Abstract:
A number of recent developments in the last three months have catapulted antimicrobial resistance onto the world stage. Many other countries, such as the U.S. and U.K., have committed significant funds to tackling the issue and set specific goals for tracking progress. Canada lags behind and has yet to invest seriously in combatting antimicrobial resistance. Public and healthcare professionals have roles to play in changing government mindset on the issue and encouraging it to take action. Should they fail to act, the health of all Canadians may be compromised in the future.
Main Article:
In the last three months, much action has been taken by the likes of the World Health Organization (WHO) and G7 to develop action plans to fight antibiotic resistance. While much of the world takes a stand against this growing crisis, Canada continues to lag behind.
Antibiotics are amongst the most prescribed drugs to treat bacterial infections. Unfortunately, bacteria eventually become resistant to an antibiotic, meaning that the drug is ineffective. The more we use antibiotics, the faster resistance develops. To make matters worse, no new class of antibiotic has been introduced since 1987. Pharmaceutical manufacturers have little incentive to invest the billions of dollars required to develop antibiotics because they may only be effective for a few years before resistance emerges. Infectious disease experts believe we are headed back to the pre-antibiotic era–where today’s minor infections will kill again.
In Canada, 18,000 people are infected with resistant bacteria in hospitals each year, which cost our healthcare system an estimated $1 billion (Public Health Agency of Canada [PHAC], 2014; PHAC, 2015a). By 2050, it is estimated that 10 million people worldwide will die from these infections annually (O’Neill, 2014). Many health experts have pegged antibiotic resistance as the most critical health issue of the 21st century.
It is estimated that 50% of all antimicrobial use is inappropriate (CDC, 2013). Antibiotics have no effect on viral infections (like the flu or most colds) despite being commonly prescribed in these situations. This promotes resistance of all the bacteria in our environment. A relatively new concept in medicine is antimicrobial stewardship: ensuring patients get the correct antibiotics, at the right time, but only when they are required.
In order to fight resistance, many countries have prioritized stewardship programs, drug development, improving diagnostics, and investment in infection control and public health. In 2014, U.S. President Barak Obama personally issued an executive order addressing the seriousness of antibiotic resistance (The White House, 2014a). It was announced that the 2016 U.S. budget would include $1.2 billion for antibiotic development, research, and stewardship programs (The White House, 2015). Germany’s Chancellor Angela Merkel addressed the World Health Assembly and insisted that all countries work towards combating the sources of antimicrobial resistance (WHO, 2015). Roughly £275 million have been spent over the past eight years fighting antimicrobial resistance in the U.K. and last year, the government announced a “War Cabinet” to tackle the problem (Medical Research Council, 2014).
Furthermore, other countries are setting defined targets to measure their progress. By 2020, the U.S. has committed to a concrete reduction in the incidence of Clostridium difficile infections, which are responsible for 14,000 deaths and $1 billion in medical costs annually (The White House, 2014b). They have committed to reducing inappropriate antimicrobial use in and out of the hospital and cutting inappropriate outpatient antibiotic use by 50% compared to 2010 levels (The White House, 2014b).
In contrast, the Canadian government lacks urgency and scope in its decision-making around antibiotic resistance. In April 2015, Health Minister Rona Ambrose announced a $4 million investment in research and an additional $2 million per year starting in 2016 (PHAC, 2015b). The federal government released an action plan in March that set no concrete goals for reductions in superbug infection rates or in antimicrobial use. Rather, it described the need for a national plan and vaguely set targets to evaluate the issue and determine priorities over the next five years (PHAC, 2015a). In 1997, the federal government identified that resistance is an issue that demands a national strategy, thus why are we still in the planning phase? We cannot keep planning to make a plan; we need to start taking action.
Our government must take a strong stance on fighting antibiotic resistance. As we wait for the federal government to create a good plan, change must be made amongst healthcare providers and Canadians. Some sick patients expect to leave their doctor’s office with a prescription despite showing symptoms of a viral illness. Research has demonstrated that patient expectations influence how doctors prescribe antibiotics. The culture of prescribing antibiotics needs to change for both the public and physicians. That is why a group of medical students at the University of Toronto recently launched the Students for Antimicrobial Stewardship Society (SASS)—to increase awareness about this deadly problem among future healthcare providers and to integrate it into their educational curricula.
Antibiotic resistance is the world’s problem, which urgently needs the support and leadership of governments everywhere. Canada must improve its investment into antimicrobial resistant research, implement the recommendations of the WHO, and set specific goals in reducing resistance levels. Canadians cannot continue to sit quietly and watch this problem grow; they must urge their provincial and federal parliament members to prioritize tackling antibiotic resistance. We jeopardize the future health of generations to come if we fail to act.
References:
Centers for Disease Control and Prevention. (2013). Antibiotic resistance threats in the United States, 2013. Atlanta: U.S. Department of Health and Human Services.
Medical Research Council. (2014). New Science Minister announces ‘war cabinet’ to tackle antimicrobial resistance on all fronts. Retrieved from: http://www.mrc.ac.uk/news-events/news/war-cabinet-to-tackle-amr/
O’Neill J. (2014). Antimicrobial resistance: Tacking a crisis for the health and wealth of nations. The Review on Antimicrobial Resistance.
Public Health Agency of Canada. (2014). Antimicrobial resistance and use in Canada: A federal framework for action. Ottawa: Government of Canada.
Public Health Agency of Canada. (2015a). Canadian antimicrobial resistance surveillance system—Report 2015. Ottawa: Government of Canada.
Public Health Agency of Canada. (2015b). Statement from the Honourable Rona Ambrose Minister of Health – Auditor General’s Findings on Antimicrobial Resistance. Government of Canada. Retrieved from http://news.gc.ca/web/article-en.do?nid=967769
The White House. (2014a). Executive Order—Combating Antibiotic-Resistant Bacteria. Office of the Press Secretary. Retrieved from https://www.whitehouse.gov/the-press-office/2014/09/18/executive-order-combating-antibiotic-resistant-bacteria
The White House. (2014b). National strategy for combatting antibiotic-resistant bacteria.
The White House. (2015). Fact sheet: President’s 2016 Budget Proposes Historic Investment to Combat Antibiotic-Resistant Bacteria to Protect Public Health. Office of the Press Secretary. Retrieved from https://www.whitehouse.gov/the-press-office/2015/01/27/fact-sheet-president-s-2016-budget-proposes-historic-investment-combat-a
WHO. (2015). Sixty-eighth World Health Assembly opens in Geneva. Retrieved from http://who.int/mediacentre/news/releases/2015/wha-18-may-2015/en/
