The discovery and development of antimicrobials ― chemical agents that inhibit the growth of, or kill, microorganisms ― has been hailed as one of society’s great technical achievements. Antimicrobials have transformed modern medicine, veterinary care, and agricultural practices. Thanks to their introduction, previously incurable infections became treatable, and routine medical interventions such as organ transplants and chemotherapy became possible, as did surgeries such as joint replacements and caesarian sections.
Yet even Alexander Fleming, who discovered penicillin in 1928, cautioned about the inevitability of antimicrobial resistance (AMR). Pathogens naturally evolve resistance to antimicrobials, but this process is increased by the inappropriate overuse of these drugs. As Fleming predicted, antimicrobial effectiveness has declined over time. Recent reports suggest that absolute numbers of infections due to resistant microbes are increasing. This increase occurs for two reasons: the evolution and spread of resistance within and between pathogens to frequently used drugs, and a lack of development of new antimicrobials. The OECD estimates that 50% of infections in G7 countries are resistant to routinely used antimicrobials, and that patients with resistant infections have two to three times higher mortality and risks of complications. Worldwide, AMR causes over 700,000 deaths annually.
AMR will profoundly affect the way we live, how our health is managed, and our general quality of life. As resistance rates increase, bacterial infections will be harder to treat, and the routine surgeries and interventions that people have come to expect and rely on may be too risky to undertake. Cancer patients, those with compromised immune systems, the elderly, and the very young will be especially vulnerable to infection, bearing a greater burden of increased morbidity and mortality.
Economic impacts will stem from AMR, as resistant infections will remove people from the workplace, decreasing the labour force and ultimately impacting GDP. It is estimated that AMR may reduce global GDP by around 3.5% between today and 2050 as morbidity and mortality increase.
These projections are disturbing on their own, but they may not capture the full social and economic impact in any one country, let alone globally. Gaps in the surveillance of resistant infections make it difficult to estimate the current impacts of AMR. In Canada, there are additional challenges in tracking and managing AMR because of the division of healthcare surveillance and provision between the federal and provincial/territorial governments. Recognizing the broad potential impacts of this growing threat, the federal government asked the CCA to assess the socio-economic impact of AMR. To address this issue, the CCA has assembled a multidisciplinary panel of 13 experts from Canada and abroad, chaired by Dr. B. Brett Finlay, O.C., O.B.C., FRSC, FCAHS, Peter Wall Distinguished Professor at the University of British Columbia.
Our assessment will review the evidence on how resistance may impact the Canadian economy, its effects on different social and patient groups, and on resultant changes to healthcare provision and quality of life for the Canadian population as a whole. The Panel is developing a model that will simulate the effect of AMR on Canadian GDP by modelling changes to the labour force.
As with every CCA assessment, this report will focus on assessing the available evidence to inform decisions. We hope our work on AMR provides a solid base for policy discussion, and public conversation. By understanding the potential impact of AMR, Canada may be better prepared to address its consequences.
Stay tuned: CCA’s report will be out in 2019. You can pre-order a copy on our website.
Eric M. Meslin, PhD, FCAHS
President and CEO, Council of Canadian Academies