By: Andrew Morris and Bill Tholl
See original article published in the Ottawa Citizen here
Sept. 20, 2016 – Canadians visiting an ailing relative or friend in hospital now expect to see quarantine signs slapped on rooms or even entire wards. There are times when as many as 80 per cent of all beds in a facility are in exile because of an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) or some other nasty bug that has become difficult, or impossible, to treat in humans. This past year saw the emergence of E.coli strains that are resistant to the very last antibiotic available to treat such infections.
The Public Health Agency of Canada (PHAC) reports that at least 18,000 Canadians are hospitalized annually with drug-resistant infections. An unknown (untracked) number of those patients die every year. Our best guess is that anywhere between 3,000 and 3,500 Canadians die each year from drug-resistant infection and this can only be expected to grow.
The average human contains three times as many bacteria as cells in his or her body. Many are beneficial, helping us to digest foods and produce enzymes. But others aren’t, and while attacking the deadly ones with antibiotics, and particularly through the misuse and abuse of such drugs, we have encouraged whole new generations of bacteria to become ever-more immune to assault. This is a phenomenon known as antimicrobial resistance; with our help, bacteria are mutating into “superbugs” which are becoming more and more difficult to kill. So dire has the situation become that many experts warn that mankind stands poised on the precipice of an “antibiotic apocalypse” in which medicine is “plunged back into the dark ages.”
Some are responding to the challenge. Great Britain announced plans to develop quality standards for prescribing antibiotics and to begin reviewing all antibiotic prescribing by all doctors. Denmark, Norway, and the Netherlands have implemented strict regulation of medical and agricultural antibiotic use. The United States recently doubled outlays for antibiotic-resistance initiatives to U.S. $1.2 billion. Canada’s contributions to-date are but a rounding error of the U.S.’s contributions.
Unless solutions are found, run-of-the-mill surgeries, such as knee or hip replacements, as well as organ transplants, will become too risky to undertake. Chemotherapy and radiation will be too dangerous to administer to cancer patients. Burn units might as well shut their doors while dialysis machines are sent to the junkyard. It’s estimated that 10 million people around the world will die annually from infections by 2050 because we have lost the capacity to treat them, surpassing cancer mortality by a wide margin.
Canada’s response? The former Conservative government was disinclined to act, and essentially refused to move on inappropriate antibiotic use. PHAC has been ringing the alarm bell but, to-date, the present prime minister hasn’t given the green light to fund a comprehensive and sustainable action plan. Federal Health Minister Dr. Jane Philpott knows better, but needs the prime minister’s go-ahead.
While Canada awaits leadership from the top, it is falling further and further behind other developed nations in responding to a threat that England’s Chief Medical Officer, Dame Sally Davies, says is as grave as terrorism.
On Sept. 21, heads of governments from around the world will gather at the United Nations General Assembly in New York to refine a global response to the crisis. We need Canadian leaders to join the global battle by putting their political muscle into developing and implementing a Canadian action plan supported by the financial resources needed to properly tackle the many dimensions of the problem. Because right now, the superbugs are winning.
Dr. Andrew Morris is Director of the Antimicrobial Stewardship Program at Sinai Health System University Health Network, Professor of Medicine at the University of Toronto, and Chair of the Antimicrobial Stewardship and Resistance Committee, Association of Medical Microbiology and Infectious Diseases Canada. Bill Tholl is President and CEO of HealthCareCAN, the national voice of Canada’s hospitals and health care organizations.