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Opinion: Antimicrobial resistance a global threat — and Canada is ill-prepared: Senator Seidman

April 26, 2024

Experts have sounded the alarm for decades. Antimicrobial resistance is likely to be Canada’s next major health crisis and it is time for the federal government to take sufficient action to address it.

Antimicrobial resistance requires urgent global action because of the misuse and overuse of antimicrobials in humans, animals and plants. Resistance occurs when bacteria, viruses, fungi and parasites do not respond to drugs designed to treat them, increasing the risk of serious disease spread. Drugs like penicillin and its derivatives have been the cornerstone of modern medicine for almost a century. Can you imagine a world in which these drugs have lost their effectiveness to treat infections like pneumonia and strep, or to prevent serious infections in surgery and organ transplants?

As a member of the Senate Committee on Social Affairs, Science and Technology for more than 12 years, I recall our 2014 study on prescription pharmaceuticals warning about the overuse of antibiotics and their unintended consequences to the entire eco-environment. Listening to expert testimony, it was clear to me then, as it is clear to me now, that antimicrobial resistance will become a worldwide threat. Canada must employ a whole-of-government approach to work towards a solution.

An expert panel of the Council of Canadian Academies estimated that in 2018, antimicrobial resistance cost the Canadian health-care system more than $1.4 billion and was directly responsible for the deaths of 5,400 Canadians. They predict that by 2050, if resistance to all first-line antimicrobials reaches 40% — a scenario they deem highly plausible — 13,700 Canadians will die each year from resistant bacterial infections.

In October 2023, Auditor General Karen Hogan tabled an independent auditor’s report on antimicrobial resistance in the House of Commons. In a press release, she was direct: “To successfully fight antimicrobial resistance, Canada needs a full picture of antimicrobial use and resistance across the country, and a solid plan so that the right antimicrobials are available and used in the right way to protect the health of Canadians. While the Public Health Agency of Canada released a Pan-Canadian Action Plan on Antimicrobial Resistance in June 2023, I am concerned that it lacks critical elements, such as concrete deliverables, timelines, ways to measure progress, and clear roles and responsibilities for each level of government. Without these elements, it is unlikely that this plan will result in any progress.”

Notably, the audit found that Canada had not taken sufficient action to improve market access to antimicrobial drugs available in countries such as the United States, the United Kingdom and Sweden. Canada lacks market access to 19 of the 29 reserve antibiotics classified as “antibiotics of last resort” by the World Health Organization (WHO). Of 13 “novel” antibiotics made commercially available since 2010, the U.S. has access to all 13; Canada has access to only two. A combination of regulatory and economic incentives is needed to improve the situation, but Health Canada and the Public Health Agency of Canada (PHAC) have yet to act.

The report also states that serious gaps persist in data collection outside of hospitals and in vulnerable populations. PHAC did not have specific data for its report to the UN, nor for the 2020 WHO report on global antimicrobial resistance.

The auditor general made recommendations not only to Health Canada and PHAC, but also to the Canadian Food Inspection Agency, and Agriculture and Agri-food Canada. With special regard to antimicrobial use in agriculture, there are recommendations to ensure that antimicrobials in animal feed are sold by prescription only, and that veterinary antimicrobial use is reviewed. Perhaps Canada should go further, take a lesson from the European Union, and ban antibiotic use for growth stimulation in farm animals.

The COVID-19 pandemic demonstrated that Canada must learn from past failures to strengthen its public health responses, especially the roles and responsibilities of different levels of government. After the SARS outbreak in Canada in 2003, the federal government maintained a national emergency strategic stockpile of personal protective equipment. But in 2019, Canada disposed of its expired supplies, including N95 respirators, because it was counting on the provinces to have their own stockpiles. Meanwhile, Ontario also disposed of its N95s, counting on the federal stockpile in case of emergency. And so, despite the lessons of SARS, when the COVID-19 pandemic arrived, Canadian governments were caught flat-footed, and we were left vulnerable.

Antimicrobial resistance is considered one of the top 10 global public health threats. We can predict with certainty; the future is here. Canadians deserve better than federal departments and all levels of government dishing blame at each other while nothing gets done. It’s time to learn from past failures and put antimicrobial resistance at the forefront of Canada’s agenda.

Senator Judith G. Seidman represents the Quebec division of De la Durantaye in the Senate. She is an epidemiologist and aging-related health researcher.

This article appeared in the March 20, 2024 edition of The Hill Times.