Evidence of meeting #7 for Science and Research in the 45th Parliament, 1st session. (The original version is on Parliament’s site, as are the minutes.) The winning word was amr.
A recording is available from Parliament.
Conservative
Tony Baldinelli Conservative Niagara Falls—Niagara-on-the-Lake, ON
Dr. Castonguay, what are your thoughts?
Assistant Professor of Health Economics, School of Public Health, Université de Montréal, As an Individual
That includes multisectoral approaches simultaneously from federal and provincial governments.
Conservative
Infectious Diseases Specialist, Toronto General Hospital and Professor of Medicine, University of Toronto, As an Individual
Appoint an AMR czar.
Conservative
Liberal
The Chair Liberal Salma Zahid
We will end this panel with MP McKelvie for two minutes.
Please go ahead, MP McKelvie.
Liberal
Jennifer McKelvie Liberal Ajax, ON
Thank you.
Thank you to my colleagues for ceding their time, because we did want to give Dr. Conly the opportunity to answer the question I asked previously, but we ran out of time.
As this work is unfolding, are there some early priorities you would like to share with us today?
Professor of Medicine, University of Calgary, As an Individual
Yes.
One very specific one is a great Canadian success story called the digital supercluster. There was a huge announcement in December 2022 by then-minister Champagne about a collaboration with the digital supercluster. If you remember, it involved a significant amount of funding and a Canadian company, Firstline, in the development of a stewardship app that has gone global with respect to the WHO “AWaRe” categorization—access, watch, reserve. It is now on a server. This is a major Canadian contribution to global efforts against AMR.
It has not been advertised well. With some directed funding, this stewardship app looks at the essential medicines that were done by McMaster University for the use of simple agents such as penicillin and others that are less likely to create resistance. In the digital world, some additional contributions of small amounts of money would go a long way. There are more cell phones in the world than there are flush toilets. This would go a long way towards educating the masses and would be a great Canadian G7 contribution.
If there were one thing I could focus on, it would be this “AWaRe” categorization that would be a benefit not only to Canada but to the world, as well as the stewardship app that's been developed for veterinary practice. My key takeaway message would be to go digital.
Liberal
The Chair Liberal Salma Zahid
With that, this panel comes to an end.
Witnesses, I really want to thank you all for your important testimonies.
We will suspend the meeting so that the next panel can take their seats.
Liberal
The Chair Liberal Salma Zahid
I call the meeting to order.
Before we begin, I would just like to make a few comments for the benefit of our new witnesses for this panel. 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. For those in the room, you can use the earpiece and select the desired channel. I remind you that all comments should be addressed through the chair.
With that, I would like to welcome our three witnesses for this second panel.
Participating by video conference, we have Dr. Rita Dhami, adjunct clinical assistant professor at the school of pharmacy at the University of Waterloo. From Fedora Pharmaceuticals Inc. we have Dr. Sameeh Salama, chief science officer and chair, Canadian Antimicrobial Innovation Coalition. Our third witness is also joining by video conference. From Infection Prevention and Control Canada, we have Dr. Gregory Rose, infectious diseases and infection control consultant.
Welcome. Thanks a lot for appearing before the committee today.
You will have five minutes for your opening remarks, and then we will go into rounds of questioning.
We will begin with Dr. Dhami.
Please go ahead.
Rita Dhami Adjunct Clinical Assistant Professor, School of Pharmacy, University of Waterloo, As an Individual
Thank you, honourable Chair and members of the committee.
I'm here today both as a pharmacist-researcher practising in antimicrobial stewardship and infectious diseases and as the chief pharmacy officer at the Canadian Society of Healthcare-Systems Pharmacy. I'd like to express strong support for this motion to continue funding antimicrobial resistance research and innovation.
Antimicrobial resistance represents one of the most pressing public health challenges of our time. Resistant organisms are no longer confined to hospitals; they're present in our communities, food supply and environment.
My colleagues have already highlighted that there have been great social and economic impacts of antimicrobial resistance. In 2023, the Government of Canada acknowledged that and released the pan-Canadian action plan on antimicrobial resistance, which set out five key pillars. This framework is essential, but meaningful impact will require ongoing funding and cross-jurisdictional coordination.
Now, under these key areas, I want to highlight a few additional opportunities.
Under the pillar of “surveillance”, the Canadian nosocomial infection surveillance program, CNISP, has tracked resistance trends for decades. Its most recent data confirms the threat. Rising rates of carbapenem-resistant organisms and methicillin-resistant staphylococcus aureus continue to be a problem. This confirms that Canada is not immune to global trends.
We know that the drivers of antimicrobial resistance are multifactorial: inappropriate prescribing, agricultural use of antimicrobials, global travel, and gaps in infection prevention and surveillance. Increasingly, research is highlighting the interplay of planetary health—or the climate crisis—with antimicrobial resistance. We're now learning that microplastics as small as five millimetres have been shown to facilitate the spread of antimicrobial resistance, particularly the resistance genes, by just providing enough surface for biofilm development.
Again, this evidence on the links is emerging. A lot remains to be understood, but it's certainly an opportunity.
Parallel to antimicrobial resistance monitoring, Canada has also demonstrated leadership in measuring antimicrobial use more broadly. In addition to pathogen surveillance, CNISP has expanded capacity to monitor any microbial use amongst both adult and pediatric inpatients in Canadian hospitals. The CLEAR registry, which is the Canadian LEadership on Antimicrobial Real-life usage registry, has shown that structured data collection on new antimicrobial prescribing is feasible and gives us some insights on patterns of prescribing, particularly on new antimicrobials, at a national scale. This monitoring to date has been limited to hospital settings, mostly acute care facilities. That still leaves us with some gaps in our understanding of community and long-term care antimicrobial use.
On the research and innovation front, the Public Health Agency of Canada has begun exploring push-and-pull incentives for antimicrobial development and access. Again, that includes mechanisms for early discovery research as push incentives and market-entry rewards as pull incentives to make new antibiotics financially viable and accessible in Canada. It's definitely promising work that requires more attention and long-term commitment if Canada's going to be able to develop and access the global pipeline of new antimicrobial agents.
Lastly, I want to acknowledge that, at point of care, Accreditation Canada has made antimicrobial stewardship and infection control practices required organizational practices for all acute care hospitals. Again, that emphasizes that antimicrobial resistance is a core element of patient safety and quality care. Now most hospitals have IPAC and stewardship programs, but the depth and the resources vary widely across the country.
Canada does have the scientific talent and potentially some infrastructure to lead in this field, but our research efforts remain fragmented and underfunded compared to the scale of the threat.
We'd ask for a coordinated and adequately resourced national strategy that's anchored in the pillars of research, surveillance, stewardship and innovation. That's essential if we are to safeguard the effectiveness of existing antimicrobials and prepare for future threats. Without urgent attention, we risk entering the post-antibiotic era, where routine surgeries, cancer therapies and even minor infections once again becoming life-threatening.
Thank you.
Liberal
The Chair Liberal Salma Zahid
With that, we will now proceed to Dr. Salama.
You have five minutes for your opening remarks. Please go ahead.
Sameeh Salama Chair, Canadian Antimicrobial Innovation Coalition and Chief Scientific Officer, Fedora Pharmaceuticals Inc.)
Thank you, Madam Chair, and good afternoon.
Before I begin, allow me to briefly introduce myself. I have dedicated the past 30-plus years of my research work to the development of new antibacterial and antifungal agents to address the growing threat of antimicrobial resistance. I currently serve as chief scientific officer at Fedora Pharmaceuticals, an Edmonton-based antibiotic drug discovery company, and as chair of the board of directors of the Canadian Antimicrobial Innovation Coalition. It's a mouthful, so we call it CAIC for short. This is a not-for-profit coalition of life science companies and organizations dedicated to combatting AMR.
On behalf of Fedora and CAIC, I would like to commend the House of Commons Standing Committee on Science and Research for initiating this important study on AMR in Canada. As you heard from my colleagues, AMR is a global issue. Canada is not unique in the forecasts you have heard from other global nations. AMR is recognized as a global health crisis and has become a priority at the G7 every year. We are thrilled to see commitments made at the G7 to address AMR and the broken pipeline of AMR. However, Canada is falling behind its G7 peers in the implementation of these commitments.
As a point of interest, Canada ranks last in the developed world in the introduction of antimicrobial agents. Only three out of 18 antibiotics that have been introduced in the United States are available to patients in Canada. In other words, patients in Canada who need antibiotics when they need them have to go through a complicated process of special access programs in order to access those antibiotics that are available to their counterparts in the United States.
This commitment that your committee has made is a vital opportunity to highlight both the urgency of AMR and the need to strengthen Canada's R and D infrastructure. Advancing the research pipeline is essential, but so too is addressing market barriers that hinder domestic innovation. Without a viable market, these life-saving products will never reach patients. The need to champion domestic AMR innovation has never been more urgent. Canada was home to a number of promising companies engaged in AMR R and D and commercialization. Now Fedora, my company, is one of the very last companies still standing. The global shortage of new antibiotics, and the even scarcer number launched in Canada, illustrates a clear market failure. Overcoming this challenge requires collaboration amongst government, industry, academia and the health care sector.
As with other areas of biopharmaceutical development, the key weaknesses in Canada's AMR ecosystem are limited access to capital and challenges in moving discoveries from preclinical development to commercial launch. I would be very happy to focus on that point during the question period.
Compounding this problem is Canada's vulnerability in antibiotic supply chains. Currently, all active pharmaceutical ingredients, or APIs, for antibiotics are produced overseas, predominantly in Asia. Given that antibiotics underpin all modern medicine, this represents not only an innovation challenge but also a national security risk. As Canada increases defence innovation spending to meet NATO obligations, investments in AMR R and D should also be recognized as contributing to both national and global health security.
Current funding mechanisms for early antibiotic development fall well short of those in other G7 countries. With no effective programs bridging the gap between academic research and product development—another point I would like to address in the Q and A segment—companies like Fedora risk never bringing their innovations to market. This funding gap also drives Canadian researchers toward better-funded fields, such as oncology, resulting in a loss of talent to other jurisdictions where more funding for AMR is available.
Full implementation of the pan-Canadian action plan on AMR is critical. I was actually involved in both the drafting of the framework and the action plan for AMR several years ago. Delivering on its four pillars—innovation, stewardship, infection prevention and control, and surveillance—requires both dedicated programmatic funding and strong leadership. That was actually the fifth pillar, which nobody has talked about.
There are five pillars in that action plan.
Chair, Canadian Antimicrobial Innovation Coalition and Chief Scientific Officer, Fedora Pharmaceuticals Inc.)
Absolutely.
Canada also needs to adopt push-and-pull incentives, such as the reimbursement reforms, that have been introduced by other jurisdictions.
Thank you, Madam Chair.
Liberal
Gregory Rose Infectious Diseases and Infection Control Consultant, Infection Prevention and Control Canada
Thank you, honourable Chair, as well as the members of the committee.
First, I'd like to start off by congratulating you on your foresight in dedicating at least four meetings to this incredibly important topic.
I'm actually going to start with something of an anecdote. In 2012, there was an incredibly interesting paper published by a team of U.S. and Canadian researchers. They tested antimicrobial resistance in 93 bacterial isolates that were obtained in some of the most isolated areas in the Lechuguilla Cave system in New Mexico. This cave system had been closed off to the outside world for four million years before its discovery in 1986, and it was kept free of human contact in the decades thereafter.
Despite the fact that there was no reasonable way in which one would anticipate modern antimicrobial use to be affecting the floor of the cave, when they tested the samples against 26 modern antibiotics, they found that there was at least some degree of resistance, and in some cases, up to 100% of isolates were resistant to the majority of these antibiotics. It turns out that for bacteria, resistance is a weapon of war they've been using in an interspecies war that's been going on for millions of years, and we've really only been in the game for the last hundred.
In the middle of the 20th century, we had, through breakneck speed, developed multiple new classes and multiple new agents of antibiotics, particularly between 1940 and 1970. Within two to four years of antibiotic introduction, we were starting to see reports of drug-resistant isolates popping up again and again. It didn't seem like a problem at the time because we were keeping ahead of the curve, but things have slowed down substantially in the last 55 years.
Clearly, developing new antimicrobial therapies is absolutely key. However, we also need to be able to shepherd the ones that we already have. We need measures that slow down the emergence of new resistance mechanisms, and we need measures in place to prevent the transmission from one patient to another. These are the fields of antimicrobial stewardship, and infection prevention and control.
Stewardship, or ASP, is predicated on consistent evidence that usage is linked to the development of resistance. ASP activities address resistance by promoting judicious use of antimicrobials and a shorter duration of therapy, and by de-escalating or otherwise optimizing the spectrum of activity.
ASP is a growing field, and there are several critical gaps in our understanding of best ASP practices. I have to say that—much as with infection control, which is my speciality—ASP studies tend to be small and methodologically heterogeneous to the point that, in the December 2024 WHO priorities for antimicrobial resistance research, the number one ranked priority was related to ASP.
Infection prevention and control aims to reduce the transmission of various infectious diseases, including antimicrobial-resistant ones, from one patient to another in various health care and congregate living settings. The IPAC approach to AMR includes broadly acting measures, like hand hygiene and environmental cleaning, as well as specific measures, such as identification and contact precautions for patients who are colonized.
Similar to ASP literature, our literature, unfortunately, is fairly small and of heterogeneous quality. Key knowledge gaps lie, for example, in the very detailed space of best practices for multimodal interventions. This is also reflected in WHO's research priorities.
Interventions in ASP and IPAC are very complex, very granular, and they're often quite specific to time, place and patient population. For example, an ASP recommendation on the appropriate choice of antibiotic for a skin infection would be very different in a busy emergency room in Vancouver from what it would be in a family medicine clinic in the Saguenay. An organism-specific IPAC surveillance procedure would be very different in a bone marrow transplant inpatient unit from what it would be in a pediatrician's office.
Furthermore, ASP and IPAC both need to take into account disparate considerations that aren't really part of our clinical training. Those are things like group psychology, adult learning, budgetary considerations and logistics. ASP teams and infection control professionals have had to build these skills through a lifetime of experience within their organizations. They've developed true subject matter expertise in these, but again, there is a gap in being able to share best practices from one organization to the next.
This is widest in crucial sectors, such as community hospitals, long-term care facilities and outpatient clinics. ASP and IPAC subject matter experts in these sectors tend to be disconnected from the funding and methodological support that is available to practitioners in larger academic hospitals.
This is where, in addition to many of the excellent suggestions you've heard over the last hour and a half, I want to make a very specific suggestion to this committee—look to possibilities to promote scientifically sound research coming from this grassroots level.
One readily achievable idea would be a carve-out of CIHR funding for small-cap grants of $100,000 or less for people who are not in academic centres to work on best practices in antimicrobial stewardship and infection control.
A more ambitious idea would be creating networks and linkages—
October 6th, 2025 / 12:25 p.m.
Infectious Diseases and Infection Control Consultant, Infection Prevention and Control Canada
—between subject matter experts and methodological experts.
Thank you very much.
Liberal
The Chair Liberal Salma Zahid
Thank you.
Now we will proceed to our rounds of questioning.
For the first round, we will start with MP Baldinelli for six minutes.
Please go ahead.
Conservative
Tony Baldinelli Conservative Niagara Falls—Niagara-on-the-Lake, ON
Thank you, Madam Chair.
Thank you to the witnesses for being with us today.
Most of the witnesses here today have spoken to the pan-Canadian action plan from 2023. Some have also alluded to the five pillars on which it is based.
Dr. Salama, you mentioned that.
Earlier, we heard about the need to break down the silos that exist. Again, I make reference to our briefing note, which talks about 14 departments and agencies working on this.
From a scale perspective, how does that work? Is there too much bureaucracy standing in the way? How do we reduce that? How do we better create co-operation and coordination to ensure that AMR can be tackled correctly?
Chair, Canadian Antimicrobial Innovation Coalition and Chief Scientific Officer, Fedora Pharmaceuticals Inc.)
I can speak only to the research and innovation pillar and specifically only as it pertains to products' introduction to Canada and to the innovation cycle that happens in Canada. I'll stay within that space.
Part of the pan-Canadian action plan speaks to the need for push-and-pull incentives. Pull incentives are basically incentivizing companies to bring their products into Canada. As I mentioned, there are only three out of 18 that have come to Canada. There are two main reasons for that.
First of all, relatively speaking, Canada is a smaller market. It's the size of California. To bring a product into Canada, with such a large geographical size, is complicated. More important than that are the silos that exist between federal, provincial and territorial jurisdictions. A drug cannot enter into the hospital setting without having to go through that cycle.
When we introduced the pan-Canadian action plan 2023, we insisted on the fact that there had to be complete transparency and open discussion between the different federal levels. What has become apparent is that there's also that division at the departmental levels you talked about. For example, I sit on the Public Health Agency's external advisory group on AMR. The action plan is a five-year action plan, and two years have already gone. We're into the third year right now, and we're saying that there is—
I'm sorry. Go ahead.
Conservative
Tony Baldinelli Conservative Niagara Falls—Niagara-on-the-Lake, ON
To your point about the three drugs as opposed to...was it 18?
Chair, Canadian Antimicrobial Innovation Coalition and Chief Scientific Officer, Fedora Pharmaceuticals Inc.)
Yes. It's 18.