Canada is facing a silent pandemic of antimicrobial resistance (AMR)—part of a crisis that the World Health Organization has declared a top-10 global public health threat.

In 2018, Canada reported around 1 million bacterial infections, about 25% of which show resistance to first-line treatments, leading to 5,400 fatalities. The Council of Canadian Academies projects that by 2050 the resistance rate could rise to 40%, with annual deaths reaching 13,700.

Although Canada’s AMR mortality rate is low relative to that of other American countries, bacterial diseases such as tuberculosis and methicillin-resistant Staphylococcus aureus (MRSA) are up to 10 times more common among Indigenous populations. Indigenous people in Canada generally have poorer health, attributable to decades of underfunded health systems and structural health and disease drivers, including settler colonialism. As a nation striving for global leadership in health and reconciliation with Indigenous communities, Canada must strengthen its efforts to address their unique needs and disproportionate health outcomes.

To improve its AMR response, Canada should expand the number of accessible “last-resort” antibiotics—used to treat infections where other antibiotics have failed—from two to eight. Officials should also emphasize public education, including culturally appropriate information and training for Indigenous communities.

A public opinion survey conducted in Canada between 2019 and 2022 found that only 25% of Canadians are familiar with the term antimicrobial resistance, and that 33% incorrectly believed that antibiotics kill viruses. The government acknowledges this disturbing statistic, emphasizing that public education is a significant barrier to Canada’s becoming a frontrunner in AMR prevention.

AMR in Canada

AMR occurs when microorganisms such as bacteria, viruses, fungi, and parasites undergo mutations, making them unresponsive to the antimicrobial drugs designed to prevent and treat infections in humans, animals, and plants. Infections become difficult or impossible to manage, increasing the risk of disease spread, severe illness, disability, and death. Antibiotics are crucial for modern medicine, and AMR threatens the ability perform life-saving treatments and surgeries such as cancer chemotherapy, cesarean sections, hip replacements, and organ transplants.

Although AMR affects all countries, the specific illnesses and diseases differ from country to country. In Bolivia, Haiti, and Peru, for example, the greatest AMR burden involves infectious deaths such as pneumonia, sepsis, and meningitis. In Canada, concerning diseases include bacterial pneumonia, MRSA, and tuberculosis.

Bacterial Infections Rise in Canada

Of the four pathogens Canada prioritizes, two are infecting more people as antimicrobial resistance grows

The Auditor General of Canada criticized the federal government’s efforts to curb growing resistance to antimicrobial drugs as inadequate. Even though concentrated efforts have decreased antimicrobial use in humans by 5% in recent years, concerns remain: Antibiotic prescriptions for those older than 80 have increased by 13%, use of carbapenems—the most broad spectrum antibiotics—has increased by 68%, and the per capita consumption of “last-resort” antimicrobials has increased by 2%.

Canada’s AMR Action Plan

Currently, Canada is addressing its AMR burden with its five-year Pan-Canadian AMR Action Plan, which focuses on five pillars: research and innovation, surveillance, stewardship, infection prevention and control, and leadership.

Canada’s approach to addressing the needs of Indigenous populations in combating AMR is designed to be culturally responsive and community driven. Recognizing the current gaps in knowledge regarding AMR’s drivers and impacts within Indigenous populations, the Canadian government has committed to identifying the specific priorities of First Nations, Inuit, and Métis peoples. This effort includes developing and implementing policies, strategies, programs, and services that not only are effective but also respect Indigenous cultures and practices.

The government also acknowledges the importance of addressing the broader structural health disparities that contribute to the AMR burden in Indigenous populations. This includes recognizing the ongoing impacts of settler colonialism and ensuring that Indigenous healing practices and existing community expertise are valued and integrated into the national AMR response.

Canada’s approach to addressing the needs of Indigenous populations in combating AMR is designed to be culturally responsive and community driven

Canada also plans to invest in health care and patient education, tailored to Indigenous populations, to raise awareness about the dangers of AMR and the importance of responsible antibiotic use. Building data infrastructure is another priority because it will support both surveillance efforts and the development of guidelines for appropriate prescribing within Indigenous communities.

One critical aspect of the plan is the enhancement of surveillance systems in rural and remote regions, where data collection has traditionally been limited. These regions face a disproportionate burden from communicable diseases such as tuberculosis and MRSA. By improving surveillance, Canada can better monitor and address these diseases, ensuring that Indigenous communities receive the attention and resources they need.

In addition to surveillance is a pressing need to evaluate the current antibiotic prescription practices in First Nations communities. Antibiotics are often prescribed by nurses without physician consultation, a practice that may contribute to inappropriate use and the escalation of AMR. Addressing this issue requires targeted interventions, including Indigenous-led antimicrobial stewardship programs that promote appropriate prescribing practices.

When compared with that of other global leaders in AMR programs, such as Sweden and the United Kingdom, which have focused heavily on public education, Canada’s approach demonstrates gaps in the need for culturally tailored and community-specific interventions. By aligning its AMR strategies with the needs and values of Indigenous peoples, Canada can build a more inclusive and effective response to this growing public health challenge.

Dancers take part in the grand entry of the 43rd annual Kamloopa Powwow. — Dancers take part in the grand entry of the forty-third annual Kamloopa Powwow, in Kamloops, British Columbia, Canada, on June 28, 2024. REUTERS/Marissa Tiel

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Johanne Lisa Jensen-LeBlanc

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Centering Indigenous Groups in Canada's Antimicrobial Resistance Plan

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