Innovation pilot to improve access to antimicrobials in Canada
Learn about the need for new antimicrobials to fight infections and how we're addressing antimicrobial resistance. Also learn about our work to make more antimicrobials available in Canada.
On this page
- Why Canada needs new antimicrobial drugs
- How we're addressing antimicrobial resistance
- What is the antimicrobial innovation pilot
- How we developed the innovation pilot
- Next steps for advancing the innovation pilot
- Stay informed
Why Canada needs new antimicrobial drugs
Antimicrobials (antibiotics, antifungals, antivirals and antiparasitics) are life-saving and essential to modern health care.
Antimicrobial resistance (AMR) occurs when microbes evolve in ways that reduce the effectiveness of the medications used to fight infections. When resistance to antimicrobials increases, it becomes more difficult to treat common and minor infections successfully. When an infection can't be treated effectively with an antimicrobial drug, the risk of severe illness, even death, increases.
AMR was first observed soon after the first antibiotic was introduced. Since then, the overuse and misuse of antimicrobials have accelerated resistance. At the same time, not enough new drugs are being introduced to keep up with the growing spread of resistance.
AMR is a global problem and countries around the world are working together to mitigate and respond to its impacts. Here, in Canada, AMR is a serious and growing threat. In 2018 alone, it was estimated that AMR contributed to about 5,400 deaths.
Current efforts to develop new antimicrobials are not sufficient to address the health care needs in Canada and around the world.
One reason is that the cost to develop and market antimicrobials is usually far greater than the return on investment for drug companies. This is a challenge for countries with smaller populations, like Canada, as the size of the market limits potential revenues.
Another reason is that these drugs are often priced lower than other medications, which means sales revenues are low.
Also, antimicrobial drugs are used carefully and only when needed to help them keep working, protect patients and slow the spread of drug-resistant infections.
The time and cost required to bring a product to market in any country are key considerations for companies seeking regulatory approval. In Canada, the small population size and complex health care system further limit potential returns, making market entry even more difficult.
Additional challenges also impact Canada's antimicrobial drug ecosystem:
- Drug valuation process
- added value of a new antimicrobial drug compared to existing treatment options, and how to assess that value
- Pricing evaluation
- price controls that can limit returns on investment in research and development
- Listing on public formularies
- each province and territory determines which drugs they will cover under their own public drug plans
- Complex distribution and supply chains
- driven by Canada's large geography and different jurisdictional requirements
- Labelling requirements
- specific requirements (such as bilingual labelling)
Because of these challenges, fewer than half (8 out of 23) of the antimicrobial drugs developed worldwide since 2010 are available to patients in Canada.
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How we're addressing antimicrobial resistance
The Government of Canada is committed to addressing AMR and securing access to new effective antimicrobials.
In the Minister of Health's 2021 mandate letter, the government issued a clear call to work with partners to take increased and quick action to:
- monitor, prevent and mitigate the serious and growing threat of antimicrobial resistance and
- preserve the effectiveness of the antimicrobials that people in Canada rely on every day
In response, the Public Health Agency of Canada (PHAC) worked with federal, provincial and territorial partners to develop an action plan on AMR. The 5-year Pan-Canadian Action Plan on AMR (2023 to 2027) sets out a coordinated, multisectoral and multijurisdictional approach to addressing AMR in Canada.
The plan identifies 10 priority actions under the following 5 pillars:
- Research and innovation
- Surveillance
- Stewardship (antimicrobial management)
- Infection prevention and control
- Leadership
These pillars guide Canada's goal to mitigate the impacts of AMR and strengthen access to new antimicrobial drugs.
In Budget 2023, the government committed to developing a pilot project to help secure access to new antimicrobials for people in Canada.
PHAC is leading this initiative, with support from Health Canada and the Privy Council Office's Impact Canada. We're consulting with provincial and territorial partners, industry and international stakeholders and health professionals, including clinical experts.
Learn more:
- Minister of Health mandate letter
- Best Brains Exchange summary report
- Pan-Canadian Action Plan on Antimicrobial Resistance
What is the antimicrobial pilot project
The Antimicrobial Economic Pull Incentives Pilot Project (AMR Innovation Pilot) is a time-limited, first-of-its-kind approach in Canada. It was originally planned to run from 2024 to 2027, but the timeline has been revised to run from 2026 to 2029. The AMR Innovation Pilot has been designed to introduce innovative, outcomes-based financing mechanisms to address the market challenges that limit the availability of new antimicrobial drugs.
The AMR Innovation Pilot uses targeted economic incentives to help improve access to antimicrobial drugs that meet priority and unmet public health needs for people in Canada. The incentives include supports that are intended to make the marketplace more attractive for companies responsible for antimicrobial drugs. The AMR Innovation Pilot also aims to encourage antimicrobial stewardship practices.
International context
Canada is part of a small group of countries advancing innovative economic incentives approaches to address antimicrobial resistance and improve access to critical life-saving treatments.
Those countries include:
- United Kingdom:
- subscription-style payment models for antimicrobial drugs
- new evaluation and procurement approaches
- Sweden:
- targeted funding to make priority antimicrobial drugs available to citizens
- Japan:
- a securement support program as part of its national AMR action plan
- Italy:
- a national public funding model for priority antimicrobial drugs
Global AMR Research and Development Hub
The Global AMR Research and Development (R&D) Hub was established in 2018 following a mandate from the G20 to strengthen international cooperation on AMR R&D. The hub is a multilateral platform that tracks and analyzes global AMR R&D investments and initiatives. It is helping to identify gaps, avoid duplication and align efforts to accelerate the development of new antimicrobial solutions. There is also a publicly available dashboard, where countries can share information on antimicrobial pull incentive initiatives.
As an active participant in this platform, Canada:
- shares information and coordinates efforts with other countries
- draws on lessons from these models to tailor our approach to our health system and market
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How we developed the innovation pilot
For the first phase of the AMR Innovation Pilot, PHAC:
- gathered evidence and expert advice
- engaged with partners
- identified priority needs
In 2022, we commissioned the Council of Canadian Academies (CCA) to review incentive models that could encourage the entry of new antimicrobial drugs into Canada. This included considerations from a panel of domestic and international experts on approaches that could be successful in Canada.
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We consulted with a range of partners, such as:
- industry stakeholders
- provinces and territories
- clinicians and pharmacists
- Canadian and international public health and policy experts
Identifying priority needs
In 2023, we collaborated with clinicians and pharmacists to identify priority pathogens of greatest concern based on public health risk and antimicrobial needs.
The following priority pathogens were identified by health professionals:
- Enterobacteriaceae
- Pseudomonas aeruginosa
- Staphylococcus aureus
- Neisseria gonorrhoeae
- Acinetobacter baumannii
These priority pathogens are aligned with:
- Canada's Priority AMR Pathogen List
- Health Canada's Pathogens of Interest List
- World Health Organization's Priority Pathogens List
- International antimicrobial economic incentives initiatives
Next steps for advancing the innovation pilot
The AMR Innovation Pilot represents a first-of-its-kind approach in Canada. Advancing this work within existing federal frameworks while ensuring rigour, accountability and alignment with other international economic incentive models required additional design time. It is important that the AMR Innovation Pilot is built on a strong and sustainable foundation, with the aim to:
- improve access to priority antimicrobial drugs not currently marketed in Canada
- encourage market entry in Canada by providing incentives that align with public health needs
- support measurable outcomes through clear performance expectations and reporting requirements
Collaboration with the Privy Council Office's Impact Canada
To enable an outcomes-based financing approach, PHAC is working in partnership with Impact Canada, which is housed within the Impact and Innovation Unit of the Privy Council Office.
Impact Canada has expertise in designing and delivering initiatives focused on measurable results. It uses dedicated authorities and a structured methodology to:
- design and deliver innovative programs
- support outcomes-based financing models
- apply rigorous performance measurement
- engage strategically with partners and stakeholders
Since 2017, Impact Canada has delivered 29 initiatives across the Government of Canada, demonstrating strong results for both innovators and government partners.
This collaboration enables PHAC to apply a proven model to the AMR Innovation Pilot, including the development of funding and payment mechanisms that support meaningful, outcome-driven results.
We're working with Impact Canada to finalize the design and delivery of the AMR Innovation Pilot. As part of this process, we will consult with stakeholders before finalizing the design elements.
We anticipate that the AMR Innovation Pilot solicitation process, will launch in late fall 2026, with details on the funding to be announced in the coming months.
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Stay informed
For more information, including upcoming consultations, ways to participate, timelines and program updates, visit the AMR Pilot Project page.
We encourage stakeholders to monitor this page for ongoing updates as the initiative progresses.