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.

On the agenda

Members speaking

Before the committee

Barkema  Professor, Epidemiology of Infectious Diseases, Faculty of Veterinary Medicine, University of Calgary, As an Individual
Bogoch  Infectious Diseases Specialist, Toronto General Hospital and Professor of Medicine, University of Toronto, As an Individual
M. Castonguay  Assistant Professor of Health Economics, School of Public Health, Université de Montréal, As an Individual
Conly  Professor of Medicine, University of Calgary, As an Individual
Dhami  Adjunct Clinical Assistant Professor, School of Pharmacy, University of Waterloo, As an Individual
Salama  Chair, Canadian Antimicrobial Innovation Coalition and Chief Scientific Officer, Fedora Pharmaceuticals Inc.)
Rose  Infectious Diseases and Infection Control Consultant, Infection Prevention and Control Canada

12:25 p.m.

Conservative

Tony Baldinelli Conservative Niagara Falls—Niagara-on-the-Lake, ON

How long is the process to bring one new drug into Canada? To your point, to bring drug number four into Canada, how long would it take to do that?

12:25 p.m.

Chair, Canadian Antimicrobial Innovation Coalition and Chief Scientific Officer, Fedora Pharmaceuticals Inc.)

Sameeh Salama

It varies.

It could be two or three years within the federal level—sometimes less than that—but then it has to go to the provincial level, and it could take another two or three years.

What you need to understand is that by the time a drug reaches the market the 20-year patent has already used at least 10 years of its lifetime. For a product developer to produce a drug into the market, they basically have another 10 years of exclusivity. If it takes another six or seven years for the approval in Canada, basically what you're telling the developer is that they have three years to make up their investment, which is really very small.

12:30 p.m.

Conservative

Tony Baldinelli Conservative Niagara Falls—Niagara-on-the-Lake, ON

That's interesting.

I want to move on to the whole issue of the environmental and societal perspectives and impacts. With regard to the lack of federal funding, for example, not only in research terms but just in health care in general, right now we're spending more to service the national debt than on health care. In fact, the Province of Ontario will spend more than the country of Canada altogether.

Do health care practices like overcrowding in hospitals and hallway health care increase the risk and acceleration of AMR in Canada, Dr. Rose?

12:30 p.m.

Infectious Diseases and Infection Control Consultant, Infection Prevention and Control Canada

Gregory Rose

Absolutely. Yes, I think there are a lot of problems with hospital infrastructure in Canada.

For 30 years now we've had Canadian Standards Association recommendations that there not be any rooms in any hospitals in Canada where there is more than one patient or there is less than one toilet per patient, because we know that being in the same environment and, particularly, sharing the same washroom facilities, is a risk of transmission of a wide variety of pathogens: in particular, gram-negative organisms. These are bacteria that live in our gut, that cause a wide variety of infections and that in fact are one of the chief concerns when we think about antimicrobial resistance.

12:30 p.m.

Conservative

Tony Baldinelli Conservative Niagara Falls—Niagara-on-the-Lake, ON

This is a question for all of our witnesses.

You've all spoken on the need for enhanced federal funding. The government right now has talked about asking all departments and agencies to look for about 15% in savings over the next three years. What will the impact be of reduced federal funding, considering that they're all saying AMR could be a global crisis? What will that reduction do?

12:30 p.m.

Chair, Canadian Antimicrobial Innovation Coalition and Chief Scientific Officer, Fedora Pharmaceuticals Inc.)

Sameeh Salama

Can I take the first part of this?

Tony Baldinelli Conservative Niagara Falls—Niagara-on-the-Lake, ON

Sure.

12:30 p.m.

Chair, Canadian Antimicrobial Innovation Coalition and Chief Scientific Officer, Fedora Pharmaceuticals Inc.)

Sameeh Salama

I want to reference a recent paper by The Lancet eClinical Medicine, which talks about the “fair share gap” that exists in funding for AMR. The paper suggests that Canada's fair share currently, as opposed to the other G7 countries, is about 2.5% of the global antimicrobial revenue. The European share, for example, is 48%. That translates into a $1-million to $21-million annual commitment from the Canadian government. The Canadian government has already signed up to the AMR commitments, but the fair share number has been in discussion over the years.

Reduced funding right now is going in the opposite direction. There is no funding for that. I just wanted to make sure that number is available for you.

12:30 p.m.

Conservative

Tony Baldinelli Conservative Niagara Falls—Niagara-on-the-Lake, ON

Thank you.

The Chair Liberal Salma Zahid

We will now proceed to MP Noormohamed for six minutes. Please, go ahead.

Taleeb Noormohamed Liberal Vancouver Granville, BC

Thank you very much.

Thank you to the witnesses for appearing.

I'm going to put a question to Dr. Salama and Dr. Dhami.

The data shows that new superbugs, antimicrobial-resistant bugs, are going to transit to $2 trillion in costs to the global economy by 2050. We talked a little about some of the needs and imperatives for funding. One of the things I'm quite concerned about is that most of these bugs don't think about land or air borders in the way that humans do. These things travel. They cannot be managed by any one country on its own. However, we're seeing a tremendous amount of rhetoric and funding cuts coming out of other countries, particularly the United States. We saw a $379-million cut recently to antimicrobial resistance research in the United States.

What is the global impact of getting this wrong? What are the concerns that we should all have, as Canadians and global citizens, with this consistent and rapid erosion of funding across the world for this type of research? We still see the attitudinal approach that humanity heals itself. We're hearing a lot of this stuff about how things take care of themselves.

How would you respond to those two things, and what should we be most concerned about?

I'll start with you, sir, and then go to Dr. Dhami.

12:35 p.m.

Chair, Canadian Antimicrobial Innovation Coalition and Chief Scientific Officer, Fedora Pharmaceuticals Inc.)

Sameeh Salama

I want to put some correct numbers out, just to make sure that you understand the picture.

Right now, in Canada, we're seeing one in four patients presenting with a resistant infection. By 2050, this number is projected to be 40%, so we're looking roughly about one in two patients having infections that are resistant to standard treatment. This translates to roughly 400,000 Canadians dying every year from AMR by 2050, at a cost of $120 billion to the hospitals and $380 billion in GDP loss. These numbers are very significant. This is by 2050.

When we talk about funding for research, we should not only look at funding for basic university research, which is the frustrating part that I have been dealing with for the last 30 years. Universities produce innovation, but there's a gap between what happens at the university level and the drugs that make it to market. Universities do not produce drugs; companies produce drugs. The gap in the innovation cycle in Canada has existed for as long as I have been working in that space, with no real access to funding for companies like ours, for example. That's why the industry has disappeared in Canada. It's not just a supply chain; it's an innovation gap.

You spend billions of dollars on the universities to make sure you have great research—and I commend all my colleagues in academia—but unless we have a mechanism that exists today to bring companies and bring innovation into reality in Canada, we will fall behind—and we are falling behind. There are no mechanisms that exist in Canada.

That's why I commend ISED for introducing HERC, the health emergency readiness Canada program. That program has been talked about for a year. My understanding is that funding is now an issue for that program.

At what point are we going to realize that the billions we are spending on academic research are not realizing that return on investment?

Taleeb Noormohamed Liberal Vancouver Granville, BC

Thanks.

Dr. Dhami, please go ahead.

12:35 p.m.

Adjunct Clinical Assistant Professor, School of Pharmacy, University of Waterloo, As an Individual

Rita Dhami

In terms of impacts that we would see with a reduction in funding, across the board, we certainly are going to see rising infections and mortality. Less surveillance, less stewardship and less infection prevention lead to more resistant infections, longer hospital stays and increased mortality.

To tie back to what was just said, we are already seeing a loss of treatment options. Declining antibiotic development and stewardship capacity accelerates the spread of untreatable organisms. We certainly are well aware that we have some productivity loss, right on the front lines. With increased illness and reduced workforce participation, some of the most severe cases of infections have become more challenging.

I think, overall, when we think about it from a national-global perspective, we certainly are concerned the most about reduced pandemic preparedness. Antimicrobial resistance, again, undermines our ability to adequately respond to emerging infectious threats. We certainly want to be aligned with what our global partners are doing and continue to be a leader in this space and support the great work that has been done already on the pan-Canadian action plan. We want to continue to support, innovate and implement the recommendations that were in that framework.

Taleeb Noormohamed Liberal Vancouver Granville, BC

Thank you.

Dr. Salama, I actually spoke at the HERC gathering two weeks ago. An incredible group of people there are trying to do some of what you've said. I think there is an incredible opportunity for us in this country to commercialize and to really start to close that gap quite a bit.

I want to go back to the second part of my question. One of the things that does concern me is that there's an increasing rhetoric about working together globally. You know, “We don't want to be part of the WHO. We don't want to be involved in cross-border research.” Somehow, being ready for pandemics is a terrible thing.

How do we get people to think about this differently and actually show them the urgency of trusting science and trusting medicine in these areas?

The Chair Liberal Salma Zahid

Thank you, MP Noormohamed. Your time is up. Maybe we can get a written response to your question.

We will proceed to MP Blanchette-Joncas.

Please go ahead. You will have six minutes for your round of questioning.

Maxime Blanchette-Joncas Bloc Rimouski—La Matapédia, QC

Thank you, Madam Chair.

I’d like to welcome the witnesses joining us for the second hour of our study.

Dr. Salama, Canada is the only G7 country that has not produced its own COVID‑19 vaccines. Big pharmaceutical companies have left Quebec and Canada, shut down plants and eliminated jobs; however, they did have an interest in Canadian and Quebec markets at some point.

Does government underfunding for research and the absence of a scientific sovereignty strategy partially explain this dependency that makes us vulnerable to antimicrobial resistance?

12:40 p.m.

Chair, Canadian Antimicrobial Innovation Coalition and Chief Scientific Officer, Fedora Pharmaceuticals Inc.)

Sameeh Salama

I cannot really comment on the COVID-19, but what I can answer is in the context of AMR.

AMR, as mentioned by my colleagues, is not a Canadian problem; it's a global problem. Travel across the world has made it very easy for antibiotic-resistant bugs to travel between countries. The issue I really see arising for Canada is not a matter of “if” but “when” we run into a scenario where antibiotic resistance really becomes a crisis situation—just like what happened with COVID—and Canada again relies on international partners for the supply of much-needed antibiotics. This scenario cannot happen.

The strain is coming. We will never be able to stop antibiotic resistance. Antibiotic resistance is a natural way for bacteria to survive. They will always use it. All we are trying to do is to slow down that curve so that it is under control. When Canada relies on international partners for supply chain and innovation, then we're back to basically where we were before COVID. This is a crisis that's going to happen if we don't do anything.

What we are proposing to the Canadian government is, “Let's do something about it.” We have the time now to do something about it, but we cannot sit back and wait until something happens or somebody else introduces something. We have to deal with it.

Maxime Blanchette-Joncas Bloc Rimouski—La Matapédia, QC

You develop new antimicrobials; however, you indicated that these drugs are not profitable for big pharmaceutical companies. In 2020, 82% of all antimicrobials sold in Canada were intended for use in animals.

In your opinion, what role should Ottawa play to provide real economic incentives and support domestic businesses and research centres to ensure that Quebec and Canada do not depend exclusively on foreign players the next time we have a crisis?

12:40 p.m.

Chair, Canadian Antimicrobial Innovation Coalition and Chief Scientific Officer, Fedora Pharmaceuticals Inc.)

Sameeh Salama

Two things were introduced in the pan-Canadian action plan and the recommendations; they are push-and-pull incentives.

The push incentive is for Canadian innovators to be able to take their innovations at their universities and produce them. There are mechanisms that apply. We mentioned HERC. In the United States there's small business innovation research, SBIR. We need those mechanisms for Canadian innovators.

With newer antibiotics that are introduced on the market, we are talking about pull incentives. As I mentioned before, the pull incentives are to incentivize companies to bring their products into the country here.

We have been talking about pull incentive pilots. Unfortunately, we're becoming known as the country of pilots, where pilots are adopted, but they take a long time. They need be done in consultation with industry. The stakeholders are the companies. If they want to bring their products into Canada, the pilots—the incentives—have to be workable. They have to be something they can work with. We cannot introduce a pilot that's going to make it even more complicated for the company to bring the product, because they will never do that. That's what we're seeing.

We are now asking the government to really stand behind PHAC, the Public Health Agency, in working on the pilots to make sure that there is sufficient funding. I mentioned that the commitments we're asking for from the Canadian government are from $11 million to $21 million for the pull incentive to bring their products. The manufacturing can take place in Canada here so we can be sufficient as far as the supply chain is concerned, if those products come into Canada.

Maxime Blanchette-Joncas Bloc Rimouski—La Matapédia, QC

Antimicrobial resistance could cost the global economy up to $100 billion by 2050 and reduce Canada’s gross domestic product by up to $20 billion by 2025.

Does the federal government’s lack of interest, which translates into critical underinvestment in research and public health, increase this risk directly?

12:40 p.m.

Chair, Canadian Antimicrobial Innovation Coalition and Chief Scientific Officer, Fedora Pharmaceuticals Inc.)

Sameeh Salama

I think we go back to the same cycle. There's funding under CIHR for academic research, and there's a lot of innovative work on academic research in different centres in Canada, but right now there's no mechanism. It's not really that there is reduced funding; there is no practical mechanism that can work for those innovators to take their products from the university setting into development and into a spin-out company. If you want to start a new business with a new antibiotic, and you want to take it into the market eventually, there needs to be a funding mechanism.

For example, private investments right now have dried up. People look at the antibiotic market and see that it doesn't really pay for their investment. They could spend even $2 billion or $3 billion—the figures for antibiotics—and not see that return in their investment. Why would they invest in that space? That's why government intervention is so important.

Maxime Blanchette-Joncas Bloc Rimouski—La Matapédia, QC

In its report entitled “Disruptions on the Horizon” published in 2024, Policy Horizons Canada, one of the Government of Canada’s centres of excellence, states that antimicrobial resistance has become the “leading cause of death globally” and is already disrupting food systems because “it is more expensive for producers to ensure animal or plant health.”

Do you see a tangible risk to our supply chains and farm economy if Canada does not provide more support for research and prevention? Since my time is up, can you share your response in writing?

The Chair Liberal Salma Zahid

Yes, if the witnesses can respond to Mr. Blanchette-Joncas' question in writing, that will be circulated to all the members.

Now we will start our second round of questioning with MP Mahal for five minutes.

Please go ahead.

12:45 p.m.

Conservative

Jagsharan Singh Mahal Conservative Edmonton Southeast, AB

Thank you, Madam Chair.

I want to start with Dr. Salama for two reasons.

One is that you come from my hometown, Edmonton, and we are neighbours in my riding of Edmonton Southeast. The second thing is that you are doing the practical stuff when it comes to industry and making drugs that the public can really use. That's really commendable.

During your testimony, you cried out loud about lack of funding. The funding does go to academia to a certain extent, but when it comes to funding the industry, the pharmaceuticals and the researchers who can produce those drugs that can be made available, you have faced a lot of frustration there.

You told the panel that you have 30-plus years of experience in developing drugs. Can you shed some light on what you have done in reaching out to the federal government for funding on the research side—and not just on the academia side—of drug development, and what kind of results have you had?