Canada must renew leadership on antimicrobial resistance

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AMR is rendering the global antibiotic arsenal ineffective. Left unchecked, it will lead to the collapse of Canadian health systems. Without a final national action plan, Canada will remain ill-prepared to combat this growing threat.

This article originally appeared in The Hill Times on October 3, 2022.

Antimicrobial resistance poses a dire threat not only to the future of public health, but also to the economic prosperity of Canada and the entire world.

Just before COVID-19 hit, the Public Health Agency of Canada sponsored a first-ever national-level study on the socio-economic impact of antimicrobial-resistant bacteria, fungi, and other pathogens. The results were alarming. It found that antimicrobial resistance (AMR) already costs us around $3.4-billion each year—an annual toll that could grow to $44-billion by 2050.

And while bacterial resistance to existing antibiotics is steadily increasing, the pipeline for new antibiotics is drying up. Why? There’s little incentive to take on the billion-dollar costs of developing new antibiotics.

In fact, across the world, a new class of antibiotics has not been approved in 35 years. Yet current antibiotics are no longer as effective in beating infection as they once were. It is estimated that over 25 per cent of bacterial infections are resistant to first-line antibiotics. According to a new Lancet report, AMR kills 1.27 million people worldwide every year; by 2050, this number could be as high as 10 million. Looking ahead, AMR is poised to drain as much as 3.8 per cent of global annual GDP.

Aware of these challenges, our policymakers since 2017 have been planning a robust AMR strategy based on four pillars: Infection Prevention and Control; Stewardship; Surveillance; and Research and Innovation.

The government of Canada has taken numerous other positive steps, but the final consultation on a draft National Action Plan initially scheduled for February 2020 was understandably delayed as our policymakers shifted to COVID-19 response. The delay has been costly, however. A new U.S. Centers for Disease Control report, for example, found that the pandemic in the United States has reversed progress made in combating AMR—and the same is likely true in our country.

In fact, according to the AMR Preparedness Index, Canada ranks lower than its peers in preparing a national strategy for AMR. Thankfully, experts have already identified promising approaches to fighting AMR. We just need to commit to and implement them.

For example, the Public Health Agency of Canada should lead in coordinating AMR efforts across Canada’s provincial health systems to avoid over-usage of antibiotics and to encourage vaccinations, which can help avoid the need for antibiotics in the first place.

Ottawa should also collaborate with domestic and international stakeholders in developing economic incentives to revive the pipeline of new antibiotics. Over the past several years, other countries in the G7 and G20—including the United Kingdom, United States, France, Germany, Japan, and Sweden—have explored policies to help incentivize the research and development of new antibiotics. In 2021, the G7 finance ministers committed to partnering with industry leaders to explore “a range of market incentive options”—especially “pull” incentives that encourage firms to invest in new antibiotics, even if they’ll only be prescribed in low volumes—along with pilot projects exploring new financial and regulatory structures.

Canadian policymakers should fully embrace this multilateral effort. The federal government should work to pass regulatory reforms to help accelerate the approval and market launch of newly developed antibiotics. Ultimately, while learning from international best practices is important, Canada needs to develop a “made-in-Canada” approach well-suited to our unique health care systems, taking into account our federal, provincial and territorial components.

To support the development and implementation of incentive policies, it will be crucial to prioritize physician education, public health guidance, and public awareness, which requires additional resources and should be updated with a greater focus on AMR and antimicrobial stewardship. This will help reduce the unnecessary or inappropriate prescription of antibiotics, extending the effectiveness of current treatments. These efforts are especially critical in the wake of a COVID-caused spike in antibiotics usage.

AMR is rendering the global antibiotic arsenal ineffective. Left unchecked, it will lead to the collapse of Canadian health systems. Without a final national action plan, Canada will remain ill-prepared to combat this growing threat.

Now is the time for Canada to renew its vision for leadership toward a future that can far more effectively manage the AMR threat we have today.


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