Science and Research Committee on Oct. 6th, 2025

[The Chair, Liberal, Salma Zahid]

I call the meeting to order.

Welcome to meeting number seven of the Standing Committee on Science and Research. Pursuant to the motion of June 18, 2025, the committee is meeting to study antimicrobial resistance.

Today's meeting is taking place in a hybrid format, pursuant to the Standing Orders. Members are attending in person in the room and remotely using the Zoom application.

Before we continue, I would like to ask all in-person participants to consult the guidelines written on the cards on the table. These measures are in place to help prevent audio and feedback incidents and to protect the health and safety of all participants, including our interpreters. You will notice a QR code on the card, which links to a short awareness video.

I would like to make a few comments for the benefit of the witnesses and members.

Please wait until I recognize you by name before speaking. For those participating by video conference, click on the microphone icon to activate your mic, and please mute yourself when you are not speaking.

For those on Zoom, at the bottom of your screen, you can select the appropriate channel for interpretation: floor, English or French. Those in the room can use the earpiece to select the desired channel.

As a reminder, all comments should be addressed through the chair. For members in the room, if you wish to speak, please raise your hand. For members on Zoom, please use the “raise hand” function. The clerk and I will manage the speaking order as best we can. We appreciate your patience and understanding in this regard.

I would now like to welcome our witnesses.

For the first panel, we have Dr. Herman Barkema, professor of epidemiology of infectious diseases at the faculty of veterinary medicine at the University of Calgary; Dr. Isaac Bogoch, infectious diseases specialist at the Toronto General Hospital and professor of medicine at the University of Toronto; François M. Castonguay, assistant professor at the Université de Montréal; and, by video conference, Dr. John Conly, professor of medicine at the University of Calgary.

Welcome, everybody. Thanks a lot for coming and appearing before this committee on this important study.

All witnesses will have five minutes for opening remarks, and then we will go to the rounds of questions. Today, we will start with Dr. Barkema.

The floor is yours.

[Herman Barkema, Professor, Epidemiology of Infectious Diseases, Faculty of Veterinary Medicine, University of Calgary, As an Individual]

Thank you very much for the invitation. I got it when I was in Chile, and I came over here for this important meeting.

As you will know, antimicrobial resistance, AMR, is a growing global crisis that, if left unchecked, severely threatens our health care, food security and economic stability. Without effective antibiotics, many easily treatable infections in humans and animals would be fatal. Some routine medical procedures, like hip and knee replacements and certain types of chemotherapy, would pose unacceptable risks to patients.

One of the key challenges in addressing AMR is that the problem is not restricted to human health. The same genes that confer AMR in human infections can also be found in agricultural, veterinary and environmental settings. These AMR traits pose a serious risk to our food supply and create multiple reservoirs that hamper containment efforts. Although the spread of AMR is a serious challenge, there are effective methods for addressing the problems, including infection prevention and control programs, antimicrobial stewardship efforts and precision antimicrobial prescribing practices. These practices are proven to slow and, in some cases, reverse AMR trends when applied to select human and animal applications. However, four major gaps prevent us from deploying these concepts at national and regional scales.

The first one is that we lack the technology and monitoring programs needed to track the spread of AMR genes and microbes across reservoirs. Second, the health and economic impacts resulting from the movement of AMR traits between reservoirs are not sufficiently documented to justify widespread intervention. Third, there is no policy framework and also no overseeing organization for implementing AMR containment programs across provinces and territories and across human, animal and environmental sectors. Fourth, we have yet to develop the cross-sectoral infection prevention and control programs needed to control the spread of antimicrobial resistance across reservoirs. Addressing these gaps opens a path to controlling Canada's AMR crisis. We need to develop a policy framework for regional and national intervention.

Another critical challenge is that, when addressing AMR, our containment strategies are generally sector-specific, but microbes don't respect these jurisdictional boundaries. For example, antimicrobial stewardship programs are siloed within either human or animal health and do not consider environmental reservoirs. Moreover, we lack the policy framework and an overall organization needed to coordinate surveillance, stewardship, and infection prevention and control across sectors and between government departments. This framework will need to be informed by our scientific findings and an understanding of the relevant decision-makers in Canada and their respective jurisdictions, by a comparative analysis of AMR containment approaches that are successfully employed in other jurisdictions and by a consideration of the barriers to implementing this one-health approach to containment.

The need for monitoring and controlling AMR is widely recognized. However, existing programs, such as waste-water monitoring, clinical microbiology and agricultural surveillance, are siloed. Additionally, most surveillance programs lack the molecular resolutions for looking at the genes needed to differentiate between selection for specific resistance genes and the expansion of resistant lineages. AMR cannot be solved through half measures or sector-specific strategies. I always compare it to a boat with nine holes; when eight of them are patched, the boat will still sink. A unified, action-oriented approach is required to make meaningful progress in stopping the spread of resistance.

AMR monitoring is a routine practice in nearly all health field jurisdictions and our surveillance is based on phenotypic testing on agar plates, where we look at what antibiotics these strains are susceptible to, but they do not capture the molecular characteristics of the pathogens.

[The Chair, Liberal, Salma Zahid]

If you can please wind up, you will get an opportunity to talk about things in the rounds of questioning.

[Herman Barkema]

Okay.

Some examples of what is needed include surveillance of reference lab data; targeted surveillance of hospital waste water; municipal waste water surveillance; determining how much international travel contributes to the transmission of AMR; agricultural surveillance and determining to what extent animal and agricultural AMR reservoirs contribute to human infections; and examining the role of companion animals and wildlife reservoirs.

[The Chair, Liberal, Salma Zahid]

Thank you.

We will now proceed to Dr. Bogoch.

Please go ahead. You have five minutes for your opening remarks.

[Isaac Bogoch, Infectious Diseases Specialist, Toronto General Hospital and Professor of Medicine, University of Toronto, As an Individual]

Thank you so much.

Thank you for the invitation to speak today.

My name is Isaac Bogoch. I'm an infectious diseases physician and scientist and a professor of medicine based out of the University of Toronto. I frequently treat drug-resistant organisms in my clinical practice, and my research focuses on how these organisms spread globally through human mobility patterns. I'm grateful that you're studying this topic, given its tremendous negative impact in Canada and around the world.

Antimicrobial resistance arises from the misuse and overuse of antimicrobial drugs, which render them ineffective. It causes substantial morbidity and mortality at both an individual and a population level.

I see this at the bedside as a clinician, as AMR leads to the delayed initiation of appropriate antimicrobial agents, and it results in predictable negative consequences, but many are not aware that about 70% of the global antibiotic consumption is in agricultural animals, with only about 30% of use in humans.

This imbalance underscores the importance of what's known as the “one health” concept, which recognizes the significant interconnectedness between human, animal and environmental health. Because of this, we need to take a collaborative and cross-sectoral approach to AMR.

In humans, AMR is of course a massive problem. A recent study published in The Lancet estimated that there were about 1.27 million annual deaths directly caused by AMR, with 4.7 million deaths where AMR played some role. Now, that's more deaths—4.7 million—per year than HIV, tuberculosis and malaria combined.

We can't just invent our way out of this mess by developing new drugs. In an arms race between humans creating new drugs and microbes adapting to these drugs, the microbes win every time.

Canada is doing relatively well compared to other countries, but we're not immune—pun intended. We have national strategies, we have better regulations over antibiotic use, and we have infection prevention and control programs to ameliorate AMR spread in health care settings, but here's the uncomfortable truth: We can do everything right in Canada and still fail.

AMR, like other pathogens, doesn't respect political borders. Resistant organisms can emerge in one part of the world and spread through human mobility patterns and through trade. While AMR is appropriately framed as a “one health” issue, it's equally important as a health security concern. As we saw during COVID, our supply chains for diagnostics and therapeutics are already fragile and may be further strained by growing geopolitical instability.

There's an ongoing war in the Ukraine that may be spreading to other NATO countries, with two allies invoking article 4 to date. In this conflict, up to 80% of combat wound infections are resistant to conventional first line antibiotics, which would pose serious risks should Canada be drawn in. Compounding this, Russia's past biologic weapons programs are 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.

But it's not all bad. Globally, there are large surveillance programs to study and track AMR, and these are led by the WHO and the U.S. CDC. Unfortunately, major partners are pulling back funding and, quite frankly, global health leadership is imploding. While that leaves us all more vulnerable, it also presents a major opportunity for Canada to fill this vacuum as a global leader in health care and public health, with a focus on combatting AMR.

What's a smart path forward? We have to take an intersectoral approach, with both a national and a global perspective. Here are a few key points.

Number one, strengthen antimicrobial stewardship programs and infection prevention and control initiatives in Canada and abroad. Also, hopefully, we can pull diplomatic levers to help reduce the misuse of antibiotics globally.

Number two, enhance AMR surveillance in Canada and abroad. We don't need to reinvent the wheel. We can already fill support and funding gaps with pre-existing programs.

Number three, invest in research and innovation in Canada and abroad. This could mean supporting public-private partnerships; enabling Canada to be self-reliant; support for R and D for new antibiotics; rapid diagnostic tests; and even alternative therapies like phage therapy, where we use viruses to kill bacteria, and please ask me about that in the question period. We also can create regulatory frameworks to make this usable.

Number four, launch public awareness campaigns in Canada and abroad to educate the public and various sectors.

Number five, leverage the security aspect of AMR to fund such initiatives. AMR is not a future problem. It's here, it's growing and it's a global health threat. We can either act now or pay a much higher price later on.

Thank you so much for your time.

[The Chair, Liberal, Salma Zahid]

Thank you.

We will now proceed to Dr. Castonguay. The floor is yours.

[François M. Castonguay, Assistant Professor of Health Economics, School of Public Health, Université de Montréal, As an Individual]

Good morning, Madam Chair and members of the committee.

My name is François Castonguay, and I am an economist by training and currently a professor and researcher based at the school of public health, Université de Montréal. My interests focus on improving public policies in various health areas, including antimicrobial resistance, while ensuring that policy decisions are guided by the best evidence.

I work in Quebec, where I use mainly French, but I will present in English.

AMR creates a huge economic burden on provincial health care systems. In 2018, costs were over $1.4 billion, with the potential to exceed $7.6 billion by 2050. Much of this, as my colleague said, is because of routine procedures becoming less feasible or riskier.

AMR is not just a health care problem; it's also affecting the broader economy. The negative impact on GDP could grow to $21 billion by 2050, and the impact on non-health care sectors is expected to grow significantly. It represents about 30% today, but by 2050, about two-thirds of costs would be attributable to non-health care sectors, driven mostly by sectors like animal product manufacturing and labour-intensive industries. This shows how AMR is becoming increasingly multisectoral.

One current strategy that Canada has put forward is the pan-Canadian action plan on AMR, which is organized, as my colleagues mentioned, around different pillars. One is stewardship, which includes measures that promote responsible prescribing in primary care and have been shown to reduce inappropriate usage in a low-cost way. Another is surveillance. Using whole genome sequencing allows us to track the evolution of resistant strains and limit their spread. In Canada, this measure alone could save up to $70 million annually. Vaccination is, potentially, a highly cost-effective solution as well. It simultaneously reduces the burden of vaccine-preventable diseases and prevents downstream complications that might otherwise require antimicrobials.

However a key question remains: Which pillar should we prioritize to obtain the best return on investment? Economics gives us concrete tools to guide decision-making. It helps balance trade-offs between health, economic outcomes and broader social impacts.

Breaking down silos will be essential because AMR sits at the intersection of human, animal and environmental health. Intersectoral co-operation will add value by pooling resources and expertise across health, agriculture, fisheries, the environment and research, often without big additional costs. Economics should be seen as a key enabler by quantifying benefits, comparing investment scenarios and ranking interventions, thus supporting efficient, integrated and sustainable AMR strategies.

Previously mentioned interventions can be implemented in the short term by provincial governments, but a promising longer-term solution would be the adoption of an integrated framework that combines economic tools with the “one health” approach, which considers interactions between human, animal and environmental health. “One health” generates measurable economic value. By integrating health, agriculture, fisheries and environmental perspectives in decision-making, we can optimize investments and maximize health and economic returns without necessarily requiring new funding. Combining the “one health” approach with economic tools would strengthen the pan-Canadian action plan on AMR by allowing us to identify priority pillars of action and interventions, improve intergovernmental and intersectoral co-operation and find ways to allocate public resources toward actions with the best return on investment.

In conclusion, combining the “one health” approach with economics to fight AMR would enable provincial and federal governments to save lives, preserve antimicrobial effectiveness for future generations and strengthen the sustainability of provincial health systems and their economic resilience to future health crises, including AMR.

In short, smart economics and integrated health governments can make Canada a global leader by protecting both lives and livelihoods.

Madam Chair and members of the committee, thank you for the invitation to appear today and for your attention.

[The Chair, Liberal, Salma Zahid]

Thank you.

We will now proceed to our last witness for this panel.

Dr. Conly, please go ahead. You will have five minutes for your opening remarks.

[John Conly, Professor of Medicine, University of Calgary, As an Individual]

Thank you very much, Madam Chair.

Good morning, members of the House of Commons Standing Committee on Science and Research. I am profoundly grateful to have the opportunity to present to you. I've been working on this portfolio for three decades.

My name is John Conly. I'm an infectious diseases physician in the department of medicine, in active clinical practice, and also an epidemiologist scientist. More recently, with my colleague, Dr. Herman Barkema, I am a co-director of the newly designated WHO collaborating centre for AMR research and appropriate use of antimicrobials. I'm pleased to say we're the only global WHO collaborating centre that has a focus on the area of AMR research.

Before I begin, I'd like to briefly provide a territorial acknowledgement. because I am on the lands of the University of Calgary that acknowledges and pays tribute to the traditional territories of the people of Treaty 7. Treaty 7 includes the Blackfoot Confederacy, the Tsuut'ina Nation, and the Stoney Nakoda Nation. We are also home to Métis Nation Districts 5 and 6.

I have no disclosures in the last three years other than academic and public organization-related disclosures.

We've learned from the other speakers about the concerns over AMR and what's driving them. I was very pleased to hear about both the clinical and economic impacts of AMR. I would also refer you back to the study that was released in 2018 by the standing committee on the status of AMR in Canada and its many recommendations. You may have looked at it.

We are aware that AMR is a slowly-moving tsunami. Many of us consider it to be a silent pandemic, just gradually moving and far out to sea; we have not seen the full implications. We know that it has a huge clinical impact. There was a systematic review by the WHO released 10 years ago. It showed that for the three most common organisms—you've heard of staph infections, for example, or E. coli, which is a common infection for bladder and kidney—there was a 1.6 to twofold increase in mortality if you're infected with a drug-resistant organism compared to a drug-sensitive organism.

There was a global burden of disease study in The Lancet. This is done every few years. In 2022, it revealed that there are death rates from AMR directly attributable that are 10 to 25 per 100,000 lowest in Australasia and 250% higher in sub-Saharan Africa. We are also seeing unabated increases in conflict zones.

I look forward to the release on October 13 of the global antimicrobial resistance and use surveillance system report. Many of us have been engaged in looking at this. You will see that the results are very sobering. This is the so-called WHO GLASS report.

The drivers of this slow-moving tsunami are numerous. We've heard about multiple drug resistance; panresistance; massive reductions in research and development for new antibiotic agents; unabated and massive use in all sectors of society, which we've heard about; a propensity for rapid spread; and the fact that these drug-resistant organisms know no political boundaries. They are agnostic in that respect.

We know that this is a huge issue with humans, using an estimated 34.8 billion antibiotic doses per year with a 65% increase between 2000 and 2015. In animal and agricultural use, it ranged between 63,000 to 240,000 tonnes per year. We've heard about the interconnectedness in a “one health” setting. We know there was a propensity for a spread.

In 2024, there were one billion people who took airline flights across the world. You can see how rapidly—and just from the pandemic that we had with COVID-19—in such a shrunken world how AMR can spread so readily. COVID has had a major impact.

The CDC released a study just recently, and showed that there was a statistically significant increase in both bacteria and fungi related to this. There was also a systematic review in which Dr. Barkema and I were involved. It was published in 2022. It showed a markedly increased prevalence of antibiotic-resistant microbes associated with the COVID pandemic.

We've also seen significant burdens in society with the EU suggesting €1.5 billion per year and $20 billion in the U.S. These are direct societal costs exclusive of indirect costs.

The economic impact in Canada was very well outlined in the Council of Canadian Academies report from 2019, which predicted a $388-billion drop in the GDP in Canada with a rise to 40%. It has already made up to $2 billion in GDP—

[The Chair, Liberal, Salma Zahid]

Please wind up.

[John Conly]

To wind up, what we need to tackle AMR is for Canada to step up in a bold and ambitious way in implementation. There are many recommendations from the pan-Canadian action plan and the CCA report. We need to use our digital superclusters, particularly with the stewardship app that was provided globally through the digital supercluster and science and innovation ministry.

We need more action on this area from Canada, not a lot of new recommendations and reports. We need implementation and action.

Thank you.

[The Chair, Liberal, Salma Zahid]

Thank you.

We will now go to our rounds of questioning and start the first round with MP Ho for six minutes.

Please, go ahead.

[Vincent Ho, Conservative, Richmond Hill South, ON]

My first set of questions are for Professor Barkema.

You mentioned that there is no policy framework for AMR, just a lack of it. Back in 2018, there was a report sent to the House of Commons and the Liberal government advising the government of this issue of AMR and calling for it to take action.

Could you speak a bit more about that? Do you think that's an issue? Do you think there's been any progress on this front—or a lack of progress, for that matter?

[Herman Barkema]

Thank you for that question. I'll leave the political issues and whatever for the people who are working on that, so you'll have to speak to them about it.

I'm the co-chair of the advisory committee on AMR of the Public Health Agency of Canada. The PCAP, the pan-Canadian action plan, was released two years ago. A lot of work has been done on that.

Canada is a beautiful country and I love being here, but the reality is, as you know very well, that health and agriculture are under provincial jurisdiction. We need to work together on this framework. It's not only that we need to work federally—and we need leadership on it federally....

I was involved in a report that we did for the Public Health Agency of Canada, led by Dr. Gerry Wright and Andrew Morris, on what organization we need in Canada to do this. This report is collecting dust at this moment—you will have to ask other people why that is the case—but there are ideas on how to get this done.

I'm worried about current federal spending going toward security. This important security issue will not get enough funding to continue. That's a worry we all have in this area. As the others have mentioned, with the wars and everything that is going on, it is important that this gets funded. Bucks don't stop at borders. We need to look at that as well.

[Vincent Ho, Conservative, Richmond Hill South, ON]

Certainly, Canada needs to do its part. It's very concerning to see that we spend about a billion dollars a year on health care research. That's on everything. It's not just on AMR; it's on everything health care-related.

We have this Liberal government running these massive deficits. We're now servicing the debt to the tune of $68 billion a year. It really puts into perspective where the priorities are. Is it inflationary deficits or solving the next health issue? It's really concerning to see that and to see that the medical community, the health community, the health care community and the public health community have put together this report that's collecting dust. It seems like nobody in this government takes it seriously. Nobody in this government is taking action after all this time has been spent on putting together this report.

Dr. Bogoch, you mentioned supply chain issues and likened them to the mismanagement of COVID and emergency preparedness. Could you elaborate a bit more about the supply chain issues that keep you up at night?

[Isaac Bogoch]

I think everyone in the room remembers the very early days of COVID when we were scrambling to get equipment, including masks, into the country. I think that woke up a lot of people to not only how interconnected we truly are, but also how vulnerable we are when those supply chains are weakened. I think, when we're talking about AMR, we still have to be cognizant of this issue in terms of how we make diagnoses, how we treat, how we get our antibiotics and how we conduct our surveillance programs. We have to really ensure that we have more self-reliance.

I can't speak on behalf of other provinces, but I know that, for example, the chief medical officer of Ontario, Dr. Kieran Moore, has paid very close attention to this and has worked very diligently in ensuring that there is the capability or the capacity for local creation.

[Vincent Ho, Conservative, Richmond Hill South, ON]

Federally, though, you're not seeing the level of attention that you would expect, especially when we're talking about a national framework and trying to coordinate the responses of all the different provincial agencies.

[Isaac Bogoch]

I would say it's a work in progress, and better coordination among the provinces and federal-provincial work could improve this process.

[Vincent Ho, Conservative, Richmond Hill South, ON]

Are you confident with the state of affairs right now, or do you think—

[Isaac Bogoch]

I'm uncertain.

[Vincent Ho, Conservative, Richmond Hill South, ON]

You're uncertain. Wow.

At a time when Canadians are facing uncertainties in all aspects of life, this adds to the uncertainty.

[The Chair, Liberal, Salma Zahid]

I'm sorry, but your time is up. Thank you.

We'll now proceed to MP Jaczek.

You will have six minutes. Please go ahead.

[Helena Jaczek, Liberal, Markham—Stouffville, ON]

Thank you, Madam Chair.

Thank you to all our witnesses.

I first became aware of this issue of antimicrobial resistance as a practising physician in the eighties, when I was doing my Master of Public Health at the University of Toronto, and now we find ourselves here with an ongoing major issue in front of us.

It seems like successive governments perhaps have not been addressing the issue to the extent that they might have over the last several decades. Now it's at least heartening to know that our government has introduced a pan-Canadian framework.

My first question is to Dr. Barkema. You talked about the framework. Dr. Castonguay has raised the issue of economics being part of a “one health” approach. Would you agree that perhaps the framework should also look at economic considerations?

[Herman Barkema]

I fully agree. I am also working in agriculture. Farmers are not going to apply antimicrobial stewardship if there is a huge cost associated with it, so yes, that needs to be done.

Also, we need priorities in health care, whether we like it or not. Some of those will be economically driven, so I totally agree with that point.