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Report predicts drug resistance will likely kill 400,000 Canadians by 2050

VANCOUVER – Superbugs are likely to kill nearly 400,000 Canadians and cost the economy about $ 400 billion in gross domestic product over the next 30 years, a historic report warns.

A panel of experts warns, "When antibiotics fail: the rising cost of antimicrobial resistance in Canada" that the percentage of treatment-resistant bacterial infections is likely to rise from 26 percent in 2018 to 40 percent by 2050.

That increase is expected to cost Canada 396,000 lives, $ 120 billion in hospital expenses and $ 388 billion in gross domestic product over the next three decades.

"This is almost as big, if not bigger, than climate change in a sense, because it directly affects people. The numbers are staggering," says Brett Finlay, professor of microbiology at the University of British Columbia who chaired the panel, in interview. . "It's time to do something now."

The Canadian Public Health Agency commissioned the report on the socioeconomic impacts of antimicrobial resistance and the Canadian Academies Council convened the independent panel. The 268-page document released Tuesday represents the most comprehensive picture yet of the country's resistance rate, as well as its costs to the health care system and the economy.

Antimicrobial resistance occurs when microorganisms, including bacteria, viruses, and fungi, evolve to resist drugs that would otherwise kill them. The unnecessary use of antimicrobials in humans and agriculture aggravates the problem and travel and widespread international trade help resistant bacteria spread around the world.

The most common antimicrobials are antibiotics, which treat infections caused by bacteria. The report focuses on resistant bacteria, but uses the broader term antimicrobial, because surveillance data tends to be collected under this heading.

A Canadian Press investigation last year revealed that Canada has been slow to act against the growing threat. At the time, the federal government did not know how many Canadians were dying of resistant infections and had not worked out a plan that would establish responsibility for provinces and territories.

A pan-Canadian action plan has not yet materialized, but the new report estimates an annual death toll in Canada. The panel used the current 26% resistance rate to calculate that resistant infections contributed to over 14,000 deaths in 2018, and of these, 5,400 were directly attributable to infections – just slightly less than those caused by Alzheimer's disease.

The panel's economists used a more cautious model to project the impacts than a well-known international report by British economist Jim O'Neill, which predicted up to 10 million global deaths annually by 2050.

The findings of the Canadian report on the economic and social cost of antimicrobial resistance are strong. Currently, the problem costs the national health system $ 1.4 billion a year, and by 2050 that number is expected to grow to $ 7.6 billion, the report says. The cost to GDP is expected to jump from $ 2 billion to $ 21 billion annually.

Resistant infections decrease quality of life and increase isolation and stigma, and the impact will be unevenly distributed, as some socioeconomic groups are at greater risk, the report adds. These groups include indigenous, low-income, homeless people, as well as those traveling to developing countries where resistant microbes are most common.

"Discrimination can be directed toward those with resistant infections or those at risk of infection," the report warns. "Canadian society can become less open and confident, with people less likely to travel and more likely to close Canada's borders to migration and tourists."

Antimicrobial resistance has the potential to impact everyone, says Finlay.

"It will change the world," he says. "We all go to hospitals and we all have infections."

The report notes that resistance may increase risk and reduce the availability of routine medical procedures, including renal dialysis, joint replacement, chemotherapy, and caesarean section. All of these procedures pose a threat of infections for which antibiotics are commonly prescribed.

Limiting the impacts of antimicrobial resistance requires a "complete reevaluation" of health care in Canada, the report concludes.

The panel states that Canada does not have an effective federal, provincial and territorial surveillance system for antimicrobial resistance and use, with little comprehensive data describing the number of resistant infections and their characteristics.

It also requires improved administration, involving the careful use of antimicrobials to preserve their effectiveness, rigorous prevention and control of infections through hand hygiene, equipment cleaning, and research and innovation for new treatments.

The report notes that new broad-spectrum antimicrobials are unlikely to be discovered. None have been found in decades and there is little profit incentive for pharmaceutical companies to invest in drugs that quickly cure patients. However, the panel calls for more flexible regulations and incentives to promote the discovery of new antimicrobials that treat infections caused by specific bacteria.

Alternative therapies are also being developed to treat or prevent resistant infections, including vaccines and treatments using phages, which are viruses that attack bacteria, the report adds.

Canada should immediately invest $ 120 million in research and innovation and up to $ 150 million in administration, education and infection control, accompanied by provinces and territories, says Dr. John Conly, panelist and professor at the University of Calgary. specializing in chronic diseases.

Government and the public must "absolutely" be as concerned about antimicrobial resistance as they are about climate change, says Conly.

"It's a slow tsunami. Like a wave, it's at sea, but it will land on us much sooner than climate change."

This report from The Canadian Press was first published on November 12, 2019.

Laura Kane, Canadian Press

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