Pan-Canadian Framework and Approach to

Antimicrobial Resistance

Presentation to the TATFAR Policy Dialogue

September 27, 2017

• To provide TATFAR members with an overview of Canada’s coordinated

approach to Antimicrobial Resistance (AMR), and the development

process for the pan-Canadian Framework on Antimicrobial Resistance and

Antimicrobial Use

• To learn about TATFAR members’ experiences in implementing their

National Action Plans on AMR

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Purpose PURPOSE

AMR in Canada

• Surveillance data indicates that rates of infection for some resistant pathogens have

declined in recent years but remain above 2007 levels, 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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Drivers for Action on AMR

• Stakeholders are taking action

• Provinces and territories are developing their own approaches (i.e. Alberta, Ontario)

• Canadian Veterinary Medical Association published prudent use guidelines for antimicrobials

• Professional associations in the agri-food sector (National Farmed Animal Health and Welfare

Council, Chicken Farmers of Canada, Canadian Cattlemen’s Association, Canadian Pork

Council, Dairy Farmers of Canada) adopting on-farm food safety programs with a focus on

AMR

• Stakeholder-led antimicrobial awareness activities (Do Bugs Need Drugs?,

AntibioticAwareness.ca, Choosing Wisely Canada)

• Consumer/market demand

• Grocery stores introducing antibiotic-free lines (e.g. Loblaws Free From line)

• Fast food restaurants incorporating meat raised without antibiotics into their menus (Now:

A&W pork and chicken; in progress: McDonald’s, Wendy’s)

• International partners and initiatives

• WHO Global Action Plan on AMR

• Bilateral and multi-lateral research initiatives (Canada-UK, JPIAMR)

• G7 and G20 declarations on AMR (from 2015 to present)

• UNGA Political Declaration of the High Level Meeting on AMR

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Government of Canada actions addressing AMR

• Canada has undertaken significant work to address AMR, including:

• Enhancing and integrating AMR and AMU surveillance through the Canadian

Antimicrobial Resistance Surveillance System (CARSS)

• Organizing a workshop held in October 2016 to begin discussion on AMR and AMU

surveillance in animal agriculture

• Undertaking awareness campaigns over the past three years

• Advancing regulatory and policy changes for medically important veterinary

antimicrobials

• Creating a Vaccine Research Priority List with AMR priority pathogens in 2015

through the interdepartmental Vaccine Research, Innovation and Development

Working Group

• Developing a list of priority organisms of concern for AMR surveillance in

Canada in collaboration with FPT partners through the Public Health Network

• Supporting research and innovation through internal and external initiatives (e.g.

Genomics Research and Development Initiative)

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Government of Canada actions addressing AMR (continued)

• The Government of Canada is addressing AMR through a multi-sectoral

approach:

• Establishment of the Expert Advisory Group on AMR (EAGAR), formed to

advise the Chief Public Health Officer on matters related to AMR and AMU

(first meeting in 2014)

• Development of a Federal Framework (October 2014) and Action Plan

(March 2015) on AMR to coordinate and leverage federal activities. The

Action Plan builds on the Framework strategic areas of focus, identifying

Government of Canada’s concrete steps, within existing resources and

authorities

• Establishment of an interdepartmental governance structure on AMR

(including 9 implicated departments) in 2015 to guide the federal

response to AMR, inform Canada’s contribution to the international AMR

agenda, and support F/P/T efforts to develop a national approach to AMR

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Building a Pan-Canadian approach to AMR

• AMR is not just an issue for the federal government - across Canada, responsibility is

shared across multiple sectors, all levels of government, and with stakeholders • Groups were taking action, but not in a coordinated or strategic way

• An F/P/T governance structure for AMR was approved by Deputy Ministers of Health

and Agriculture that is reflective of the One Health approach

• Public health, health care, agriculture/agri-food sectors

• All levels of government and stakeholders

• Clearly defined roles and responsibilities

• Under this structure, led by the Government of Canada, the F/P/T AMR Steering

Committee developed the framework, providing direction to task groups and liaising with

health and agriculture government tables to seek input.

• Four Task Groups (one for each pillar) were established and were tasked with:

• Identifying existing best practices, expertise, tools, resources, while also identifying gaps and

opportunities;

• Providing the F/P/T AMR Steering Committee with advice and recommendations for health care

(hospital and community settings) and animal health in the veterinary and on-farm/agri-food

settings via a report;

• Acting as AMR champions in reaching across to colleagues to engage them in their group’s work

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F/P/T Governance Model on AMR

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Pan-Canadian Framework

• The Framework seeks to:

• Coordinate and leverage

individual actions being taken

across sectors;

• Share information and best

practices;

• Create opportunities for

collaboration;

• Establish a coherent approach

that will guide and align our

collective efforts across sectors

and ensure we are moving

together in the same direction

• It is a high level policy document

outlining strategic objectives,

outcomes and potential action

areas under each of the pillars

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Pan-Canadian Action Plan on AMR

• The Framework is a comprehensive guidance document, but it lacks several

key elements:

• Specific targets

• Prioritization of activities

• Notable actions and assignments

• The focus now turns to the development of an action plan to support

implementation of the Framework objectives

• The pan-Canadian action plan will:

– Operationalize the Framework

– Clearly define F/P/T governments and stakeholders roles and responsibilities for

AMR

– Identify and drive commitment to specific actions by jurisdictions and stakeholders by

identifying and leveraging current or new activities

– Outline measurable outcomes and timeframes for completing deliverables

• Foster sectoral coordination and collaboration

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Questions for Discussion

• What obstacles did you face during the early implementation of your plans?

How did you overcome them?

• How did you get your stakeholders engaged in your plan implementation?

• How did you set your targets, and how did you get stakeholder buy-in?

• How did you ensure alignment of your plans and activities with the WHO Global

Action Plan, and other international efforts?

• Did you develop a Monitoring and Evaluation Framework simultaneously with

the Action Plan, or after?

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Role of Key Federal Departments Engaged in Pan-

Canadian Framework on AMR

Health Portfolio

• Public Health Agency of Canada is providing national leadership and works with partners on

the public health aspects of antimicrobial resistance, e.g. surveillance, laboratory analysis,

infectious disease outbreaks, awareness and public health guidance development

• Health Canada regulates the approval of antimicrobial drugs for humans and animals, and sets

policies and standards related to the safety and nutrition of the food supply

• Canadian Institutes of Health Research supports antimicrobial research and collaborates

internationally on AMR research projects

• Canadian Food Inspection Agency enforces regulatory requirements for the health and

safety of animals and the food supply, and the development of national biosecurity standards

Agriculture and Agri-Food

• Agriculture and Agri-Food Canada supports the development and adoption of industry-led

assurance systems, and monitors trade and market access activities

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Annex 1