When a patient in a Canadian intensive care unit develops a bacterial infection that defies standard frontline medication, the attending physician does not simply walk to the hospital pharmacy. If the infection resists first- and second-line drugs, the specialist must turn to third- or fourth-line antimicrobial therapies that are routinely unavailable within Canadian borders. On December 2, 2025, infectious disease specialist Dr. Terry Wuerz told the House of Commons Standing Committee on Health that obtaining those therapies forces clinicians into an administrative maze of paper forms, phone calls, and faxes to Health Canada’s Special Access Program. Getting a single unapproved antibiotic released can take up to three weeks, during which a bloodstream infection moves in hours.
The testimony was part of a five-meeting investigation into antimicrobial resistance tabled in Parliament in October 2026 under the title Antimicrobial Resistance: Confronting a Silent Pandemic. Chaired by Sukh Dhaliwal, the committee examined why Canada has become an international outlier in accessing novel antimicrobial therapies. Between 2010 and 2021, eighteen new antibiotics were launched globally to counter drug-resistant superbugs. Canada secured commercial access to exactly three.
The consequences of that market absence are neither hypothetical nor distant. In 2018, drug-resistant infections directly caused an estimated 5,400 Canadian deaths, drained $1.4 billion from provincial healthcare budgets, and reduced national gross domestic product by $2 billion. Drawing on research from the Council of Canadian Academies, witness after witness warned lawmakers that 26 percent of Canadian infections were resistant to first-line antibiotics in 2018, a proportion projected to reach 40 percent by 2050. Without structural intervention, resistant pathogens are on track to claim nearly 400,000 Canadian lives and inflict hundreds of billions of dollars in economic damage over the next three decades.
Yet as the committee’s 46-page report reveals, Canada’s federal apparatus has largely met this escalating threat with procedural coordination rather than enforceable mandates or dedicated fiscal resources. The federal government released its much-heralded Pan-Canadian Action Plan on Antimicrobial Resistance in June 2023. More than three years later, the parliamentary committee found that the initiative still lacked binding timelines, measurable health outcomes, and a dedicated federal budget line to implement them.
The Special Access Maze
Under the Food and Drugs Act and its accompanying regulations, the Special Access Program allows healthcare practitioners to request non-marketed drugs for patients facing serious or life-threatening conditions when conventional therapies fail or are unsuitable. For novel antibiotics, however, what was designed as an exceptional regulatory relief valve has turned into routine operational triage.
Clinicians testified that the program remains chained to manual, mid-century bureaucracy. Dr. Sameer Elsayed, an infectious disease physician at Western University, explained to MPs that the system relies on manual document transmissions that divert precious clinical hours away from patient stabilization. A specialist facing an intractable pathogen must draft individualized justifications, navigate federal fax queues, coordinate cross-border logistics, and arrange for international shipping costs often borne by hospital operating budgets. For patients suffering from septic shock or rapidly advancing necrotizing soft-tissue infections, a three-week delivery window is not a delay. It is a clinical dead end.
The committee heard that pharmaceutical manufacturers routinely bypass Health Canada when launching new antimicrobial molecules. Canada represents less than two percent of the global pharmaceutical market. Because effective antibiotics must be used sparingly to prevent pathogens from developing resistance, sales volumes are intentionally low. Under traditional fee-for-service and volume-based pricing models, pharmaceutical developers face substantial Canadian regulatory filing fees and post-market compliance costs that exceed their projected revenues. Without federal pull incentives, such as subscription-style market entry models that pay developers a predictable annual fee regardless of how many doses are consumed, manufacturers simply decline to submit their drugs for Canadian review.
In Recommendation 7, the committee called on the federal government to overhaul the Special Access Program, strip away administrative hurdles, and replace paper and fax workflows with a modern digital portal. But as witnesses repeatedly emphasized, expediting emergency imports treats the symptom while leaving the systemic market failure untouched.
An Action Plan Without a Ledger
When public health officials appeared before the committee, they pointed to decades of foundational groundwork. Nancy Hamzawi, president of the Public Health Agency of Canada, testified that the country has built twenty years of integrated antimicrobial surveillance experience. The centerpiece of that apparatus, the Canadian Antimicrobial Resistance Surveillance System, pulls together data from ten federal tracking networks across human health, agriculture, and the natural environment.
Yet when lawmakers pressed on how those surveillance streams translate into concrete prevention, the limits of federal authority became obvious. Healthcare delivery, hospital infection control budgets, and physician prescribing practices fall squarely under provincial and territorial jurisdiction. The federal government can coordinate, analyze, and publish guidelines, but it cannot order a regional health authority to hire additional infection control nurses or force a hospital to deploy rapid molecular diagnostic tests.
That jurisdictional divide has left the Pan-Canadian Action Plan adrift. Witnesses described the June 2023 document as an essential statement of principles that remains entirely aspirational in execution. The plan established five broad pillars: research and innovation, surveillance, stewardship, infection prevention and control, and leadership. However, Ottawa never established a dedicated funding transfer to back the plan, nor did it assign an executive official with statutory authority to hold federal departments and provinces accountable for milestones.
In its primary finding, the committee recommended that the federal government collaborate with provincial and territorial counterparts to set measurable targets and binding timelines, ensure the action plan receives dedicated funding, and immediately appoint a national coordinator for antimicrobial resistance. Without an executive coordinator, MPs concluded, multi-jurisdictional initiatives inevitably dissolve into working groups that monitor decline without the operational leverage to reverse it.
Gaps in the Ward and the Stockpile
The operational friction documented in the report extends far beyond hospital pharmacies. Witnesses testified that basic infection prevention and control programs in community hospitals, rural care centers, and long-term care homes are cracking under chronic staffing shortages. Kevin Stinson, representing Infection Prevention and Control Canada, told the committee that acute resource constraints in frontline facilities regularly push healthcare workers to take shortcuts on core safety protocols, including routine hand hygiene and personal protective equipment standards.
The federal backup system designed to protect against supply disruptions showed its own deep vulnerabilities. During the COVID-19 pandemic, the Public Health Agency of Canada rushed to acquire emergency supplies for the National Emergency Strategic Stockpile. Witnesses informed the committee that large volumes of imported isolation gowns procured during the emergency were substandard, highly flammable, and ultimately expired sitting unused in federal storage.
Scot Magnish, representing the Association of Canadian Medical Device Manufacturers, testified that Ottawa’s emergency procurements repeatedly bypassed domestic producers who adhered to strict safety certifications and labour standards, purchasing cheap foreign goods that posed flammability risks. Public Health Agency officials conceded that expired equipment is routinely purged and that medical gloves in the federal stockpile still originate entirely from manufacturers in China and Malaysia, with the federal stockpile serving merely as a backstop for provincial inventories. In Recommendation 5, the committee urged Ottawa to prioritize Canadian manufacturing and enforce strict safety and ethical labour compliance in all future stockpile contracts.
At the same time, Canadian veterinarians and agricultural researchers warned of systemic surveillance blind spots outside the hospital sector. While Canada has restricted the preventative use of human-class antibiotics in livestock, witnesses noted that antimicrobials continue to be administered across agriculture for economic growth promotion. Data collection on antimicrobial use in food animals and long-term care settings remains fractured, leaving public health authorities without an integrated baseline to track resistant strains before they spill into the general population.
The Cost of Inaction
The structural picture that emerges from the committee’s inquiry is one of institutional stall. In 1945, when penicillin entered mass production, bacterial pneumonia, wound infections, and post-surgical sepsis ceased to be automatic death sentences. Modern organ transplantation, cancer chemotherapy, joint replacements, and neonatal intensive care all rest on the foundational assumption that clinicians can suppress bacterial infection at will.
The evidence presented to Parliament confirms that assumption is eroding. When Canadian physicians are forced to spend weeks petitioning federal regulators for third-line therapies that other peer nations approve as a matter of routine, the health security framework is already failing. The recommendations tabled by Sukh Dhaliwal’s committee do not call for exotic regulatory powers. They ask for basic institutional mechanics: an accountable coordinator, dedicated funding allocations, an online import registry, and financial pull mechanisms that bring novel life-saving antibiotics into Canadian hospitals before the patient in the intensive care unit runs out of time.
We spent hours pulling through committee evidence, sessional papers, and Health Canada’s Special Access registries to unpack why Canada is falling behind on life-saving antimicrobial therapies.
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Source Documents
House of Commons, Standing Committee on Health. (2026, October). Antimicrobial Resistance: Confronting a Silent Pandemic (Sixth Report, 45th Parliament, 1st Session; Catalogue No. XC62-1/1-451-6E-PDF). Ottawa: King’s Printer for Canada.