Can you please explain?
Evidence of meeting #8 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.
Evidence of meeting #8 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.
The Clerk
I can if you authorize me, Chair.
It's not a technical problem. I think the interpreter has to think about the words he just heard, because they are scientific terms. There may be a delay in that.
Bloc
Maxime Blanchette-Joncas Bloc Rimouski—La Matapédia, QC
Madam Chair, I didn’t understand what the clerk just said.
Liberal
The Chair Liberal Salma Zahid
It's not a technical issue. It's only because there are very technical terms, so it takes them some time to do that interpretation. It's not a technical issue.
Bloc
Maxime Blanchette-Joncas Bloc Rimouski—La Matapédia, QC
I’m using words that are too scholarly then, is that correct?
I’ll continue, but I’m having difficulty keeping track of how much time I have left.
Bloc
Maxime Blanchette-Joncas Bloc Rimouski—La Matapédia, QC
Dr. Weese, thank you for your understanding with these adjustments.
You spoke about coordination at the international level. On our end, in Québec, we took leadership. For the past four years, we have banned the use of category one antimicrobials in agriculture. We have an approach that is tailored to the local reality, and it is working well.
How can we put in place a standardized approach that does not impinge on the leadership already shown by Québec?
Professor, University of Guelph and Director, Centre for Public Health and Zoonoses, As an Individual
The standardized approach would be using successes like Quebec's as an aspiration for the rest of the country and not trying to bring everyone back to the middle. Quebec has taken the lead in those areas, as you know.
There are differences in different livestock sectors across the country, so you can't automatically replicate Quebec, but you can use that as a demonstration that, yes, you can do this in many situations if you do everything else right. I think that's the key, as it's such a broad problem.
We can use this, if there's national coordination and national motivation, as an example of where we can try to get the rest of the country to. The problem, as mentioned earlier and as you know, is that veterinary medicine, drug access and health are provincial, so it's difficult for the federal government to mandate something. However, the federal government can provide support so we can get the national networks together to use successes, Quebec being one: This is done here, so how do we get everyone else to do that?
Part of it needs to be better communication and collaboration with industry, too. This comes back to hesitancy about vaccinations, and it comes back to working with farmers. You need trust, and you need a two-way information exchange. You can't go to a farm and say, “You're going to do this because they do it in Quebec.” That probably won't go over very well. If we build trust and infrastructure and we bring in support mechanisms to let them improve their practices, that's how to do it.
That's why it's not just a matter of saying, “Here are Quebec's approaches; we need to do this everywhere else.” We need to build the foundation so that can be done and build the communication, obviously using the success in Quebec as the starting point.
Bloc
Maxime Blanchette-Joncas Bloc Rimouski—La Matapédia, QC
Thank you very much.
Madam Chair, how much time do I have left?
Bloc
Maxime Blanchette-Joncas Bloc Rimouski—La Matapédia, QC
Thank you very much.
Dr. Sauve, you work directly in the field, where antimicrobial resistance first emerges. To what extent does the lack of funding for antimicrobials programs in hospitals limit the implementation of best practices in health institutions?
Antimicrobial Stewardship Pharmacotherapy Specialist, As an Individual
I'm not sure I can comment specifically on the financing piece, but I would say that AMR is definitely having an impact on the front line. Certainly, the clinical impact is apparent, and we are seeing more patients with resistant infections. What that means is they may not be receiving effective treatment in a timely manner, which translates to worse patient outcomes. They may be having to rely on second- or third-line drugs, in which case many of these have more side effects that are harmful to patients and are also costly to the system.
We also know that AMR can contribute to things like longer hospital stays, which, again, compounds the issue. Exposing patients to more time in hospital is not good for them and not good for the system either.
We're certainly seeing these impacts directly on the front lines. It's definitely not something that is far away or a future problem; it is something that is already having an impact day-to-day on what we do.
Liberal
The Chair Liberal Salma Zahid
We will now proceed to MP Baldinelli for five 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.
Dr. Sauve, you said in your opening remarks that one in four infections is now resistant, and you spoke about the financial burden that places on our health care system.
We heard on Monday from Dr. Castonguay, who mentioned it cost the provincial health care systems between, I think, $1.4 billion and $1.8 billion in 2018, and this could grow to $21 billion by 2050. When you see those types of numbers, it leads to the question of how one tackles that. Just think that in the province of Ontario, they're spending $80 billion on health care, and it's projected to grow to $100 billion. Right now, the federal government is spending only $52 billion on health care for the entire country, and it's projected to spend $68 billion just on servicing our debt.
That's not money going to health care or health care research. That's not money going to the provinces so they can get additional spaces to train doctors and nurses. Even as part of the tri-council agencies, the Canadian Institutes of Health Research spends only about $1.2 billion, and now the government is asking its departments and agencies to please find efficiencies and savings of about 15% over the next three years.
In terms of how that is going to impact the health care system, does that not concern you? In a hospital setting, what do you think the impact is?
Antimicrobial Stewardship Pharmacotherapy Specialist, As an Individual
Yes, certainly in hospitals we're always worried about reduced funding and what that means for health professions and jobs, as well as the care that patients are receiving.
In the health care setting we're very used to trying to find ways to implement cost-effective or cost-saving interventions. I think some of the other panellists have really highlighted that investing in some of the preventative strategies to minimize the burden of infections in Canadians actually is not only good for their health but also can lead to cost savings down the road.
A lot of that is very similar.... When we think about AMR, for a lot of these preventative strategies, or even stewardship strategies—which I'm more familiar with in the hospital setting—there is literature and evidence that shows that having antimicrobial stewardship programs and certain interventions can actually save the systems money.
I think it is certainly, like many other things, a scenario where sometimes you do have to invest the money in order to find the savings. We need access to good data about resistance and costs so that we can actually measure how effective interventions are and look at that in terms of a cost-benefit analysis, too.
Conservative
Tony Baldinelli Conservative Niagara Falls—Niagara-on-the-Lake, ON
Thank you so much.
I want to go to you, Dr. Weese.
You talked in your remarks about the need for better and actionable information and funds to implement some of the recommendations that came from the pan-Canadian action plan on antimicrobial resistance....
I think we called this study just because people want to hear me not pronounce that name correctly.
Do you have concerns there as well, particularly when it comes to the research funds and impacts from an animal care perspective?
Professor, University of Guelph and Director, Centre for Public Health and Zoonoses, As an Individual
Obviously, we have concerns about funding, because we don't have enough to do what we want to do.
I think the other issue we have is when we try to do interdisciplinary work. We don't have systems that are set up for that very well. We have NSERC, which looks at the animal, engineering and agricultural side. We have CIHR, which looks at the human side. They like someone else to deal with the interface.
Conservative
Tony Baldinelli Conservative Niagara Falls—Niagara-on-the-Lake, ON
In reading the briefing notes prior to the study, you find that there are about 14 agencies and government departments that are all involved in studying and have a portion of looking into an action and taking action on AMR. On this notion of the need for better coordination, how does that take place? That's a lot of work that needs to be done to break down silos, would you not suggest?
Professor, University of Guelph and Director, Centre for Public Health and Zoonoses, As an Individual
Absolutely. We know that when you have too many people involved, it's too easy for everyone to say it's not their problem. We see that with funding. We see that with agencies. They don't see the direct impact or action step for them, so it's easy to step back and wait for someone else.
Again, that speaks to the need for national coordination that can work across those silos federally, provincially, territorially and locally, within academia and industry, so we can actually get action.
Conservative
Liberal
The Chair Liberal Salma Zahid
Thank you.
We will now proceed to MP Jaczek, for five minutes.
Please go ahead.
Liberal
Helena Jaczek Liberal Markham—Stouffville, ON
Thank you, Madam Chair.
Thank you to both of our witnesses this afternoon.
You've both emphasized prevention and the need to reduce the use of antimicrobials.
Dr. Sauve, I'm aware of some of the work you've been doing with faculties of pharmacy to educate students in the faculty to become more aware of antimicrobial resistance. There are a lot of existing pharmacists out there. Do you have any ideas of how we could perhaps continue this conversation more broadly with pharmacists in general in other settings? I'm thinking of long-term care, perhaps, where there might be more of a team approach between the physicians and pharmacists involved in the care of seniors in long-term care.
Could you tell us a bit about your work in terms of trying to improve the awareness of AMR that you've been doing, and how you might see it being extended to other sectors?
Antimicrobial Stewardship Pharmacotherapy Specialist, As an Individual
Yes, thank you.
The work I have been doing is on developing a curriculum framework for pharmacy programs across Canada in order to enhance their education on antimicrobial resistance and antimicrobial stewardship, so that our next generation of pharmacists are not only aware of this issue but also have the skills and the knowledge they need to be able to impart change.
What we really know is that those of us practising in this field can't do this alone. It can't be only infectious disease specialists or pharmacists who specialize in this field. We need all health care providers to be engaged and to be working on these in their respective areas.
There is a lot of opportunity to take some of the competencies for graduating students that we've developed in the pharmacy curriculum. I know other professions have been working on this as well. It may need some minor tweaking to be able to expand these more broadly to pharmacists who are currently practising and to target education and training initiatives for practising pharmacists or other practitioners.
We also need to think about this in terms of many of the health care professionals who are trained in other countries around the world and choose to come to work in Canada. Their education in other countries on AMR or the landscape of AMR and on antimicrobial prescribing may be very different from that education here, so we also need some targeted interventions and some work with accreditation and licensing bodies to make sure that when these professionals come to work in Canada, they do have the training and support they need to contribute to this effort for antimicrobial stewardship and against resistance here.
There are a lot of opportunities there. I will say one thing that could be useful in long-term care and in the community, where stewardship has traditionally been lagging behind for pharmacies. My role as a stewardship pharmacist is almost exclusively in hospitals at the present time. If we want to have health care providers engaging in these other areas, like long-term care and the community, we do need some leaders to be in those spaces to help with training and education. Currently, we just don't have those positions that exist.
Liberal
Helena Jaczek Liberal Markham—Stouffville, ON
Thank you.
Dr. Weese, you have commented on the lack of surveillance data when it comes to the use of antimicrobials and to antimicrobial resistance in the veterinary area. Particularly, you mentioned pets. How would you see, in a practical way, that we might improve that surveillance? What is needed to get the kind of data that we require?