Canada’s Activities in Combatting Antimicrobial Resistance Presentation to the JPIAMR Management Board March 29, 2017
AMR in Canada • Surveillance data indicates that rates of infection for some resistant pathogens have declined in recent years but remain above levels seen before 2007, indicating more work needs to be done: – MRSA rates in hospitals have decreased by 25% since 2008 – VRE incidence declined by 30% from 2012 to 2014 – C. difficile infection rates have also dropped 35% in the 3-year period from 2011 to 2014 • Neisseria gonorrhoeae is of particular concern: Canada has seen a 43.1% increase in the rates of reported cases between 2004 and 2013, and over 50% of isolates were shown to be resistant to at least one antibiotic, including higher azithromycin resistance levels than in the US and UK (3.3% in 2014, up from 0.35% in 2009) • Medically important AMU in animals is significant: – 73% of antimicrobials distributed to animals in Canada were of the same classes as those antimicrobials used in human medicine – In 2014, approximately 82% of medically-important antimicrobials were distributed and/or sold for use in food-producing animals. 2
Federal Framework and Action Plan on AMR • Launched in October 2014, the Antimicrobial Resistance and Use in Canada: A Federal Framework for Action mapped out a coordinated, collaborative federal approach for responding to AMR. In particular, it laid the foundation for action across multiple sectors, and outlined the key focus areas and plans for action of the Government of Canada. • Subsequently, in March 2015 the Government of Canada followed up with the Federal Action Plan on Antimicrobial Resistance and Use in Canada: Building on the Federal Framework for Action. This document identifies concrete steps that key departments and agencies of the federal government will take to prevent, limit and control the emergence and spread of AMR. Actions were particularly focused in the areas of surveillance, stewardship and innovation. • These documents set the stage for further action on AMR, and lay the foundation for Canada’s national action plan, as committed to during the World Health Assembly in 2015. 3
Federal Response to AMR and AMU 4
Federal Framework (2014) and Action Plan (2015) on AMR • Key results to date: Enhanced integrated surveillance activities (CARSS) Initiation of pilot projects addressing surveillance gaps (AMRNet; ESAG) Implementation of regulatory and policy changes for veterinary antimicrobials to enhance regulatory oversight Stewardship strengthened through engagement of practitioners via awareness campaigns and learning activities, and updated clinical guidelines on STBBIs Launch of research initiatives focused on AMR point-of-care diagnostics F/P/T multi-sectoral governance established to deliver pan-Canadian Framework and Action Plan • Stakeholders are undertaking complementary actions: HealthCareCAN: Stakeholder-led healthcare antimicrobial stewardship action plan (human) and network Canadian Veterinary Medical Association: Pan-Canadian framework on veterinary oversight National Farmed Animal Health and Welfare Council: National stewardship efforts in the agri-food sector 5
Towards a National Strategy: Pan-Canadian Framework on AMR • The Pan-Canadian framework is a high level policy document outlining strategic objectives, outcomes and potential action areas under each of the components o Will guide and align collective actions within and across sectors with shared responsibility for AMR o Completion by May 2017 to meet Canada’s commitment under the Global Action Plan on AMR • With a Pan-Canadian framework we are trying to: o Coordinate and leverage actions being taken across sectors to eliminate siloes o Share information and best practices o Create opportunities for collaboration o Establish a coherent approach that will guide our collective efforts and ensure we are moving together in the same direction with clearly defined roles and responsibilities o Involve and engage all levels of government • The Framework development is being facilitated through a dedicated governance structure that reflects a One Health approach with F/P/T government representation and human and animal health stakeholders. Key elements of the structure include: • The AMR Steering Committee (senior F/P/T representatives) • Task Groups (expert stakeholders from industry, academia, non-governmental organization and health and agricultural representatives from F/P/T governments) • Deputy Minister Champions (human and animal health/agriculture from provincial and federal governments) 6
Foundation of pan-Canadian Framework on AMR Surveillance Stewardship Infection Prevention & Research and Control Innovation Desired Outcomes Enhanced understanding of Effectiveness of current Health professionals and the Better tools and approaches to how AMR spreads in human antimicrobial drugs of public adopt appropriate detect and treat drug resistant and animal settings importance to humans antimicrobial use practices infections in humans and maintained animals Comprehensive picture of Reduced infections in health care AMR and AMU in Canada and the community Potential Actions Support the development of a Strengthen the promotion of Increase awareness and understanding Support the development of rapid centralized, harmonized appropriate AMU in human and of AMR, and the role that infection diagnostics that guide the choice database platform to integrate animal medicine prevention and control play in limiting of treatment and therapeutic use human and animal health data the spread of infectious agents Support clinical trials for drugs Identify priority organisms that Develop awareness, education Improve management practices to that are already on the market, and/or don’t have other support contribute to AMR in animals and training to improve reduce the need for antimicrobials and humans prescribing practices in human and veterinary settings Explore alternative and adjuvants Enhance human AMR/AMU Increase awareness and understanding to antibiotics as a made in data collection in community- Strengthen regulatory oversight of the importance of biosecurity Canada approach that addresses based settings and framework on veterinary measures to limit the spread of both veterinary and human medicines and medicated feed s infectious agents and the need for medicine antimicrobial use 7
Framework Components • Surveillance – Goal : Create strong, integrated surveillance systems to provide a comprehensive picture of AMR and AMU in Canada – Areas of focus : development of clear objectives for AMR and AMU surveillance throughout the collection process; fostering of shared ownership of surveillance systems through active stakeholder engagement; promotion of centralized and standardized data sharing platform to integrate data across sectors; creation of clear technical guidance for all data-related activities, and standardized definitions for AMR • Infection Prevention and Control – Goal : Contain the spread of resistant organisms and reduce AMR and AMU, put in place standardized infection prevention and control approaches, programs and policies – Areas of focus : development and delivery of effective communication, education, and training programs and tools to improve IPC; facilitation of the application and oversight of IPC best practices through regulations, guidelines, KT and education; collaboration with affected groups to address inequalities impacting the delivery of IPC programs; investments in IPC research to improve efficacy in both human and animal health 8
Framework Components • Stewardship – Goal : Creation of programs and policies that highlight education, awareness raising and increased regulatory oversight, to reduce inappropriate prescribing and use of antimicrobials in humans and animals to conserve the effectiveness of new and existing treatments – Areas of focus : creation and funding of a pan-Canadian Antimicrobial Stewardship Network; implementation of a robust AMU data collection system; implementation of regulatory and policy changes to enhance regulatory oversight; development of pan- Canadian harmonized governance tools; creation of enhanced educational curricula for prescribers and public awareness programs focused on AMR • Research and Innovation – Goal : enable evidence-based responses to AMR through increased knowledge, innovative tools and collaborative approaches to better understand resistance and develop new treatments and strategies. – Areas of focus : support for a multi-sectoral network that will facilitate discovery, best practices and economic and production impact; investigation of alternatives and adjuvants to antimicrobials and development of R&I capacity; support for clinical and effectiveness trials of antimicrobials, alternatives and adjuvants; creation of a supportive environment for research and innovation; incentivize pharmaceutical investment in AMR by improving drug licencing processes 9
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