This article originally appeared in the Ottawa Citizen on July 26, 2023
When bacteria and other organisms become resistant to antimicrobials, including antibiotics, antivirals and antiparasitics, “superbugs” are created. As the problem worsens, we need new drugs to fight it.
The Pan-Canadian Action Plan on Antimicrobial Resistance (AMR) announced by the federal government last month is an important first step towards addressing this major health threat. The five-year plan, developed with the provinces and territories, provides a blueprint to coordinate Canada’s AMR response.
According to the World Health Organization, antimicrobial resistance is a leading cause of death worldwide, and one of the 10 threats to global health it identified in 2019. It occurs when bacteria and other organisms become resistant to antimicrobials, including antibiotics, antivirals and antiparasitics, creating so-called “superbugs.” Unfortunately, the pandemic led to an increase in superbug infections, with some scientists pointing to more antibiotic prescriptions as the cause.
In Canada, AMR was the cause of death for nearly 15 people a day in 2018, according to the Council of Canadian Academies. In addition, the council found that about 26 per cent of infections were resistant to the drugs commonly used to treat them. This number is expected to increase to 40 per cent by 2050, projecting the loss of 396,000 Canadian lives between 2020 and 2050, a $120-billion cost to the health-care system, and a $388-billion decrease in GDP.
To address this, the action plan identifies five priority areas: research and innovation; surveillance; stewardship; infection prevention and control; and leadership. It also outlines the need for a coordinated effort between governments, industry, academia, medical professionals and international organizations to promote the development, access and appropriate use of new antimicrobials.
However, the specific financial commitments and incentives to deliver on the priority areas are noticeably missing. As we move towards implementing the action plan, the federal government must consider additional critical steps.
First, it should adopt and appropriately invest in economic incentives — commonly known as “pull incentives” — to develop and purchase new antimicrobials, based on existing models established in the United Kingdom, the United States and Japan. In the recent federal budget, we were encouraged to see proposed funding for the Public Health Agency of Canada to secure new antimicrobials. However, without a concrete funding commitment similar to the commitments of other G7 countries, Canada will remain behind its G7 partners in combating antimicrobial resistance.
The U.K., for example, has already committed to investing $13 million per antibiotic per year over 10 years, with the potential to increase this amount to $26 million. In Canada, a study sponsored by the public health agency estimated that the federal government needs to commit between $13 million and $28 million per antibiotic per year over 10 years to be able to effectively fight antimicrobial resistance.
Secondly, organizations that conduct health technology assessments of new medicines must do a better job of recognizing the value of new antibiotics. These organizations are responsible for reviewing drugs, and making pricing and listing recommendations for public drug plans. Currently, they largely compare new antibiotics to older ones and, therefore, fail to take into consideration the immense economic, health and societal value of more effective new treatments.
Finally, the federal government must work with the provinces to test and implement an access and distribution incentive model to support the appropriate use of existing and new antimicrobials. Canada has a unique opportunity to utilize the health data and stewardship programs established by the provinces, and the federal-provincial-territorial distribution systems put in place during COVID-19, to ensure that Canadians have the latest antimicrobials when they need them.
But we have some catching up to do. Research published in Clinical Infectious Diseases showed that Canada only approved two of the 18 antibiotics launched in 14 high-income countries between 2010 and 2020. In contrast, the U.S. and the U.K approved 17 and 11 new antibiotics respectively during the same period.
As more drug-resistant diseases, such as gonorrhea, staphylococcus infections and strains of tuberculosis become increasingly persistent, time is not on our side.
The federal health minister’s mandate letter from 2021 instructs him to “take increased and expedited action” to mitigate the growing AMR threat. Each year that we fail to reduce AMR numbers, the financial toll — not to mention loss of human life — is felt nationwide.
Governments and industry must work together and commit to more investments and reduced wait times for new antimicrobials to ensure positive announcements like the action plan have the desired impact on Canadians’ lives.
Pamela Fralick is President of Innovative Medicines Canada, which represents the pharmaceutical industry companies that develop new vaccines and medicines.
