Addressing Antimicrobial Resistance in Canada – The Call for an Integrated and Comprehensive Surveillance System

By:

Simon Otto, PhD DVM, Assistant Professor SPH, Lead Investigator, HEAT-AMR (Human-Environment-Animal Transdisciplinary AMR) Research Group, Centre for Healthy Communities, Healthy Environments Thematic Area Lead

Kelsey Robertson, MPH, Project Coordinator, HEAT-AMR Research Group

Antimicrobial resistance (AMR) has been identified by the World Health Organization as a global health issue, with wide ranging impacts on human, animal, and environmental health. Antimicrobials refer to a broad range of medications used to treat infections caused by bacteria, viruses, fungus, and parasites. Overuse or misuse of these medications can result in the development of resistance. Resistance occurs as microorganisms adapt and change in the presence of medications to a point where treatment is no longer effective. Due to the importance of antimicrobials for multiple sectors, a One Health approach is essential for understanding antimicrobial use (AMU) and addressing the consequences of resistance. Utilizing One Health means collaborating across disciplines to address problems that impact human, animal and environmental health.

One of the first steps in tackling AMR is developing a sound understanding of AMU patterns, and, in turn, tracking how AMR evolves and spreads. Therefore, in our study we were interested in evaluating the extent to which AMR/AMU surveillance systems in Canada are integrated (involve multiple sectors) and comprehensive (bring together a wide range of data sources). In other words, we asked - how well can current Canadian monitoring systems track and respond to information from multiple sectors about AMR/AMU in humans, animals and the environment? 

To do this, we started by reviewing a 2014 report by the National Collaborating Centre for Infectious Diseases that analyzed Canadian AMR/AMU surveillance, and a 2016 report by the Canadian Council of Chief Veterinary Officers that evaluated animal AMU surveillance in Canada. From these reports, we identified eight core requirements of an integrated and comprehensive One Health surveillance system. Core requirements included elements such as timely and integrated reporting of AMR/AMU data, and sufficient resources for surveillance programs.

Next, we reviewed information about 6 national, 1 territorial, and 22 provincial surveillance programs, and interviewed 29 subject matter experts to gain an understanding of the current landscape. We created a novel evaluation tool to rank the level of sustainable implementation of 7 common program elements (funding, organizational capacity, partnerships, program adaptability, communications, strategic planning, and enabling policy) for each of the 8 core requirements of an integrated and comprehensive surveillance system. This evaluation tool gave us granular detail on the level of progress towards the ultimate goal of a Canadian surveillance system able to track and respond to AMR/AMU data across multiple sectors.

Our team identified modest progress in surveillance systems since the 2014/2016 reports were published, largely building on the success of existing programs by adding new components. Based on the evaluation tool, strengths were identified in core requirements such as national surveillance of human and animal AMR/AMU. However, other core requirements for an integrated and comprehensive surveillance system remain in exploratory, or initial implementation phases, such as sufficient funding and resources for programs, comprehensive and timely reporting, and the lack of standardized data collection. Many added components currently rely on time-limited funding.

Based on this work, three critical areas for action were identified:

1. Expand on current success to further develop a complete, integrated AMR/AMU surveillance program
2. Change Federal/Provincial/Territorial policies to provide standardized AMR/AMU reporting
3. Increase investment in AMR/AMU surveillance resources, including dedicated personnel, funding, and enabling structures and policy

AMR is a growing issue, and action is needed to ensure continued and future access to effective antimicrobial treatments. Integrated surveillance is required to understand the scope of AMR/AMU in Canada across One Health sectors. Through an integrated and comprehensive surveillance program, we will have the necessary information to design, implement, and evaluate effective stewardship interventions.  

Interested in reading the full study? The article is co-published through The Canadian Veterinary Journal and the Canadian Journal of Public Health to highlight the importance of a One Health approach.