Canada Takes One Health Approach to Antimicrobial Resistance

As the global public health community focuses its attention on the ongoing spread of avian influenza across North America — including the hospitalization of a critically ill teen in British Columbia — networks of Canadian researchers are working behind the scenes to address the dangers of drug-resistant microbes found among livestock, hospitals, and everyday environments.

In a report released on November 20, the Public Health Agency of Canada found 7 of the top 10 watchlist drug-resistant infections have increased in recent years, including typhoidal and non-typhoidal salmonella, invasive streptococcus strains, and certain staphylococcus strains. Infections linked to Clostridioides difficile, Mycobacterium tuberculosis, and methicillin-resistant Staphylococcus aureus at healthcare facilities are stable, but no infections on the watchlist appear to be decreasing.

Antimicrobial drugs remain the cornerstone of modern medicine for treating bacteria, viruses, fungi, and parasites. But decades of misuse and overuse have accelerated resistance, leading to hard-to-treat infections. Without new solutions, upward trends in drug-resistant infections could spell dire consequences for human health, livestock and animal health, environmental health, food safety, and healthcare systems worldwide.

“With increasing antimicrobial resistance (AMR), this means that we will run out of treatment options for common infections and go back to the pre-antibiotics era, where routine medical procedures or common infections can be deadly,” said Amy Lee, PhD, assistant professor of molecular biology and biochemistry at Simon Fraser University in Burnaby, British Columbia, Canada.

Lee and fellow researchers are working on new ways to identify severe bacterial infections in newborns and prevent sepsis. They are also part of a nationwide network of scientists focused on pandemic preparedness, which recently received funding from the federal government to develop vaccines against several highly resistant bacterial infections.

“The AMR crisis is a challenging problem that can only be tackled if we all work together,” Lee told Medscape Medical News. “We must work at the intersections of animals, humans, and the environment.”

A ‘One Health’ Approach

In September 2023, a Council of Canadian Academies expert panel released a report that found 26% of Canada’s 1 million bacterial infections reported in 2018 were resistant to first-line antibiotic treatments. By 2050, that will likely increase to 40%. Globally, AMR could lead to 10 million deaths each year.

“AMR is an incredibly complex problem that no single approach or solution can solve,” said Dao Nguyen, MD, associate professor of medicine in microbiology and immunology at McGill University and director of the McGill AMR Centre, Montreal, Quebec, Canada.

In Canada and the United States, antibiotic overprescription is most commonly associated with respiratory infections, Nguyen told Medscape Medical News. Worldwide, pneumonia is the leading cause of infectious deaths and most commonly associated with death due to AMR.

“Pneumonias highlight the challenges of not having adequate diagnostic tests to inform accurate and timely clinical decisions and to avoid unnecessary antibiotic use in some settings, but they also highlight the challenge of not having access to appropriate life-saving antibiotics in other settings,” she said. “These two realities reflect the complex, and at times competing, issues underlying the AMR problem.”

In 2023, Canada’s federal, provincial, and territorial ministers of health and agriculture released a Pan-Canadian Action Plan on Antimicrobial Resistance, providing a 5-year blueprint to address and accelerate a nationwide response.

A key component of the plan is One Health, an approach launched by the World Health Organization (WHO) in 2017 to incorporate human health, animal health, and the environments they share — and look at it from a global angle. That’s why McGill AMR Centre and similar groups across Canada incorporate researchers from multiple disciplines, looking at how primary care physicians diagnose infections, what types of infections are circulating among poultry and cattle, and how to develop new antimicrobial options.

“After several decades of complacency, our antibacterial drug development pipeline is inadequate and leaves us poorly equipped for the AMR crisis,” Nguyen said. “However, antimicrobial therapy is an arms race against microbes, which can always evolve to develop resistance. We also need to think outside the box to develop other complementary approaches for treating infectious diseases.”

Focusing at Home and Worldwide

The fight against AMR starts locally. In a recent study published in Implementation Science in September 2024, researchers in Ontario found that sending antibiotic audit and feedback reports to family physicians reduced antibiotic prescribing by 5%. Although the percentage seems small, that translates to a decrease of thousands of prescriptions across the province.

“Research shows that personalized, recurring feedback is much more effective in creating lasting change than generic or sporadic feedback,” said Jennifer Shuldiner, PhD, lead author of the study and a scientist at Women’s College Hospital in Toronto, Ontario, Canada.

“Audit and feedback programs are a low-cost, high-impact strategy that can significantly improve population health outcomes,” she said. “These strategies also provide physicians with the opportunity to reflect on their practices and identify areas for improvement.”

More scientists and public health experts are embracing this idea of “antimicrobial stewardship” — a system-wide approach to help healthcare professionals follow the latest evidence-based guidelines for prescribing antimicrobials.

“AMR doesn’t stop at borders. However, Canada is in the fortunate position to have the resources and expertise to contribute to the fight against AMR,” said Caroline Ritter, DVM, assistant professor of veterinary epidemiology at the University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada.

“Working together with experts in stewardship and human, animal, and environmental health is extremely important,” she said. “But I also think we need to include disciplines such as social sciences and implementation science so we can motivate and support people to adopt the recommended practices.”

Beyond the local level, though, one of the barriers in monitoring AMR hinges on limited data from low- and middle-income countries, as well as limited data on animal populations and the environment. To bridge the gaps, veterinary medicine specialists at the University of Calgary are collaborating with partners in the United Kingdom, Indonesia, and WHO to develop alternative data sources and boost global surveillance.

“I am keen to better understand the factors driving the spread of AMR across humans, animals, and the environment, which would inform the development of antimicrobial stewardship programs that balance effectiveness with practical implementation,” said Diego Nobrega, DVM, PhD, assistant professor of veterinary medicine at the University of Calgary, Calgary, Alberta, Canada, and a Canada Research Chair in Antimicrobial Resistance and One Health.

This fall, Nobrega, Lee, Nguyen, and Ritter participated in a University of Calgary seminar series focused on containing AMR with a One Health approach. The program is part of the Canadian Antimicrobial Resistance Network (CAN-AMR-Net), a training platform for healthcare practitioners focused on AMR.

“For fellow healthcare professionals, the key takeaway is that combating AMR requires a collective effort across disciplines,” Nobrega told Medscape Medical News. “Healthcare professionals should focus on the adoption of evidence-based antimicrobial use practices to preserve these life-saving tools for future generations.”

Carolyn Crist is a health and medical journalist who reports on the latest studies for Medscape Medical News, MDedge, and WebMD.