What we examined (see Focus of the audit)

This audit examined whether the Public Health Agency of Canada and Health Canada have fulfilled their key responsibilities to mitigate the public health risks posed by the emergence and spread of antimicrobial resistance. The audit focused on antibiotic resistance.

Why we did this audit

Antimicrobial drugs, commonly called “antimicrobials,” are considered a cornerstone of modern medicine. Health professionals rely on these drugs to treat common infections, such as pneumonia, and reduce the risk of serious complications and death. Using them allows health professionals to perform many medical procedures more safely, including organ transplants, joint replacements, and chemotherapy for cancer.

Antimicrobial resistance develops naturally, but it accelerates when antimicrobials are not used prudently—meaning the right drug used at the right dose, frequency, and duration. Infections caused by organisms that have developed resistance may require lengthier and costlier treatments, some with serious side effects, and carry a higher risk of death for patients. For some multi-drug-resistant infections, few treatments are available.

What we concluded

We concluded that the Public Health Agency of Canada and Health Canada have not fulfilled key responsibilities to mitigate the public health risks posed by the emergence and spread of antimicrobial resistance in Canada.

What we found

Developing a pan-Canadian antimicrobial resistance strategy

Overall, we found that the Public Health Agency of Canada (the Agency) has not succeeded in mobilizing all federal, provincial, and territorial partners and other stakeholders toward the development of a pan-Canadian strategy to address antimicrobial resistance. Since 2011, the Agency has discussed areas of collaboration with the provinces and territories, but has not succeeded in achieving consensus on the scope of such a strategy. In 2014, the Agency engaged with some federal organizations to develop a federal framework to address antimicrobial resistance. However, the Agency, in collaboration with its partners, has not yet determined how the framework will be used to mobilize the provinces, territories, and other stakeholders in identifying priority actions, clarifying roles and responsibilities, and establishing clear and realistic deadlines for the development of a pan-Canadian strategy.

This finding is important because there is no national strategy in place to address antimicrobial resistance. The Public Health Agency of Canada considers that dealing with this issue requires a comprehensive approach with strong national leadership and the cooperation of all levels of government and sectors. The Agency also considers that the lack of integration and coordination of activities raises the health risks posed by antimicrobial resistance.

• Significant work to develop a pan-Canadian antimicrobial resistance strategy remains to be done

  Recommendation. The Public Health Agency of Canada, in cooperation with its federal partners, provinces, territories, and other stakeholders, should identify priority actions, clarify roles and responsibilities, and establish clear and realistic deadlines for the development of a pan-Canadian strategy to address antimicrobial resistance.

Surveillance of antimicrobial resistance and use

Overall, we found that the Public Health Agency of Canada has identified weaknesses in its collection, analysis, and dissemination of surveillance information on antimicrobial resistance and antimicrobial use. The Agency is developing a strategy to address these weaknesses, but has yet to finalize the scope of improvements, funding sources, and timelines for implementation.

This finding is important because the Agency is responsible for obtaining, analyzing, and disseminating national-level surveillance information about antimicrobial resistance and antimicrobial use. This information is needed to understand the scope of resistance and the extent of antimicrobial use in Canada. Based on this understanding, actions can be taken to mitigate the risks to human health.

• The Public Health Agency of Canada is developing a strategy to address surveillance weaknesses

  Recommendation. The Public Health Agency of Canada, in collaboration with provinces, territories, and other health stakeholders, should address the weaknesses in surveillance it has identified to ensure that adequate data on antimicrobial resistance is available.

Prudent antimicrobial use

Overall, we found that the Public Health Agency of Canada and Health Canada have taken some steps to promote prudent antimicrobial use in humans. The Agency has developed six national guidelines intended to prevent and control antimicrobial-resistant infections, but it has identified the need for more. Health Canada requires that most antimicrobial drugs used in humans be sold by prescription only.

However, Health Canada has not taken some important steps needed to promote prudent antimicrobial use in food animals. For example, the Department has not strengthened existing regulations to prohibit farmers from importing unlicensed non-prescription antimicrobial drugs that are important to human medicine for use in their own animals. The Department does not assess these drugs for quality, safety, or efficacy. According to the Department, the use of these drugs in food animals may have serious public health implications, including the development of antimicrobial resistance. Furthermore, the Department allows certain antimicrobials that are used to treat serious infections in humans to be sold without a prescription for use in food animals.

• The Public Health Agency of Canada and Health Canada have taken some steps to promote prudent antimicrobial use in humans

  Recommendation. We made no recommendations in this area of examination.

• Health Canada has not taken some important steps to promote prudent use of antimicrobials in food animals

  Recommendation. Health Canada should finalize its plans to address “own-use importation” of veterinary antimicrobial drugs and strengthen its control over the importation of veterinary antimicrobial active pharmaceutical ingredients.

  Recommendation. Health Canada should periodically review all antimicrobials important to human medicine to determine whether their approved uses and availability in veterinary medicine increase the risk that these antimicrobials will become ineffective in treating infections in humans.

Entity Responses to Recommendations

The audited entities agree with our recommendations, and have responded (see List of Recommendations).

Related Information

For more information

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