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.