canada’s activities in combatting · canada’s activities in combatting antimicrobial resistance...
TRANSCRIPT
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.
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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.
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Federal Response to AMR and AMU
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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
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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)
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Foundation of pan-Canadian Framework on AMR
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Desired Outcomes
Increase awareness and understanding
of AMR, and the role that infection
prevention and control play in limiting
the spread of infectious agents
Improve management practices to
reduce the need for antimicrobials
Increase awareness and understanding
of the importance of biosecurity
measures to limit the spread of
infectious agents and the need for
antimicrobial use
Support the development of rapid
diagnostics that guide the choice
of treatment and therapeutic use
Support clinical trials for drugs
that are already on the market,
and/or don’t have other support
Explore alternative and adjuvants
to antibiotics as a made in
Canada approach that addresses
both veterinary and human
medicine
Surveillance Stewardship Research and
Innovation
Potential Actions
Effectiveness of current
antimicrobial drugs of
importance to humans
maintained
Better tools and approaches to
detect and treat drug resistant
infections in humans and
animals
Support the development of a
centralized, harmonized
database platform to integrate
human and animal health data
Identify priority organisms that
contribute to AMR in animals
and humans
Enhance human AMR/AMU
data collection in community-
based settings
Enhanced understanding of
how AMR spreads in human
and animal settings
Comprehensive picture of
AMR and AMU in Canada
Health professionals and the
public adopt appropriate
antimicrobial use practices
Reduced infections in health care
and the community
Infection Prevention &
Control
Strengthen the promotion of
appropriate AMU in human and
animal medicine
Develop awareness, education
and training to improve
prescribing practices in human
and veterinary settings
Strengthen regulatory oversight
and framework on veterinary
medicines and medicated feeds
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
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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
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Pan-Canadian Framework: Lessons Learned
• Governance Model
o Inclusion of federal, provincial and territorial governments, along with
representatives from academia, industry, and NGOs in the governance
structure fostered a shared sense of responsibility and ownership
• One Health Approach and cross-sectoral engagement
o By including representatives from the human health, animal health, and
agriculture in the development of the Framework, stakeholders have developed
relationships that are extending beyond collaborations on AMR
o Multi- and cross-sectoral engagement has also created interdisciplinary learning
opportunities
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Pan-Canadian Action Plan
• Once the Framework is complete the focus will turn to the development of an
Action Plan to support implementation of the Framework objectives
o The Action Plan will lay out the details of concrete deliverables, measurable
outcomes and timeframes
o On a longer track to provide opportunities for broad engagement and further
discussion about what stakeholders can contribute, from ideas to implementation,
within their sphere of influence
• Engagement may include events and activities such as stakeholder
consultations through forums or conferences; a series of workshops; discussion
guides for human and animal health stakeholders and/or government officials;
etc. The ultimate goal of these activities is mobilizing commitment to framework
implementation.
• In leading the development of the Action Plan, PHAC will continue to work with
F/P/T partners and stakeholders across sectors.
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Canadian Antimicrobial Resistance Surveillance System
• CARSS is the national coordinating program for PHAC’s surveillance systems and
programs that gather information about AMR and AMU in humans and animals
• CARSS uses data from PHAC’s existing surveillance systems and national
laboratory reference services to develop a national picture of AMR and AMU in
humans and animals
o This picture is intended to inform public health action (e.g., antimicrobial stewardship,
infection prevention and control), research, and innovation
• CARSS:o provides integrated information on AMR/AMU surveillance;
o informs the expansion of surveillance activities to areas of greatest need;
o provides useful and relevant information to stakeholders and the public in support of
antimicrobial stewardship interventions to further protect the health of Canadians
• Second CARSS Report released on September 12, 2016 (analysis of 2014 data)
http://healthycanadians.gc.ca/publications/drugs-products-medicaments-
produits/antibiotic-resistance-antibiotique/antimicrobial-surveillance-
antimicrobioresistance-eng.php
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Canadian AMR/AMU surveillance
information
Canadian Tuberculosis
Laboratory Surveillance
System (CTBLSS)
Canadian HIV Strain and Drug
Resistance Surveillance
Program
National surveillance of
antimicrobial
susceptibilities of
Neisseria gonorrhoae
Laboratory reference
services
Canadian Integrated
Program for Antimicrobial
Resistance Surveillance
(CIPARS)
Human antimicrobial use
(AMU) surveillance
Canadian Nosocomial
Infection Surveillance
Program (CNISP)
National surveillance of
Invasive Streptococcal
Disease
FluWatch
CARSS Contributors
Prudent Use of Antimicrobials in Humans
• Putting the Pieces Together – a Stakeholder-led Antimicrobial Stewardship
Action Plan
• Antibiotic resistance information and awareness materials for Canadians and
health care professionals through the Government of Canada website
• Pan-Canadian Public Health Network (PHN) Communicable and Infectious
Disease Steering Committee Task Group Report on Antimicrobial Use
Stewardship
• Do Bugs Need Drugs? - an education program for the community and
healthcare professionals, providing resources for physicians, pharmacists,
nurses, and the public
• Canadian Guidelines on Sexually Transmitted Infections (which include
diagnosis and treatment of antimicrobial resistant gonococcal infections)
• AntibioticAwareness.ca which offers practical tools and information to
practitioners and patients
• Choosing Wisely Canada, a campaign to help clinicians and patients
• Hospital-based stewardship programs
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Prudent Use of Antimicrobials in Animals
• Canada is taking steps to strengthen veterinary oversight of antimicrobial use
• Veterinary Oversight of Antimicrobial Use – A Pan-Canadian Framework for
Professional Standards for Veterinarians’ was developed by the Canadian
Veterinary Medical Association (CVMA)’s Veterinary Pharmaceutical
Stewardship Advisory Group and the Canadian Council of Veterinary Registrars
– Template of professional standards to be used by provincial and territorial veterinary
regulatory (licensing) bodies when developing their own regulations, guidelines, or
bylaws relating to veterinarians professional responsibilities in providing oversight of
use of antimicrobials in all circumstances. The framework is intended to contribute to
the development and implementation of uniform regulations across the country.
• Food animal producer associations are taking leadership in shaping their on-
farm food safety programs
– Chicken Farmers of Canada
– Canadian Cattlemen’s Association (CCA) Verified Beef Production Plus (VBP+)
– Canadian Pork Council (CPC) Canadian Quality Assurance Program (CQA)
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International initiatives related to AMR
• Canada (PHAC, CIHR, CFIA) is one of the countries that co-leads the Global
Health Security Agenda Action Package on AMR; will Chair starting in
September 2017
• Objective is to develop an integrated and global package of activities to combat
antimicrobial resistance, spanning human, animal, agricultural, food and
environmental aspects
• Canada collaborates with the US, EU, and Norway as part of the Trans-Atlantic
Task Force on AMR (TATFAR)
• Current (3rd) phase involves a series of Action Items in 3 key areas: appropriate
therapeutic use in human and veterinary medicine; prevention of drug resistant
infections; and strategies for improving the pipeline of antimicrobial drugs
• In the fall of 2016, Canada joined the Global Antimicrobial Surveillance System
(GLASS); established by the WHO to foster standardized AMR surveillance
globally
• There are currently 31 fully registered countries, with 11 more expressing interest
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Moving Forward
In the coming months, the emphasis will be on several key activities
• Finalizing the pan-Canadian Framework on AMR
• Launching the pan-Canadian Action Plan process
• Strengthening AMR and AMU surveillance systems
• Continuing to collaborate with domestic and international partners on multi-sectoral
initiatives to address the threat of AMR
• Ongoing exchanges of ideas with industry partners (how they could contribute to
our initiatives and programs, how we could support their ideas)
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