Antimicrobial Resistance

In Recent News

Following its 2015 report on the same topic, the Office of the Auditor General (OAG) issued a report on Antimicrobial Resistance last week (Full Report Report 6—Antimicrobial Resistance). One of the reasons that the OAG investigated this topic is that not only does antimicrobial resistance make existing antimicrobials less effective, but it also forces the healthcare system to rely on more expensive drugs of last resort, which can also become less effective over time. The audit focused on: the development of a pan-Canadian action plan on antimicrobial resistance; the collection and analysis of data on antimicrobial resistance and use; efforts to preserve the effectiveness of existing antimicrobials; and efforts to improve access to antimicrobials. An overview of its report is below:

Why is this important?

According to research funded by the Public Health Agency of Canada (PHAC), it is estimated that, in 2018:
- 26% of infections in Canada did not respond to first-line antimicrobials, with 5,400 deaths attributable to antimicrobial resistance;
- antimicrobial resistance cost Canada $1.4 billion in additional health care spending, because of longer and more complex hospital stays and reduced Canada’s gross domestic product by $2 billion, including $200 million associated with the animal farming industry, through lower labour productivity.
According to the Council of Canadian Academies, by 2050, the rate of resistance to antimicrobials is likely to increase to 40%, with annual deaths in Canada estimated to increase to 13,700.
Canadians do not have market access to 19 of the 29 antimicrobial drugs that the WHO classified as reserve antimicrobials or antimicrobials of last resort.

Findings

Overall, the federal government did not do enough to address the growing resistance to antimicrobial drugs, such as antibiotics, to help safeguard the health of Canadians.
In June 2023, the PHAC a released the Pan-Canadian Action Plan on Antimicrobial Resistance. The plan lacks concrete deliverables, timelines, and details about who is accountable. Without these key elements, it is unlikely that the plan will result in meaningful actions and produce desired outcomes.
PHAC and Health Canada did not do enough to improve market access to new antimicrobial drugs available in other countries.
Health Canada has strengthened its oversight by implementing regulatory and policy changes to preserve the effectiveness of antimicrobials but it has not assessed whether the changes are working as intended.

Recommendations

The PHAC should work with Health Canada, the Canadian Food Inspection Agency, and Agriculture and Agri-Food Canada, to engage with federal, provincial, and territorial partners and stakeholders to complete, execute, and monitor the Pan Canadian Action Plan on Antimicrobial Resistance.
Health Canada should finalize its review of veterinary antimicrobials with unspecified or prolonged durations of use and prioritize product label changes by considering, for example, how important these antimicrobials are to human medicine and how often they are sold.
The Public Health Agency of Canada, in collaboration with Health Canada and federal, provincial, and territorial partners and stakeholders, should use national data on antimicrobial resistance to determine which antimicrobials Canadians need most and implement measures to support market access to these drugs.