Science and Research Committee on Oct. 8th, 2025

[The Chair, Liberal, Salma Zahid]

I call this meeting to order.

Welcome to meeting number eight of the Standing Committee on Science and Research. Pursuant to the motion of the House on 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 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 the interpreters. You will also 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 as well as all the 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. 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.

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 like to welcome our witnesses today. For the first panel, we are joined by Dr. Victor Leung, physician, by video conference; Dr. Allison McGeer, a professor at the department of laboratory medicine and pathobiology at the University of Toronto; and Dr. Simon Otto, an associate professor at the University of Alberta, by video conference.

Each witness will have five minutes for their opening remarks. We will start with Dr. Leung.

Go ahead, Dr. Leung. You have five minutes.

[Dr. Victor Leung, Physician, As an Individual]

Thank you, Madam Chair.

My name is Victor Leung. I practise as an infectious diseases physician and microbiologist in Vancouver, and I've been in practice since 2011.

On a daily basis, I treat infections, and what's becoming increasingly clear is that infections that we commonly encounter in hospital are becoming resistant to antimicrobials that we have available in Canada.

As you've heard from other witnesses so far, we need urgently to examine the barriers that are preventing access to antimicrobials in the Canadian market and change that process.

When it comes to access to antimicrobials, we know that Canada, compared to other G7 countries, is falling behind. We don't have thoughtful programs that are well designed or examples that have been piloted in other G7 countries. What we need are programs that ensure patients get the drugs when they need them, at the right time, while maintaining those stewardship practices.

In Canada, when we encounter a difficult-to-treat pathogen, we often rely on Health Canada's special access program, but from my experience working with the special access program, there is excessive administrative burden and paperwork that needs to be modernized. The whole system within special access needs to be revamped so that patients can get the antimicrobials when they need them.

I think a solution that needs to be implemented has to be coordinated between the federal and provincial governments. One example would be the hub-and-spoke model that has been discussed previously. We have high-value antimicrobials available in centres, similar to how we deal with some antimicrobials for treating malaria. The federal government has to play a central role in guaranteeing that these drugs become available to the market while also having accountable systems to ensure that these antimicrobials are not overused.

In Canada, among the different provinces that are involved, there needs to be equal access because of mobility. Antimicrobial resistance will not stay local, and changes can happen rapidly. Unlike with other drugs, depending on the condition—if individuals present with sepsis or septic shock—timely access is key.

In addition to access, which is really about controlling infections, we have to do a lot more in preventing infections. Antimicrobial resistance can and needs to be prevented using the tools that we have, but this needs to be done in a different way.

Two examples that I'd like to bring up are surveillance systems in Canada for antimicrobial resistance. Although we have multiple surveillance systems throughout Canada that are used, the problem is that the information is fragmented. It's not utilizing the information that's available from all different settings to be aggregated in a way that's timely.

A perfect example of that would be for some of the infections that we have surveillance for in hospitals. If we look at the Canadian nosocomial infection surveillance program, the data reports that are provided are out of date. They're not timely and accessible and don't enable us to plan and develop programs to prevent these infections and monitor the effectiveness of these programs for accountability.

A second example for prevention is looking at how we develop processes that are innovative. In Canada, we have solutions for that. Drawing upon our success previously with controlling HIV and the treatment-as-prevention approach, we can see that when treatment as prevention is implemented as a program to address different syndemics, like homelessness, opioid use and antimicrobial resistance, that can have an impact on targeted disease elimination and health care sustainability.

We need to focus not only on control through drug access but also on prevention of antimicrobial resistance through modernizing the surveillance systems and modernizing and expanding proven Canadian interventions that have been shown to work.

Those need to be implemented more broadly for communicable diseases, and they also can be applicable to non-communicable diseases.

Thank you.

[The Chair, Liberal, Salma Zahid]

Thank you, Dr. Leung.

We will now proceed to Dr. Allison McGeer.

Dr. McGeer, you will have five minutes for your opening remarks.

Please go ahead.

[Dr. Allison McGeer, Professor, Department of Laboratory Medicine and Pathobiology, University of Toronto, As an Individual]

Thank you very much, Madam Chair, for the opportunity to testify.

My name is Allison McGeer, and I'm an infectious disease physician and epidemiologist in Toronto.

Before I start, let me declare my conflicts of interest. My research in infection prevention and antimicrobial resistance involves a fair amount of work on vaccines. I have both research funding and personal honoraria from many of the companies that market vaccines in Canada.

I'm here today to ask you for help specifically with two areas in antimicrobial resistance. The first is the issue of what our current AMR trajectory is. As people pointed out yesterday, we've been relatively spared from the burden of AMR in Canada, in part because of the hard work of a lot of people across the One Health continuum in Canada. Nonetheless, it's very clear, as Victor has just pointed out to you, that this work is not enough. We have not greatly coordinated, but good surveillance systems across the country show that for every pathogen, AMR is increasing. We are losing ground, and AMR is accelerating. It's now harming patients.

Before the COVID pandemic, our biggest problem in Canada tended to be that you had to think a little more carefully about getting a broader-spectrum antibiotic, to make sure a patient with risk factors for resistance was covered. All of us in infectious diseases now have seen patients who have become septic because they got the wrong initial antibiotic, not because people were incompetent but because there were too many conflicting choices and you couldn't do the antibiotic choice right.

My best analogy for what's going on with AMR is what's happening with climate change. I've been watching the wildfires and heat events for the last two years, and it's clear to me that despite a lot of work on trying to mitigate climate change, it's been too little, too late. AMR is obviously a different order of magnitude, but it is exactly parallel. A decade from now, I don't want your families and mine to be watching antimicrobials fail in hospitals and be thinking the same thing, that we did too little, too late. We have a narrow window where we can take substantial, additional action on AMR that will fix things. We have evidence for lots of things that we're not doing and need to move on now.

Your first question, of course, is what we are not doing, and Victor has just pointed that out to us. Think about the COVID pandemic for a moment. We didn't get out of the COVID pandemic because we had treatment. We got out of the COVID pandemic because we have vaccines and public health information. Getting out of the AMR pandemic, and it is a pandemic, even if it's not the same as COVID, has to involve prevention. It's not to say that antibiotic access, the development of new antimicrobials and antimicrobial stewardship are not critical interventions. They are. We need them, and we need more of them, but in and of themselves, they're never going to be enough. We need to broaden our efforts to prevent infection, and we need to be looking at our federal action plan now and asking where the gaps in prevention are and what we can do to move forward on them.

There are two particularly important areas in human health that I want to touch on. I want to do it because, honestly, the veterinarians and agriculture and environmental health people are ahead of us. They've been doing better than we have been doing in human health on AMR.

The first thing I want to talk about is vaccines. We need a national vaccine strategy against AMR in the same way that we have one against pandemic pathogens, one that covers vaccine development and manufacturing within Canada but also one that ensures that we deliver publicly funded vaccines to Canadians. At the moment our vaccine delivery system across the country is badly broken. It needs to be fixed, and it needs to be fixed now. If you want to ask me a question about what the WHO thinks the benefit will be from fixing it now, I'd be happy to tell you.

The second thing I want to point out is that we also have a very significant problem with the transmission of antimicrobial-resistant organisms within our health care facilities. People have told you, and they were right, that we use more antimicrobials in animals than humans and more antimicrobials in humans in the community than in humans in hospitals, but we use our most powerful antibiotics in hospitals—we use them for our most vulnerable patients—so hospitals are a crucible for antimicrobial resistance.

Not all, but many of the pathogens that we're in increasing trouble with are pathogens where the antimicrobial resistance is arising and growing in hospitals. We have evidence from both Canadian studies and outside studies that we don't have to tolerate that, but we have not put that evidence into practice.

We urgently need a national conversation—I think it has to come nationally, despite the fact that much of what we do in hospitals is provincial—to talk about why we haven't implemented this program, whether we need to be implementing this or something different, and what we can do—

[The Chair, Liberal, Salma Zahid]

Can you please wind up? You will get some opportunity to talk about this in the rounds of questioning.

[Dr. Allison McGeer]

We need to get a handle on what is going on with this.

Thank you.

[The Chair, Liberal, Salma Zahid]

Thank you, Dr. McGeer.

Now we will proceed to Dr. Simon Otto. He's joining us by video conference.

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

[Dr. Simon Otto, Associate Professor, University of Alberta, As an Individual]

Good afternoon. Thank you, Madam Chair and the committee, for the opportunity to testify today.

I'm Dr. Simon Otto. I'm a practising veterinarian, an epidemiologist and a faculty member at the University of Alberta. My research focuses on “one health”, the aspect of how AMR is a one health concern and how it moves between and impacts the health of humans, animals and their environments.

I will speak to you about three key points, which echo those of my colleagues.

The first is that tackling AMR requires a holistic, one health approach that includes prevention of infections and stewardship of drug use.

Next, we cannot manage what we do not measure.

Last, resources are urgently required to tackle this silent pandemic.

I want to reinforce that while drug discovery and development are important, they will not solve the AMR problem, as Dr. McGeer has said. AMR is a natural phenomenon of microbes that is exacerbated by antimicrobial use. Mitigating AMR requires an approach that prevents infections and emphasizes antimicrobial stewardship.

Preventing infections will reduce the need to use antimicrobial drugs. We will never prevent them all, but we can reduce the transmission of infectious diseases in humans, food animals and companion animals through management strategies. Vaccinations, as we've heard, are one important strategy. They reduce the severity and transmission of disease, thereby reducing the number of infections and the need to treat them with antimicrobials.

Prevention goes beyond vaccinations. We rely heavily on water treatment, sanitation, hygiene and food safety to prevent human infections. Likewise, we rely on management strategies to prevent infections in intensively raised food animals, the companion animals that are part of our families, backyard farm animals, wildlife, and zoo and other animals.

Infections are inevitable, however. As veterinarians, we have an ethical obligation to treat infections in all animals under our care. This is where antimicrobial stewardship is pivotal: It's using these drugs in a way to minimize the selection for AMR.

Antimicrobial stewardship should be viewed as a continuous improvement strategy. AMR is inevitable, therefore there is no specific threshold of stewardship above which we can say we have done enough. Stewardship should focus on reducing unnecessary and improper use, such as in areas where we revert to drug use in the place of making management changes that could reduce infections.

This is where measurement comes in. Canada has a world-renowned AMR and antimicrobial use surveillance system that we've already heard about. However, the federal programs still have large gaps and important limitations. The Canadian integrated program for AMR surveillance relies on a relatively small number of farms and the food-animal commodities that are included in the program, which is incomplete. There's almost no animal pathogen surveillance, and there's no AMR surveillance in companion animals.

The human surveillance system that we've heard about covers hospital infections, but beyond new pilot projects, it still suffers from large gaps in community medicine, long-term care facilities and remote, northern and indigenous communities.

While food-animal production uses quantities of antimicrobials that exceed those of human medicine, we still do not have a clear picture of the true impact of animal antimicrobial use on AMR in animal or human health. It's clear that most resistance in humans comes from human use, just like most resistance in animals comes from animal use, with some limited examples of movement between them, which are important.

Put plainly, we cannot manage what we do not measure. To truly support stewardship decisions by human health care practitioners, veterinarians and food-animal producers, we must have a more comprehensive surveillance program that builds on the strong foundation we currently have.

The environment, such as water, soil and crops, is also an important area for surveillance that's lacking. It's a large but poorly understood reservoir of AMR that receives effluent of resistant microbes and drug residues from human and animal settings.

All of this points to the need for a substantial resource investment in money, expertise and infrastructure. While drug development is an important piece, so too are the investments in research to identify management strategies for animal and human health, vaccines and diagnostic testing, and for social science to understand how to effectively implement these strategies in a reluctant human population. All of these strategies must keep animal, human and environmental health in mind in a one health context. The needs of each sector will be unique but will impact one another.

We must have a comprehensive, one health strategy for Canada and the globe. The time is now as this silent pandemic pushes us toward the post-antibiotic era.

Thank you to the committee for making AMR one of your priorities and for the opportunity to discuss this today.

[The Chair, Liberal, Salma Zahid]

Thanks to the three witnesses for their testimony.

Now we will start with our first round of questioning. We will start with MP DeRidder for six minutes.

Please, go ahead. You have six minutes.

[Kelly DeRidder, Conservative, Kitchener Centre, ON]

Thank you, Chair.

I want to thank all the panellists for being here today and joining us in this discussion.

Victor, I'm going to direct my questions to you. You're from Vancouver, where this drug crisis we're facing has reached an all-time high and is, quite frankly, out of control. I know that in each of our ridings as well, we've been touched by the drug crisis happening here in Canada.

On October 7, the B.C. premier admitted that the decriminalization of drugs was a mistake.

How has the increase in the opioid epidemic increased infectious transmissions in the hospital you come from?

[Dr. Victor Leung]

I see opioid use and antimicrobial resistance as syndemic. These two conditions, when they interact along with other factors, amplify and make both of these conditions worse.

The way we have to address both opioid use and AMR from a syndemic approach is based on the approach that we've taken here in British Columbia, which is expanding the treatment as prevention strategy that was used and adopted by UNAIDS and Canada to target HIV elimination. Using that approach of treatment as prevention and the strategies surrounding that, we can address these conditions as a whole, as opposed to individual, fragmented conditions. If we try to address each one of these individually, the scope and the costs are much more significant. Having a packaged approach, such as treatment as prevention strategies, will help address them in a way that's sustainable for the health care system.

[Kelly DeRidder, Conservative, Kitchener Centre, ON]

Thank you for that.

You mentioned that we don't have thoughtful programs in place and there is no surveillance to measure the impact of the antimicrobial resistance.

How are your doctors and nurses affected by this? Is anybody tracking this? Is there any data to keep an eye out for the exposure to infection, and therefore resistance—even just boots on the ground with you as doctors and nurses in the hospitals?

[Dr. Victor Leung]

To clarify, I mentioned that our access systems need to be improved. Our surveillance systems also have room for improvement in terms of timeliness and ensuring that there's no redundancy in the surveillance systems we have.

At the hospital level, the way the antimicrobial resistance affects my colleagues in nursing, as well as physicians and other health care providers, is in how we have to practise, what things we need to change in a daily practice to minimize the chance of transmitting infections to our patients, and also through patient-to-patient transmissions within the health care facility.

Because of how health care is delivered in acute care facilities, infections that are antimicrobial-resistant or even hospital-acquired are, at some level, invisible, because one provider working with an individual doesn't have that whole continuum of interaction to see their health care journey. If a person acquires an antimicrobial-resistant infection seven days into their hospitalization, the health care providers interacting with them at the time may no longer be following them throughout their hospital journey. When a new team or new provider comes on, often it's just recorded in the chart as an infection. It's not obvious to the health care providers that this is a hospital-acquired infection.

That's why we have hospital infection prevention and control teams as one group that helps with surveillance. I'm suggesting that the surveillance data that's acquired and ascertained by the team needs to be acted upon, and there needs to be accountability within the system, not only at the local level but also captured at a provincial and a federal level so that we can increase awareness of the impact of these hospital-acquired infections on individuals and not continue to deal with them in the way we are now. From the health care provider's perspective, unless they are dealing with an acute case in which someone is dying in front of them, that sense of urgency and problems with antimicrobial resistance are often invisible.

[Kelly DeRidder, Conservative, Kitchener Centre, ON]

There was a report that said that 1,250,000 Canadians left an emergency room without being treated in 2024, an alarming increase of 35.54% over a five-year period. How many diseases do you think are slipping through the cracks when this many people aren't even being treated in Canada?

[Dr. Victor Leung]

When individuals seeking care aren't getting access to care, I think all the different reasons for which they've sought care could be missed. I don't know what proportion of that would be related to infections. We don't have a system to capture that.

[Kelly DeRidder, Conservative, Kitchener Centre, ON]

Thank you very much for your time, Victor.

[Dr. Victor Leung]

Thank you.

[The Chair, Liberal, Salma Zahid]

Thank you.

We will go to MP McKelvie for six minutes.

MP McKelvie, please go ahead.

[Jennifer McKelvie, Liberal, Ajax, ON]

Thank you, Madam Chair.

My first question is for Dr. McGeer.

You've done a lot of work on E. coli and antimicrobial-resistant E. coli. I know that some of your work has focused on monitoring and on monitoring waste water. I'm wondering what the state of science is around monitoring waste water. Is there somebody who's doing it well, such that we could model any such programs around theirs?

[Dr. Allison McGeer]

The challenge with monitoring waste water for antimicrobial resistance is that antimicrobial resistance concentrates in waste water—honestly, for reasons that I don't think we understand. We looked at waste water in Toronto, for instance. In 2014, right at the beginning of seeing patients with resistant organisms that we call carbapenamase-producing organisms.... It doesn't matter what they are. They're just bad. They're called CPE. We were seeing very few patients in hospitals, but we were already seeing consistent detectable concentrations in our waste-water treatment plants. That's been seen everywhere around the world. That's a function of this real concentration in waste-water treatment plants.

Now, you could see geographic differences between where patients are coming from. In Toronto there's a very large South Asian population, and a particular type of CPE is endemic in much of South Asia, so you could see some differences. In terms of actually looking for broadly resistant, gram-negative E. coli organisms in waste water, we actually don't know how to do it. We don't know how to interpret it or how to do it well. In our last study, when we looked at organisms, we could see the same genes, but very different organisms were carrying them. The genes come from humans, through the hospital waste-water system primarily, into our general waste-water system. Then in our general waste-water system, the genes actually get transferred to other organisms whose home is waste-water systems. I think that's difficult.

The second thing about waste water, unrelated to surveillance, is that waste-water treatment plants are to reduce bacterial concentrations, but they don't preferentially reduce antimicrobial resistance. If antimicrobial-resistant organisms from hospitals go into your waste-water treatment plants, antimicrobial-resistant organisms will leave the waste-water treatment. They'll be in a much diluted form, but they'll still leave.

One of the interesting things about looking at waste-water treatment plants, which people are still working on, is that there are some waste-water treatment plants where you do seem to get some preferential reduction in antimicrobial resistance. There are others that look pretty similar, admittedly to the uninitiated, where you do get substantial reductions. I think in addition to working on our surveillance systems for waste water, which we need, we also need to be looking at whether, in waste-water treatment plants, we can have technology that will preferentially reduce antimicrobial resistance so that we're not contaminating the environment from what's happening in our hospitals.

[Jennifer McKelvie, Liberal, Ajax, ON]

Is it possible to do, and has anybody done it, at the point of source? Instead of sampling at water treatment plants, sample effluent from hospitals and long-term care. Has there been thought given to shifting more toward monitoring at the source or at the discharge points, as opposed to once it's combined in a pipe on the way out? Is anybody doing that internationally? Is there anything we can learn from that?

[Dr. Allison McGeer]

There are a bunch of people doing it internationally. It's not inexpensive to do. Victor and Simon can weigh in on this if they know.

Tracking from hospital through other pathways into waste-water treatment plants is also relatively complicated. In Toronto our water doesn't always go where you think it goes in the system, as I'm sure you know. Figuring out how to do that tracing is actually difficult. I'm not aware that there are people who are doing it really well at the moment.

[Jennifer McKelvie, Liberal, Ajax, ON]

Dr. Otto, do you have any recommendations? What could we be doing better in this regard, in terms of tracing bacteria in effluence?

[Dr. Simon Otto]

I think the biggest challenge is that we don't have any official monitoring set up in those spaces. Most of the things you see internationally are that people are doing it as part of funded research projects. We're doing research on how to do it, but we don't actually have programs set up that are doing it uniformly.

Long-term care is a great example where we have huge gaps in surveillance and where we really don't know what's going on in terms of AMR surveillance. I think it's an opportunity, but it would require substantial investment.

[Jennifer McKelvie, Liberal, Ajax, ON]

If we're going down that road, the questions I asked the previous panel were more.... In your case, you're all the experts in the actual pathogens themselves, but some of them were also experts in the antimicrobials and the pharmaceuticals. Would that also have to be an important part of their approach?

Should we be looking at combined...? If we're going to start looking at monitoring or testing and pilot projects for monitoring, should we be monitoring not only the genes but also the antimicrobials and what is coming out through and going back out into the environment in that regard?