Why Canada didn’t get the new antibiotics we need…

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(MENAFN – The Conversation)

More than a quarter of infections in Canada do not go away when people are treated with standard antibiotics. This failure occurs due to a phenomenon called antimicrobial resistance (also called AMR), where bacteria and other microbes develop the ability to resist the effects of drugs designed to kill them.

Methicillin-resistant Staphylococcus aureus, a drug-resistant strain of bacteria that is a common cause of infections. (NIAID), CC BY

These drug-resistant microbes – colloquially referred to as “superbugs” – are becoming increasingly common. In 2019, the World Health Organization (WHO) declared antimicrobial resistance to be among the top 10 threats to global health. And while drug resistance has long been predicted to worsen over time, other research indicates the problem has accelerated during the COVID-19 pandemic.

As a microbiologist studying how to mitigate antimicrobial resistance, it keeps me awake at night.

Fortunately, there are ways to curb the spread of resistance. For example, ensuring the judicious and appropriate use of antimicrobial drugs, such as antibiotics, can go a long way — a principle called stewardship. One of the best ways to improve stewardship is to ensure our healthcare providers have access to the latest range of treatment options.

Unfortunately, many Canadian physicians do not have ready access to new antibiotics and must resort to prescribing older generic treatments that are increasingly ineffective due to resistance. This prescribing behavior can lead to even higher long-term resistance rates and can prolong infections in sick patients, with poorer health outcomes and higher costs to our healthcare system.

Canada lags behind its international counterparts

Although antimicrobial resistance is a global problem, it could soon become particularly serious in Canada. Today, several new antibiotics — drugs that germs have not yet learned to evade — have been approved for use in other countries, but are still not available to Canadian patients.

New research has found that of 18 new antibiotics approved and launched commercially in 14 high-income countries over the past 10 years, only two have been introduced in Canada – the fewest of any country on the list. For comparison, the same study showed that the US brought 17 new antibiotics to market over the same period, while the UK and Sweden were not far behind with 11 and 10. respectively.

So why is Canada so far behind its peers? Well, with colleagues at McMaster University and the Canadian Coalition for Antimicrobial Innovation, we’ve spent the last year trying to figure that out.

More than a quarter of infections in Canada do not resolve when people are treated with first-line antibiotics. (Pexels/Amornthep Srina)

We have learned that due to the cost of developing these drugs and their susceptibility to possible resistance, many pharmaceutical companies have abandoned antibiotic development.

Meanwhile, management principles ensure that new antibiotics are used only as a last resort, reducing sales volume and return on investment for companies that are still willing to bear development costs.

On top of that, manufacturers that still produce antibiotics tend to shy away from the Canadian market due to Canada’s small population, financial barriers in our publicly funded system, and cumbersome regulatory processes.

Potential solutions to a growing problem

We have worked collaboratively with Canadian and global experts in microbiology, industry, economics, policy and medicine to develop potential solutions. This work resulted in 30 key recommendations, which were formally submitted to Health Canada and the Public Health Agency of Canada at the end of 2021. Among these, we proposed that the Canadian government:

  • Accelerate and streamline the approval of certain antibiotics that have already been approved by the European Medicines Agency or the United States Food and Drug Administration.
  • Create specific funding streams to help Canadian hospitals purchase new antibiotics and associated diagnostics.
  • Establish national forecasts for antibiotics required by Canadian patients, including drugs not yet approved here.

We also called on the government to encourage pharmaceutical companies to bring their products to the Canadian market through an incentive model based on the true value of an antibiotic to the Canadian healthcare system, rather than the number of doses. that can be sold.

Several other countries are trying similar strategies to improve access. In 2020, Sweden began guaranteeing a minimum income to manufacturers in exchange for a guaranteed volume of antibiotics. In the same year, the UK began paying manufacturers an annual fee, completely de-linked from sales volume. In 2017, Germany began allowing new antibiotics to bypass its price reference process. And that’s just the short list.

Lessons from the COVID-19 pandemic
The early days of COVID-19 may have given us a glimpse of a future with antimicrobial resistance: an infectious disease without treatment. (Pixabay)

The early days of the pandemic provided a glimpse of what unchecked drug resistance could look like – an infectious disease without viable treatment options. However, it also showed how federal and provincial governments can coordinate to deal with a serious public health threat.

Just as our policymakers have worked together to get vaccines into the arms of Canadians, we implore them to find ways to get new antibiotics into our pharmacies.

Although antimicrobial resistance is a slower pandemic than COVID-19, it will have a massive impact on complex medical procedures that we now take for granted, such as joint replacements, cancer chemotherapy, or caring for premature babies. There is an urgent need to intensify our efforts to bring new antibiotic options to Canada to slow the development of resistance, save lives and reduce pressure on our health care system.

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