Highlights of Consultation Workshop with Provincial /Territorial Representatives on Antimicrobial Resistance - February 07, 2003

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Introduction/welcome

Diane Kirkpatrick welcomed participants, thanking them for traveling from across the country to participate in this, the first consultative session of federal, provincial and territorial officials on Antimicrobial Resistance (AMR). The objectives of the meeting were to:

• achieve a common understanding of what each jurisdiction is doing regarding AMR so that all parties can work together;
  
  
• explore as equal partners the recommendations from the Report of the Advisory Committee on Animal Uses of Antimicrobials and Impact on Resistance and Human Health;
  
  
• discuss both the recommendations and the draft federal response and obtain provincial/territorial input with a view to finding optimum ways to implement the recommendations, ensuring maximum positive impacts and minimizing the negatives; and
  
  
• explore how we might collectively take some next steps to move the issue forward.

The participants shared their expectations of the session, noting that they wanted:

• an increased awareness of where AMR fits in animal health safety,
  
  
• an understanding of partners and issues and
  
  
• to create the beginning of an action plan.

Intersol facilitator Marc Valois, reviewed the agenda for the day and noted that the objective was to conclude the session with immediate next steps.

Overview of the federal initiatives on AMR

Diane Kirkpatrick made a presentation to the group on policy development and how Health Canada is addressing the issues noting that AMR is a key horizontal issue for the Government of Canada.

• Health Canada is currently building an evidence base in accordance with the departmental decision making framework and, in particular, is in process of gathering information on the extent of the problem, changes over time, the greatest contributors to use, etc. Health Canada is conducting research projects and surveillance as well as having begun to undertake risk assessments.
  
  
• There is an internal task team at Health Canada. The external Advisory Committee that just completed its final report, was comprised of a broad base of stakeholders: including: provinces and territories, academics, industry representatives, consumers and animal welfare groups. The internal team is developing guidelines on preclearance requirements for assessing antimicrobials, a prudent use policy and looking into extra-label use, criteria for prescription drug use, importation for own use, etc.
  
  
• Involving stakeholders is an important aspect of Health Canada's work as the department's Decision Making Framework calls for involvement of stakeholders in each step of the process. In addition to federal/provincial/territorial consultations, the department is working at the national and international levels.
  
  
• To date there have been several outputs, including an issue identification paper on VDD's web site (providing a summary of relevant data, with references, policy considerations, etc.), the final Report of the Advisory Committee and the proposed Health Canada response to it, and professional and public awareness information.
  
  
• The next steps for Health Canada involve continuing to reach out to stakeholders then finalizing the federal response to the Report. The goal is to collaborate, seek input and engage all to develop a sound, national policy on AMR.

Several participants commented on the presentation, noting that: regardless of the state of evidence around the issue, we should be driving toward judicious and prudent use.

Table discussion #1: Regulation and Distribution of Antimicrobial Drugs for Use in Food Animals

Participants then discussed the Regulation and Distribution of Antimicrobial Drugs for Use in Food Animals recommendations at tables with a view to ranking priority issues and solutions. There was general consensus on several factors contributing to the inappropriate use of antimicrobials: the easy availability of drugs, the lack of education and awareness on the part of producers, the economic realities of a cheap food society, and lack of alternative production practices.

The group specifically noted the following contributing factors to inappropriate use:

• lack of scientific data, especially on the impact of regular use of drugs;
  
  
• sub-therapeutic uses and the patterning of disease causing agents
  
  
• veterinarians needing information/education in order to make informed choices;
  
  
• DTCA from U. S. sources;
  
  
• availability of drugs/APIs through the Internet, other jurisdictions and personal importation
  
  
• the link between products and profitability, and
  
  
• part-time farming

Strategies to address the availability of antimicrobials suggested by the group included:

• closing the door on the own-use and API loopholes;
  
  
• allowing access via prescription only and solving the conflict of interest for veterinarians selling drugs;
  
  
• assigning DINs to drugs given to animals;
  
  
• generate agreements to limit cross-jurisdiction traffic within Canada;
  
  
• look at the Quebec model of restricting access;
  
  
• address internet sales (within Canada and from other countries) and involve the industry in any changes.
  
  
• increased enforcement on use and importation

The group felt it would be necessary to raise the issue through the political system, "get it on the agenda;" and have resources available to implement solutions. There was also a suggestion that agreements between jurisdictions should be generated to control the movement of drugs within Canada, e.g. requiring a prescription at the point of sale.

Regarding the need to increase awareness, the group suggested several solutions including:

• generating better (i.e. more practical) information and evaluation of drugs on a drug-by-drug basis to increase informed choices;
  
  
• creating practical tools for vets to use and to inform their own choices;
  
  
• undertaking education of consumers (and especially looking at the Ontario model of requiring users to take training and have a certification to purchase OTC drugs).

Other models that were noted by the group for further exploration include: Canadian On-Farm Food Safety Program; Groupe Qualité du MAPAQ (as a model of industry-government collaboration on identifying issues and making recommendations for policy development); and building on the work of the antimicrobial committee CCAR and the Advisory Committee.

It was suggested that national and regional committees of scientific experts be created. The role of the national committee of experts would be to gather and analyze data, then develop guidelines and best practices. The regional committees would analyze the national data and adapt it to regional realities. It was thought that the CVMA, provincial associations and veterinary colleges could disseminate the information.

Some also thought tighter regulations on advertising would help.

Participants generally believed it would be beneficial to:

• harmonize all jurisdictions' efforts across Canada;
  
  
• eliminate cross border traffic; removes access differences;
  
  
• synchronize regulations;
  
  
• prevent duplication on surveillance;
  
  
• ensure better use of government resources and ensure substantive change by all moving forward together.

Several drawbacks to harmonization were identified, particularly that it could be:

• challenging to do so;
  
  
• an unpopular move because it, might impact Canada's free market economy,
  
  
• detrimental to those provinces that have already put into solutions into effect; and
  
  
• be a slower process than acting alone.

The benefits of international harmonization were identified as contributing to trade relations and, again, making better use of govt resources. Drawbacks include:

• losing trading partners if we all move at different speeds;
  
  
• a negative impact on human health if progress is slowed; and
  
  
• a need to harmonize international surveillance data.

The consensus was that while we should be aware of international efforts, we should develop policy nationally.

The group recommended that the next steps on this aspect of the issue would be to:

• ensure that any proposed regulatory changes be taken up at Assistant Deputy Minister meetings;
  
  
• find central funding for research and initiatives;
  
  
• close the door on API first to ensure industry support; and
  
  
• develop an action plan with time lines.

Diane agreed that the next steps would be to lay out an initial action plan which would then be circulated to the group for comments.

Comments from the group included the need to:

• address all the other recommendations in the Report;
  
  
• develop some mechanism for sharing information/best practices; and
  
  
• better disseminate information to producers.

Diane committed VDD to act as a central coordinating point for information and requested that other jurisdictions send their input.

Table discussion #2: Alternatives to Antimicrobial Drugs in Food Animals, Research and Education Needs

The group discussed Alternatives to Antimicrobial Drugs in Food Animals, Research and Education Needs to identify strategies and steps to move forward. Several strategies were suggested including:

• identifying alternative substances and making producers aware of them;
  
  
• identifying practices to prevent illnesses;
  
  
• financial incentives (to veterinarians to encourage prevention and to producers to enrol in quality improvement programs);

The group felt it was important to:

• know the starting point (use patterns) before engaging in activities around alternatives. For instance, it would be useful to capture use data by region - if use is widespread, the group would recommend an education campaign; if the use is focused in one area, use a more targeted approach;
  
  
• identify practices for preventing illness, other than the use of antimicrobials, and make them part of good management practices used by producers;
  
  
• encourage industry involvement, especially in funding research;
  
  
• involve producer associations at the outset of any initiative;
  
  
• look at the Quebec model of providing alternatives to prescribing;
  
  
• conduct pilot projects, on-farm demonstrations, with good management practices;
  
  
• fast track review of alternative drug products;
  
  
• generate technology and information transfers to the producer level so they adopt alternatives;
  
  
• standardize data gathering and assessment;
  
  
• improve information-sharing;
  
  
• conduct clinical trials to legitimize the efficacy of natural health products, probiotics, etc.;
  
  
• develop a joint, federal-provincial "compelling story," based on research, and common messages, etc.;
  
  
• increase communications and develop a coordinated pool of resources and intellectual capacity.
  
  
• develop and share a data base on good management practices;
  
  
• provide long-term funding for surveillance and on-farm projects;
  
  
• tying AMR into Canadian On-Farm Food Safety Program (COFFSP); and
  
  
• creating a program for champion peers.

Surveillance of Antimicrobial Resistance in Food Animals

Dr. Rebecca Irwin, Ontario/Nunavut Region, Food Program Coordinator gave a presentation on the Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS ). The goals of CIPARS include providing an approach to monitor trends in the development of AMR; monitoring changes in minimum inhibitory concentrations; generating data; generating timely reports; and working with international partners (such as Denmark and the U. S.) to allow accurate comparisons. Several active studies are underway at CIPARS, including: a national abattoir study; a national retail study; studies on human Salmonella and antimicrobial use monitoring; and several voluntary pilot projects. The first annual CIPARS report is expected to be released in July, 2003.

Members of the group suggested that:

• Dr. Irwin might want to investigate the Canadian On-Farm Food Safety Program (COFFSP) which is doing baseline studies;
  
  
• consider that being on the AFP agenda might give CIPARS extra momentum; and
  
  
• that a policy decision will be needed at the provincial level to get this on the public health agenda.

Next steps

Diane noted that the group had discovered some commonality of issues and solutions today. The first priority for VDD will be to pull all the input together and report back to the group. The draft report will be circulated for comments before it is finalized. She noted that VDD is committed to engaging in a transparent process of deliberations.

It was requested that VDD generate a report that identifies the next steps as seen by VDD and that asks provinces and other government departments what they can commit to in concert with the federal government. In this way we can push the agenda and force the dialogue on specific issues.

It was noted that the Quebec working group on AMR is already underway and that it would be crucial to integrate their work with that of the federal government.

It was noted that there is still a need to address the rest of the recommendations in the Report.

Several participants commended Diane and her team on their progress to date on this issue. The group was appreciative of having been consulted. Participants felt it was important to continue to build on the momentum generated by Health Canada and continue to ensure this issue is on the agenda in each jurisdiction.

Conclusion

Diane thanked participants, saying that it had been a stimulating and informative discussion. She was encouraged by the level of interest in the subject area and the desire to work together to build on best practices. She closed the session by saying that she was looking forward to continuing to work with the participants on this important issue.