Canadians do not have access to 19 of the 29 antibiotics the World Health Organization (WHO) has classified as "antibiotics of a last resort," a new federal audit finds.
The report tabled in Parliament on Thursday by Auditor General Karen Hogan found that amid growing resistance to antimicrobial drugs, Health Canada has not done enough to improve market access to new antimicrobial drugs available in other countries, and as the COVID-19 pandemic demonstrated, the cost of being unprepared "is measured in lives lost."
Hogan's report notes that while the Public Health Agency of Canada (PHAC) and Health Canada have taken some action to address antimicrobial resistance, "concerning gaps persist" including when it comes to collecting data outside of hospitals and vulnerable populations.
With nearly five million deaths worldwide associated with antimicrobial resistance every year, the WHO classified it as a top 10 global public health threat in 2019 and referred to it as a “silent pandemic” in 2022, Hogan's report notes.
"The government should not need a crisis to understand the importance of acting promptly," Hogan told reporters on Thursday.
PHAC-funded research estimates that 26 per cent of infections in Canada in 2018 didn't respond to first-line antimicrobials. The Council of Canadian Academies (CCA) found that in the same year, antimicrobial resistance cost Canada $1.4 billion in additional health-care spending, and reduced Canada’s gross domestic product by $2 billion.
In a 2019 report, the CCA found that by 2050 — when the rate of resistance is estimated to increase to 40 per cent — the cumulative costs to Canadian health-care systems could reach $120 billion.
Meanwhile, Hogan's study determined that two thirds of the funding the Canadian government is putting into the issue came from existing budgets.
And, when looking at 13 of the newest antibiotics of last resort, as of 2020 Canadians had access to two, while Americans had access to all 13, and Sweden and the U.K. had access to eight.
Hogan found that as the department responsible for monitoring the safety, efficacy and quality of antimicrobials for human and animal use, Health Canada had improved its oversight and regulatory measures, but the department hasn't assessed whether the changes it made are working.
Her review — a follow up to one published in 2015 — also dove into the roles the Canadian Food Inspection Agency and Agriculture and Agri-Food Canada play in providing surveillance and preserving the effectiveness of medically important antimicrobials.
She also reported that while PHAC released a "Pan-Canadian Action Plan on Antimicrobial Resistance" in June, concerns remain that it's lacking: "concrete deliverables, timelines, ways to measure progress, and clear roles and responsibilities for each level of government," and as a result, the plan could fall short. The auditor general is now recommending the relevant departments remedy this.
"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," Hogan said.
The auditor general is also recommending Canada determine which antimicrobials Canadians need most and implement measures to support market access to these drugs.
Responding to the audit's findings on Parliament Hill on Thursday afternoon, Health Minister Mark Holland highlighted the areas Hogan noted where work is underway, while acknowledging the federal government has to do more.
"In Budget 2023, funding was provided to secure access for new antimicrobials for Canadians and to promote public awareness on how to best use these drugs. We're also working with our partners so that life-saving antimicrobials already in our toolbox continue to work and to work well. We will report on our progress by next September of 2024," Holland said.
"Antimicrobial resistance is a complex challenge, but it's one that we are ready to meet in collaboration with our global partners."
In a statement reacting to the report, Conservative MP and health critic Stephen Ellis accused the federal government of failing to take "meaningful steps to address one of the most dire public health crises of our times."
"Antimicrobial resistance is the growing resistance by bacterial infections against antibiotic treatment, as well as the increasing invulnerability of humans to lifesaving antibiotics," said Ellis, who was a family doctor before getting into politics.
"Canadians are still vulnerable… because their government chose to sit on its hands," he said. "The consequences could be severe."
