrug resistance. The second category is the problems we currently have with infection prevention and control and some of the antimicrobial stewardship work. The final one is to emphasize the importance of vaccines and how we need to strengthen our national vaccination programs, because the current approach is not meeting the necessary demands...for what we can achieve with benefits from vaccination as an approach to AMR.

From a clinical access point of view, on a daily basis, we deal with infections that are often multidrug-resistant. When we see patients with drug-resistant infections, we're already downstream from the preventive approaches. We're then dealing with access to antimicrobials and selecting the best antimicrobials to help control the infection.

The problem in Canada is that our special access program is outdated. Several years ago, at the national meeting, changes that I think we all advocated for were made in terms of accessing drugs that are essential in treating some of these multidrug-resistant Gram-negative infections.

There have been some improvements. Locally at our hospital, we're the only hospital in British Columbia with future use applications for two of these antibiotics, but that's not the case in many hospitals across the nation. When they see an infection that requires treatment with antimicrobials that are not available on formulary, they have to go through an inefficient process to get access to the drug, and the delays in access are problematic in dealing with AMR.

What needs to be considered in a solution for this is revamping our incentive programs so that, like other G7 countries, we have better access to antimicrobials, along with built-in antimicrobial stewardship mechanisms to ensure that we're not overusing them. The problem, as mentioned before, is overuse, but at the same time, access to essential antimicrobials in Canada is important as we face increasing trends in antimicrobial-resistant infections.

Second, from an infection prevention and control point of view, many programs have been strengthened and surveillance systems have been developed to collect data and try to understand trends. The biggest problem I see nationally is that our surveillance systems are fragmented. If we look to other countries, we see that they're scaling back investments in infection control surveillance systems; the problem in Canada is that the access to data is delayed. As an example, if we look at the Canadian nosocomial infection surveillance program and the timeliness of data, we often see lags of one to two years. Similarly, in provincial surveillance programs for other infections, the data is not collated, aggregated and shared publicly with the users on a timely basis. This defeats the purpose of a rigorous surveillance program in Canada.

Finally, as for vaccinations, we know that vaccinations have many off target benefits, and the impacts on preventing diseases, hospitalizations and subsequent hospital-acquired infections are tremendous. The problem with vaccinations in Canada is that although we have national standards and recommendations based on science, the current supply chain funding model in public health budgets needs to shift. It can't be seen as just a pot coming from public health. It needs to come nationally from a health budget, and we should rethink a national vaccination program on vaccine procurement and distribution to improve vaccination uptake.

Thank you for your time.

[The Chair, Liberal, Hedy Fry]

I'll now go to Dr. Karl Weiss, chief of the division of infectious diseases and medical microbiology at the Jewish General Hospital.

You have five minutes, please, Dr. Weiss.

[Karl Weiss, Chief, Division of Infectious Diseases and Medical Microbiology, Jewish General Hospital, As an Individual]

First of all, hello. Thank you very much for inviting me today.

I would like to talk about five different topics. Some of them have already been discussed by the previous speakers. I've been involved with antibiotic resistance and antibiotic issues since 1995, and I was present at the Montreal conference in 1997 when, for the first time in Canada, we started talking about antibiotic resistance.

My first message is that antibiotics are essential for human health. Life expectancy in Canada in 1900 was about 40 years old; in 2025, it was around 82 or 83 years old. In 1900, 40% to 50% of newborns did not reach the age of 18. Three things changed this dramatically: hygiene, of course, but mostly antibiotics and vaccines.

Without antibiotics, we would not be able to do any major surgery, chemotherapy, dialysis or travel, so antibiotics are really essential for the modern health care system.

It's very important that, even though we talk about antibiotic resistance, we shouldn't do antibiotic bashing under the cover of antibiotic resistance. It's extremely important not to scare people about antibiotics when we talk about them but to try to enhance the good perception of antibiotics. It's an important message.

The second message is about the challenges of antibiotics. First of all, there's consumption. About 80% of all antibiotics are being used in the agricultural world, and this is mostly for economic purposes and not really for health purposes. In Canada, only about 20% are used—or 25%, depending on the statistics—for human consumption. Of these, about 70% to 75% of all the antibiotics are being used in outpatient care—mostly for respiratory tract infections. This is in the community, and we don't have a lot of data on antibiotic use in the community.

I'm a hospital-based physician at the Jewish General Hospital in Montreal, so I'm biased, as are many of my colleagues, who are distinguished experts. We always look at the problem from a hospital-based perspective and not necessarily from a general, more community-based perspective, so that's an important point to underline.

Next is prescriptions. In the vast majority of the world, you don't need a prescription to get an antibiotic. Since we live in an open world, out of about 200 countries, in the vast majority—140 to 150—you might be able to get an antibiotic without necessarily having a prescription. It's not the case in our country, which is a very good thing, but we have to be careful about this because whatever happens somewhere else will end up impacting our own environment.

The other thing is that we're opening prescriptions to more and more prescribers for all kinds of reasons. Thus, we need continuous education for health care professionals who are not necessarily very good at prescribing antibiotics. Very often, in a defensive model, they prescribe antibiotics not to be scared to provoke some problems.

The third point is the production of antibiotics.

We need to understand that, in order to achieve our goals in this country, the production of antibiotics is vital. One key component in the production of antibiotics is what we call the active pharmaceutical ingredient. The production of this ingredient is currently outsourced, mainly to India and China. Sometimes, we're unable to produce certain antibiotics locally. As a result, we depend heavily on logistics chains outside the country.

Another major issue is counterfeit antibiotics. This is the biggest issue facing all drug classes worldwide. Many poor‑quality drugs can enter the market directly or indirectly, which significantly affects the emergence of antibiotic resistance.

The fourth point is what we call antibiotic resistance itself. We have to make sure that, in terms of definition, measurement, monitoring and comparators, we are on par with other countries.

Defining antibiotic resistance is not very easy; it's sometimes difficult. As for measurement, there are many ways to do it, and we don't have a good way to measure it all the time. On monitoring, we have silos in Canada, so sometimes it's a bit more difficult.

We have weaknesses in our country—mostly that we don't have a major pharmaceutical giant to produce antibiotics and that we are a small market. We have certain things that do very well, such as agriculture. We have to improve our human networks; we have to share health data between provinces, and we have to educate the Canadian population a lot better.

Thank you very much for your time.

[The Chair, Liberal, Hedy Fry]

Thank you, Dr. Weiss.

I now go to Gerry Wright, professor, McMaster University.

You have five minutes, please.

[Gerry Wright, Professor, McMaster University, As an Individual]

Thank you very much, Madam Chair and honourable members.

Permit me to offer my condolences on the news that Kirsty Duncan passed away yesterday. She was a huge champion of this file. She was a colleague to many of you in the room and a huge help to those of us working in AMR.

I want to speak to you today in my role as an academic researcher. I started my lab at McMaster University over 33 years ago, working in the area of AMR and antibiotic discovery. I have advised industry, government and not-for-profits on antibiotic innovation, and I founded a spin-out company called Symbal Therapeutics in this area.

As you heard from Dr. Weiss, antibiotics changed the way we die. Before we had antibiotics, before the discovery of these agents and vaccines, 56% of Canadians died of infectious diseases. We're down to about 3% at this stage. We've also gained over 20 years of life expectancy. This is unprecedented in human history, but we're poised to lose this because of AMR.

My role as an academic researcher is to uncover the molecular basis of AMR, to identify potential solutions and to train the next generation of scientists. My lab uses chemistry and biology to study resistance mechanisms and to advance antibiotic discovery.

I've trained over 100 master's and Ph.D. students, post-doctoral fellows and technical staff. The sad news is that very few of them have remained in Canada, and very few are working in AMR research. The reasons for this are structural. Canada currently has limited biotech and pharmaceutical R and D capacity, especially in antibiotic discovery. Graduates are drawn abroad to vibrant biotech sectors in Boston, California and Europe.

In addition, building and sustaining an internationally competitive AMR lab is also incredibly difficult in Canada. Academic scientists operate like small businesses. We recruit talent, produce a product—high-impact research—and constantly compete for revenue, which comes primarily from the CIHR. These grants are reviewed by volunteers and panels organized by scientific discipline. However, there's no AMR panel at the CIHR. In fact, all the AMR work is lumped into work on bacteriology, fungal research and parasitology.

In contrast, in cancer research or cardiovascular research, there are multiple sources or multiple panels at the CIHR to fund these areas. This structure completely disincentivizes young investigators from pursuing AMR work, so Canada risks losing research capacity in this field.

Beyond fundamental research, translating these discoveries into innovative solutions remains incredibly challenging. Over four decades of experience, we've learned that academic findings often seed new biotech ventures, yet Canada lacks early-stage funding mechanisms to bridge the gap between discovery and application. This lack of support leaves us completely reliant on advances in other countries. We have to wait for others to discover and develop the medicines that we need to keep our citizens and our soldiers safe.

We don't need to be in this situation. There's a proven model out there. The U.S. small business innovation research program, or SBIR, provides competitive, non-dilutive grants to support start-ups that commercialize academic discoveries. A Canadian SBIR-style program would foster biotech entrepreneurship, create jobs and accelerate AMR innovation.

To illustrate, my lab recently discovered a new antibiotic, which was published in the journal Nature last spring. It targets several pathogens on Health Canada's priority list. We want to develop it in Canada, but without early-stage push funding or downstream pull market incentives, these assets risk moving abroad, along with their economic benefits.

In closing, I want to urge the committee to act on two priorities. One is to increase the overall CIHR funding and to create a dedicated AMR research stream to strengthen Canada's scientific foundation. The second is to establish a Canadian SBIR equivalent to enable the translation of discoveries from academia to industry, ensuring that Canadians benefit from homegrown innovation.

We are in strange times. Other countries are shuttering or reducing their research and development in infectious diseases. This is an opportunity for us in Canada. With strategic investment, we can help lead the global stage in response to AMR, protecting both our public health and our life sciences economy.

Thank you very much.

[The Chair, Liberal, Hedy Fry]

Thank you very much.

I will now go to Dr. Semret, associate professor of medicine, infectious diseases and medical microbiology at McGill.

Dr. Semret, you have five minutes, please.

[Makeda Semret, Associate Professor of Medicine, Infectious Diseases and Medical Microbiology, McGill University Health Centre]

Good afternoon. My name is Makeda Semret. I appreciate the opportunity to address this committee.

I lead the antimicrobial stewardship program for a network of McGill-affiliated hospitals in Montreal. I also serve as an associate director for the McGill AMR centre. I'll try not to repeat what has been very eloquently stated by my colleagues and friends around the table. My focus instead will be on antimicrobial stewardship. I will give a bit more granularity in this area, which is close to my heart.

Stewardship is how we govern the use of our existing antimicrobials. Effective stewardship ensures that antibiotics are used only when necessary and with the correct agent, dose and duration so that we preserve the effectiveness of our existing drugs, as well as the future pipelines. In hospital settings, as you've heard, we see rising counts of infections caused by such organisms as the carbapenem-resistant Enterobacterales, particularly among the at-risk populations we increasingly see in acute-care hospitals—patients with advanced comorbidities, undergoing complex procedures and generally staying in hospital for a prolonged period of time.

While infection prevention and control are crucial for limiting transmission, antimicrobial stewardship, or AMS, limits “selection pressure”—the emergence of clinically significant resistance—at both the individual and system levels. In AMS programs, we aim to reduce the overuse and misuse of antibiotics. This is through a set of coherent and coordinated activities, such as surveillance of antibiotic consumption and resistance; development of treatment guidelines, which is harder than you'd think; education of prescribers; very resource-intensive monitoring, evaluation and feedback for individual prescriptions; and research, obviously, into effective interventions.

In Canada, acute-care hospitals are required to have at least some basic components of AMS programs for accreditation standards. This requirement has been very beneficial. Successful programs can reduce antimicrobial use by 15% to 20% in the first few years. That has certainly been our case. Even though we have a very complex patient population, and we offer such services as transplantation, advanced cancer care, complex surgical procedures and so on, since 2019 we have been able to reduce our per patient antibiotic consumption by 20%. We have also decreased the proportion of antibiotics prescribed inappropriately. With these decreases, there are well-documented benefits, such as reduced rates of drug-resistant infections, including C. difficile; reductions in the length of stay in hospital; lower drug costs; and so on.

We do face challenges. I'll touch briefly on just three points that are relevant to stewardship in acute-care settings. The first is quite obvious. It is resource allocation. In our network, for example, antimicrobials account for only 3% of the total pharmacy budget. That's $4 million per year out of a total pharmacy budget of $130 million. You can imagine that this does not grab a huge amount of attention from the C-suite. Even when we reduce our antimicrobial consumption by 15% to 20%—that's a nice budget decrease—after initial gains after implementation of programs, we reach a plateau in terms of cost reductions, yet we need to maintain sustained effort that's very resource-intensive just to maintain the plateau.

The second challenge I would like to touch on is a bit more conceptual. This is the fact that AMS programs aim to prevent outcomes that have not yet occurred. The impact of our programs is much less visible compared with the impact of many other acute-care interventions done in health care. Infectious diseases are generally an area of medicine in which outcomes are not systematically measured.

The third challenge is integral to our objective. It is about assessing the appropriateness of antibiotic use. This is a very complex endeavour. We conduct audits with teams of experts. There is no single standard definition of appropriateness. It is context-dependent. There's even variability among experts who have similar training and practices.

In these challenges lie opportunities that may be interesting for Canada. We have a single-payer system. We have harmonized clinical practices across provinces and a well-connected community of infectious disease experts. We have an opportunity to develop pragmatic definitions and approaches to rating prescription quality. We can move from qualitative standards of accreditation to scalable, quantitative metrics that would measure prescription quality and program effectiveness.

I will conclude right there, and I will be happy to take any questions.

Thank you.

[The Chair, Liberal, Hedy Fry]

Thank you, Dr. Semret.

I'll go to our last—but not least—witness: Ms. Neudorf, who is a patient partner.

You have five minutes, Ms. Neudorf.

[Kim Neudorf, Patient Partner, Patients for Patient Safety Canada]

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

I represent Patients for Patient Safety Canada. We are a not-for-profit, volunteer-driven organization representing those who have experienced harm within our publicly funded health care system. We view AMR, sepsis and health care-associated infections as patient safety issues with physical, psychosocial and cultural manifestations.

Patients for Patient Safety Canada is a strong ally in supporting the reduction of AMR infections nationally and globally. We collaborate on research, help to develop national standards and public resources, raise public and professional awareness and participate in policy discussions. We accept 100% of all requests to participate in AMR initiatives.

Having the family's permission, I will share an experience that illustrates the profound human tragedy behind the science, as well as the clinical, economic and psychosocial burden of AMR.

A healthy 70-year-old sustained a simple foot fracture. Within two days, the person developed severe pain beneath the cast, accompanied by concerning changes in her vital signs and cognition. When the cast was removed, her foot was gravely infected. Sepsis was eventually diagnosed. MRSA, the most common health care-associated AMR pathogen, was identified. MRSA is notorious for causing persistent wound infections and, in more serious cases, life-threatening bloodstream infections. What followed was 419 consecutive days of hospital care. The person lost her foot and averted the amputation of her arm by two hours. Sepsis returned, as it does, and ultimately, MRSA and sepsis claimed her life.

The estimated health care costs incurred exceeded $750,000. This person never received a prosthesis, but a prosthetic foot can cost $15,000, and it can potentially cost $250,000 for a hand. Her husband was at her side each of those 419 days, incurring hotel, food and fuel costs, and he wasn't able to return to work.

Patients for Patient Safety Canada hears stories of stigma and harm. We see an opportunity for quality improvement. The lived experiences of patients and residents intersect with all five pillars of the action plan. This perspective unifies the plan's purpose by centring on the patient, the family and the community. Our recommendations will benefit the public, mitigate the moral distress and burnout experienced by health care workers, and reduce health care costs.

Many civil society organizations dedicated to AMR struggle financially. Therefore, in our first recommendation, we call on the Government of Canada to establish dedicated grants for patient organizations such as Patients for Patient Safety Canada and the Sepsis Canada patient advisory council to enable us to continue our collaborative work.

The remaining recommendations focus on people-centred engagement and empowerment. Respectfully, a supportive action that speaks to these isn't clear in the action plan.

Recommendation number two is to strengthen health promotion, infection prevention and patients' early recognition of sepsis through an equity lens. If three-quarters of a million dollars can be spent on valued treatment, can the same investment go toward community programs that promote healthy choices and living conditions, as well as bolstering our ability to prevent infections in the home and in hospital? Patients and residents do not expect to leave a health care facility more ill than when they arrived. It is crucial that high-quality infection control standards are measured and monitored in health and congregate care settings.

Recommendation number three is to develop resources for patients living with AMR, providing accessible, high-quality resources for patients, who at times feel dismissed, stigmatized and uninformed about how to live with infections complicated by AMROs. The psychosocial impact on people experiencing AMR infections or living with chronic colonization or post-sepsis is poorly understood, and support is needed.

Recommendation number four is to expand public literacy on AMR and AMU. AMR is technical. We should build on our basic knowledge of infection and antimicrobial use. This should start in primary education and continue through to university programming. We should measure the distribution of resources developed by Health Canada and PHAC. We can't learn from resources that never reach the intended audience. We should also measure the public's knowledge over time.

Recommendation number five is to integrate patient voices and national AMR strategies. The current action plan does not adequately incorporate patient and family perspectives. HESA can play a pivotal role in ensuring that patient and family voices are embedded in policy development, implementation and evaluation.

Thank you. There is more detail in my submitted brief.

[The Chair, Liberal, Hedy Fry]

Thank you very much, Ms. Neudorf.

I want to congratulate the witnesses. None of you went over time. You were great. Some of you even went under time. That's something we parliamentarians could learn to do sometimes.

We'll now go to the question-and-answer session. The questions in the round we're doing now are six-minute questions, but that includes the answers—so remember, six minutes for questions and answers. I would urge everyone to be as succinct as you can, please.

We'll begin with Mr. Bailey for the Conservatives.

You have six minutes, please.

[Burton Bailey, Conservative, Red Deer, AB]

Thank you, Madam Chair.

Dr. Leung, Canada seems to lag behind other G7 countries in providing access to new antimicrobials.

Could you elaborate on specific examples of programs or pilots in other G7 nations that Canada could copy to improve timely access?

[Victor Leung]

There are two countries I'm aware of. One is the U.K., and the other is Italy. In Italy, they have access to many of the antimicrobials, but they have also developed a system of oversight so that contracts are negotiated between the government and the manufacturers to have criteria for use and criteria to re-evaluate the program based on whether there are exceptions to overutilization.

In the U.K., they have a model based on contracted pricing to incentivize companies to participate through a subscription model.

There are other examples among the G7 countries, but what's clear is that Canada, compared to these other countries, is behind in terms of our mechanisms for procuring and accessing antimicrobials when they're needed. We can learn from that through...an example is a hub and spoke model, in which there would be oversight through a more distributed system rather than centralizing it through the existing special access program.

[Burton Bailey, Conservative, Red Deer, AB]

We've heard about the benefits of a national licensure program for medical professionals. You advocated for a coordinated federal-provincial approach, and you just spoke about the hub and spoke model for high-volume antimicrobials, similar to malaria treatment.

How should the federal government structure its central role to ensure equitable access across provinces, given patient mobility and the rapid spread of resistance?

[Victor Leung]

One thing is to ensure that hospitals aren't the ones facing the budget challenges when accessing these antimicrobials, because it becomes very problematic for various hospitals to deal with this on their own. Any kind of federal model that ensures equitable access would have to address some of the financial challenges faced by hospitals when trying to access these antimicrobials.

The second criterion that would be important is accountability in how the funding is distributed so that the federal government has measures in place for at least some oversight or some accountability when the funding is transferred to provinces, if they go by a model that's decentralized.

[Burton Bailey, Conservative, Red Deer, AB]

I have one last question.

I've heard in meetings with various stakeholders that Canada is known for having excessive administrative burdens—paperwork and red tape.

What suggestions would you put forward to improve this reality so that Canadians may gain access to the best health care possible?

[Victor Leung]

We need to modernize some systems. Currently, when accessing SAP drugs, for example, if relying on the standard system, it's through faxing and telephone calls. Subsequently, there are outdated mechanisms for tracking.

However, it's also important, if we're going to develop any kind of improved information transfer system, that we don't follow the mistakes we have made in the past—for example, with some of the information system issues we learned about during the COVID pandemic. In re-evaluating how data is transferred, both for surveillance purposes and access purposes, we would have to keep in mind some of the major mistakes we made when trying to develop IT systems.

[Burton Bailey, Conservative, Red Deer, AB]

Thank you.

[The Chair, Liberal, Hedy Fry]

You have one minute and 15 seconds, Burton.

[Burton Bailey, Conservative, Red Deer, AB]

I would like to be under time like our witnesses.

[The Chair, Liberal, Hedy Fry]

My goodness. Wow. Thank you very much.

I'll go to the Liberals for six minutes.

Ms. Sidhu.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Madam Chair.

Thank you to all the witnesses for sharing your insight.

My first question is for Dr. Bogoch.

Dr. Bogoch, you said that roughly 70% of global antibody consumption occurs in agriculture animals compared to about 30% in humans. You emphasized the “one health” approach and that resistance can emerge and spread across human, animal and environmental settings. Based on the evidence, what do we know about how much antimicrobial resistance affecting human medicine is driven by human antibiotic use versus use in animals?

[Isaac Bogoch]

That's a great question. Thanks for bringing it up.

We know a lot, given that 70% to 80% of the global consumption is in non-human animals. There's intimate interconnectivity—pardon the term “intimate”—between animals and humans, and this is how it spreads. If the goal is prevention, but we're just focusing on family physicians' not giving an antibiotic for a viral upper respiratory tract infection, we've failed.

If you look at where many of the significant issues with AMR have developed, you'll see that it's overseas, where antibiotics are being dumped into agricultural animals. The reason antibiotics are being dumped into agricultural animals is that they grow bigger and stronger and have more muscle mass, and you can sell them for more money. There are programs internationally to reduce that, but they're not really enforced.

I think—if we want to look at bang for our buck—if we, coupled with other powers that be, can pull international levers to ensure that there's less use of antibiotics in that setting and the taps are turned off, namely through global stewardship programs, that will go a long way.