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.