2023 Reports 5 to 9 of the Auditor General of Canada to the Parliament of Canada

Report 6—Antimicrobial Resistance

At a Glance

Overall, the federal government did not do enough to address the growing resistance to antimicrobial drugs, such as antibiotics, to help safeguard the health of Canadians. The World Health Organization ranks antimicrobial resistance in the top 10 global public health threats, and its effects on the health of Canadians are known. History shows—most recently with the COVID‑19 pandemic—that when it comes to health care, the cost of not being prepared is measured in lives lost.

Addressing antimicrobial resistance in Canada requires coordinated efforts from all levels of government and stakeholders. In June 2023, following the end of our audit period but before our report’s publication, the Public Health Agency of Canada released the Pan‑Canadian Action Plan on Antimicrobial Resistance. We found that the agency worked with the provinces and territories to develop the plan. However, the plan did not cover many important elements—such as concrete deliverables, timelines, and details about who is accountable for each action. Without these key elements, it is unlikely that the plan will result in meaningful actions and produce desired outcomes.

We also found that the Public Health Agency of Canada and Health Canada, who are responsible for improving Canada’s access to new antimicrobials, did not do enough to improve market access to new antimicrobial drugs available in other countries. Both organizations know that successfully encouraging companies to bring new antimicrobials to the Canadian market would require a combination of regulatory and economic incentives.

We found some progress since our last audit on antimicrobial resistance in 2015. For example, in our first audit, we identified that more data on antimicrobial resistance and use was needed to identify trends and support informed decision making. Since then, the Public Health Agency of Canada has improved its data collection. However, some gaps persist, especially around antimicrobial resistance in certain vulnerable populations and in the environment.

Health Canada—as the department responsible for evaluating and monitoring the safety, efficacy, and quality of antimicrobials for use in humans and animals—had strengthened its oversight by implementing regulatory and policy changes to preserve the effectiveness of antimicrobials. For example, the department now requires companies to report annually on the sales of medically important antimicrobials used in food animals. However, we found that the department had not assessed whether the changes it had implemented were working as intended to preserve the effectiveness of antimicrobials.

The Public Health Agency of Canada is responsible for collecting data on the United Nations’ Sustainable Development Goal 3 (Good Health and Well-Being) indicator pertaining to the “percentage of bloodstream infections due to selected antimicrobial resistant organisms.”

Visit our Sustainable Development page to learn more about sustainable development and the Office of the Auditor General of CanadaOAG.

Exhibit highlights

The One Health approach recognizes the interrelationship of humans, animals, and the environment in antimicrobial resistance

Source: Adapted from Tackling Antimicrobial Resistance and Antimicrobial Use: A Pan‑Canadian Framework for Action, Public Health Agency of Canada, 2017

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This image shows the interrelationship of humans, animals, and the environment in antimicrobial resistance, which is recognized by the One Health approach.

Antimicrobial resistance is spread among animals, among humans, and in the environment, including through contaminated water and fertilizer. It is then spread between animals and humans, including through food, and spread between humans, animals, and the environment.

Approximately two thirds of funds spent recently by all 4 federal organizations for antimicrobial-resistance activities examined as part of this audit were from non‑dedicated funding (existing budgets)

Source: Based on estimates from the Public Health Agency of Canada, Health Canada, the Canadian Food Inspection Agency, and Agriculture and Agri‑Food Canada

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This chart shows the types of funding used by all 4 federal organizations for antimicrobial-resistance activities examined as part of this audit in the 2021–22 and 2022–23 fiscal years.

The 3 types of funding spent were non-dedicated funding from existing budgets, dedicated funding for research, and dedicated funding from Budget 2021. Dedicated funding is targeted for antimicrobial-resistance activities from the Government of Canada.

In the 2021–22 fiscal year, the 4 organizations spent $3,670,000 from existing budgets (68%), $1,730,000 of research funding (32%), and $38,000 from Budget 2021 (1%) on antimicrobial-resistance activities.

In the 2022–23 fiscal year, they spent $7,670,000 from existing budgets (65%), $1,550,000 of research funding (13%), and $2,580,000 from Budget 2021 (22%) on antimicrobial-resistance activities.

Canada’s access to 13 new antibiotics of last resort lagged behind many other countries as of 2020

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This chart compares Canada’s access to new antibiotics of last resort with 6 other countries’ access to these antibiotics. These are “novel” antibiotics that have been made commercially available since 2010. “Novel” antibiotics treat bacterial infections differently than previously available drugs did.

As of 2020, the United States had access to 13 new antibiotics.

The United Kingdom had access to 8 new antibiotics.

Sweden had access to 8 new antibiotics.

France had access to 6 new antibiotics.

Italy had access to 5 new antibiotics.

Japan had access to 2 new antibiotics.

In 2020, Canada had access to 1 new antibiotic but obtained market access to another antibiotic in 2021, which was outside the scope of the study. (Source: Drug Product Database, Health Canada)