Good afternoon, Madam Chair and members. I'm very grateful for the invitation to speak to the House of Commons Standing Committee on Science and Research about Standing Order 108(3)(i).
Drawing on my own research, I would like to share what I hope to be useful elements contributing to the answer to one of the four questions listed in this standing order: What is driving an increase in antimicrobial resistance, or AMR?
To do so, I would like to focus on armed conflicts. Since 2017, together with Canadian and international collaborators, I have been leading research on the interplay between AMR and armed conflicts. In 2018, I organized a symposium on this topic in Geneva, Switzerland, where the keynote address was delivered by Dr. Tedros, who was then and is now Director-General of the World Health Organization.
The momentum generated by these early efforts was unfortunately interrupted by the COVID-19 pandemic, yet the problem has not only persisted; it has worsened. The number of active armed conflicts is now at its highest level since the Second World War, with a marked concentration in low- and middle-income countries, where the global AMR burden is already greatest.
Armed conflicts were among the first settings in which AMR was recognized as a novel phenomenon in the 1940s. Although research has since largely shifted toward peacetime and civilian contexts, resistant pathogens continue to emerge and spread rapidly in war zones. This trend has intensified as warfare increasingly unfolds in densely populated urban areas and targets civilian populations, including vulnerable groups such as children.
Military operations in Iraq and Afghanistan earlier in the century—the latter involving Canadian personnel—brought renewed attention to this issue after severe antibiotic-resistant infections were observed among wounded soldiers. The medical evacuation of American troops to hospitals in Germany and the United States subsequently facilitated the spread of AMR to civilian health care systems. The war in Ukraine has further underscored this threat, as refugee-hosting countries have reported outbreaks of drug-resistant bacteria.
With accelerating urbanization, cities have increasingly become the primary theatre of war. This shift has transformed not only the conduct of warfare, but also its environmental and public health consequences. Urban combat often devastates housing and critical infrastructure—as has been evident in Gaza over the past two years—releasing heavy metals, asbestos, petrochemicals and other toxic substances into water and soil, and exposing bacteria in these ecosystems to these toxins. Like all living organisms, bacteria are affected by such toxins and must evolve adaptive mechanisms to survive. These same mechanisms drive the emergence, persistence and spread of AMR bacteria.
Contrary to prevailing views that treat AMR in armed conflicts as a marginal topic, I contend that these environments merit close scrutiny as powerful drivers of AMR and as unique sites for studying its dynamics. Just as the Arctic stands at the front line of climate change, so too do armed conflicts represent hotspots where biological, environmental, social and infrastructural disruptions converge to accelerate AMR.
The mistake would be to assume that rising resistance in war zones remains confined to them. Emerging infections and pandemics remind us time and again that microbes respect no borders. As we enter an era of growing geopolitical tension marked by the highest number of active conflicts since World War II and rising global military expenditures, it is imperative to address the intertwined crises of AMR and armed conflicts.
Canada has a strong record of leadership in tackling global health challenges such as AMR. It is time for the Canadian government to renew that leadership by championing international efforts to make the intersection of AMR and armed conflicts a global health and security priority.
I thank you for providing me with the time to contribute to the work of this committee.
I welcome questions or comments you may have.
Thank you.