So to round out today, we're really excited to have Rupina Priyawal with us
to lead a live podcast to introduce AMR Aware.
So Rupina is a pediatric infectious disease physician and
assistant professor at the University of Saskatchewan.
She's actively involved in national trials and
retrospective chart reviews, public health collaborations for syphilis outbreaks.
And spends the rest of her time in education as the pediatric undergraduate
medical education program director.
Dr. Priyawal is also the founder, host, and
producer of a Canadian infectious disease podcast, the Canadian Breakpoint,
which was established in November 2021.
The podcast has growing listenership with over 6,000 unique downloads to date
from listeners in Canada, the US, the UK, India, and Australia.
The podcast is designed to create awareness of increasing AMR and
our fight against it.
To focus on discussions around new diagnostic methods,
how to implement new technologies in lab and clinical medicine, and
to review emerging infectious diseases.
We're really excited to have Rupina here to talk to Brad on stage as part of
a live podcast today, so welcome Rupina.
All right, thank you everyone.
I really appreciate everyone staying for the segment,
even though it's one of the last ones.
And I'm really excited because this is the first time that we're doing a live
podcast, so I'm really grateful to Bayamir and Kaja and
Elizabeth for helping me arrange this, so thank you so much.
And then I do want to give a shout out to my producer and
marketing advisor, Summer Stewart, who's been helpful.
So as I don't think I need to give more of an introduction to Brad,
because Brad wears many hats.
We just heard an amazing stewardship talk from him.
And now we're going to change gears a bit and
talk back a little bit about the AMR initiative.
And so thank you, Brad, for taking this opportunity to-
Thanks for having me.
Yeah, stay on the stage, first of all, for a longer period of time.
And also being open to being interviewed on this topic.
Happy to do so.
Thanks.
So without further ado, so
basically what we're gonna be talking about today is the AMR launch.
And so Brad is going to give us a lot of information about the AMR initiative.
I know there's been a wealth of information over the last two days.
I've learned so much during this symposium and I've been so
grateful to be here.
And so we are going to change gears and talk about the new AMR initiative.
So Brad, can you begin by summarizing not only for our audience here, but
also my audience that's tuning in live and will be listening to the podcast
on a later date?
What is the new AMR awareness campaign and why is this important?
Yeah, thanks, Rapina.
So this new campaign is called AMR Aware Canada.
It was just launched this month, just in time for World AMR Awareness Week 2024.
And just in time for this conference as well.
I think we heard a lot during this conference about the importance of working
together across sectors, across disciplines.
And I think one of the important first steps in that, kind of a foundational step,
is to try to get everyone on the same page as to what is AMR?
What are we as a group to do about this?
And I think that's what AMR Aware Canada aims to do is provide kind of
a foundational level of understanding and awareness about AMR in Canada.
So AMR Aware Canada refers to this campaign, but it's also a brand new website.
So AMRAware.ca, and that's shown up there on the screen with the QR code.
And we can put the website link in the show notes as well.
And that's got a number of great resources, some really good campaign resources for
this World AMR Awareness Week can be shared with your colleagues and
with the general public.
I should highlight though the great work by National Collaborating Center for
Infectious Diseases, NCCID, the folks there, Harpa and Amanda have done some nice
work pulling together some really great visuals.
One of which is this five things to know about antimicrobial resistance.
Each of those five things has their own graphic that can be shared and
they're really quite suitable for sharing on social media.
So I'm happy to go through the five things.
I think they might be useful to briefly talk about them, but
I encourage people to go to the website to find out more.
But the five things are basically what kind of this network of us at the AMR
Aware Canada, I should have also mentioned, is a network of individuals.
So it's about 20 collaborators, about 50 individuals, and I'm one of those.
And we all had a chance to kind of review some of these statements and visuals.
And these are the five things that we think are important for
people to know about AMR.
So one of which is that antimicrobial resistance is growing at a rate
that's faster than we're able to keep up with the development of new antibiotics.
All of these, by the way, are things that I think we as a group tend to know, but
we don't think that everyone else knows about this.
So there's an opportunity to share this.
So number two is the fact that these infections that are caused by
antimicrobial resistant organisms are becoming very difficult to treat and
in some cases impossible to treat.
Antimicrobial use is a big driver of antimicrobial resistance,
whether it be inappropriate or appropriate.
But the challenge is we know that there's a lot of inappropriate usage and
we can address that to reduce the unnecessary harm that patients are exposed to.
And then a big thing we heard from Dr.
Loxman-Iranian this morning about prevention.
So prevention is key.
Things like hand hygiene, things like immunization can help prevent infections,
which can prevent downstream antimicrobial use.
And then the fifth thing is a final call to action about the importance of
learning about antimicrobial stewardship, both from the perspective of the prescriber,
the right drug, the right dose, right route and duration, only when needed.
And from the patient's perspective as well.
Yeah, and so actually looking at the website itself,
I felt like it was very user friendly this year.
And also a lot of resources and tools that can help clinicians,
can help us communicate with the rest of our colleagues, but also with the public.
And so there's a wealth of information there.
And like you mentioned, it is a multifaceted problem.
And that's discussed, that has been discussed over the last two days as well
here, and really seeing the angles and different perspective.
And actually, like you mentioned that there's over 50 collaborators.
I think that perspective is really good to see from our end as well,
because we can see that we're not looking at the problem from one angle.
So that's fantastic.
So with AMR Aware Canada being a unified campaign in Canada,
and pretty much across the country, what are some of the leading Canadian programs
or practices that are related to the awareness?
Yeah, I think this is like so
many great things that are happening across the country.
You could spend an entire podcast just talking about this.
But I think I'd like to highlight a couple of things.
We heard a lot about upper respiratory tract infections being a major driver of
unnecessary antibiotic use in the primary care setting.
So that is a big target for patient awareness and education.
And Choosing Wisely Canada has done some really good work on that.
They have a toolkit called the Cold Standard Toolkit.
It has a list of resources, recommendations for
prescribing for common upper respiratory tract infections in primary care.
And one of the resources I think was discussed in a couple of talks is
the viral prescribing pad.
So basically, if a patient presents with an illness that's likely caused by a virus,
they don't need to go home empty handed.
They can go home with this viral prescribing pad that has recommendations for
supportive care but doesn't have any antibiotic to use.
So give some opportunity for them to learn about what they can do to monitor
when they should be following up.
And it kind of validates the fact that they have symptoms,
that they just need to be addressed without antibiotics.
Yeah, and yesterday there was a talk in regards to decision support that was
mentioned and I think all of these tools, especially being a clinician myself,
having those decision tools on that support without having to
call an infectious disease physician or let's say it's in the middle of the night
and you don't have the resources or you're in a center where you don't have a
specialist or a subspecialist where you can have that conversation.
But yet you can kind of make an informed decision and guide your patient through that.
That's fantastic that there's tools like this that exist.
Yeah, there's a great section on the website just under resources.
It's kind of like a wizard that you can filter the resources out by your audience
type, by the resource type, by the condition.
So I think that's a useful tool to check out.
And that's perfect because again we're talking about patient level awareness too
and case by case and so that's fantastic.
Yeah, and it's so nice to see that we have, during the symposium I really realized
that all of us are in the room trying to do the same thing and have that
collaboration and so nice that we have something that's unified and centralized
for us to actually, similar to when we have guidelines that we can follow.
Now we have tools and resources that we can access in one place.
It's fantastic.
I think they've done, AMR Aware Canada has done a fantastic job on that.
So thank you.
Moving on to more about the campaign.
So I'm not sure if people are familiar with this but there's been the Go Blue for
AMR campaign.
If you've tuned into the podcast, The Canadian Breakpoint in our last season on
episode 8, we had after words from University of Manitoba discuss the Go Blue
for AMR.
So basically highlighted that campaign.
Can you give us some more information about that and maybe for our audience if
they're unfamiliar with it?
For sure, yeah.
So I think we've kind of all experienced the difficulty in trying to explain
antimicrobial resistance to family members or to the general public.
It's a microscopic threat.
Literally it's invisible.
So the World Health Organization has come up with this color campaign a few years
ago called Go Blue.
And it's really to try to make the invisible more visible.
And so it's a color campaign to encourage everyone during the week, World AMR
Awareness Week, to do a few different things.
And it's actually quite easy to participate.
I'm participating right now wearing the color blue.
That's one thing you can do.
Another thing is across the country there are a variety of landmarks that are
illuminated in blue to mark World AMR Awareness Week from coast to coast.
Canada Place in BC is going to light up a confederation building in Newfoundland.
Right here in Toronto the CN Tower will light up on November the 24th.
So I have a map that I'm putting together just collating all of the different
sites that will be lighting up and so I'm happy to put that in the show notes as
well so people can go out and take photos and post them online.
There is a hashtag.
It's hashtag Go Blue for AMR.
If you search that on any of your platforms, X or Blue Sky, you should be
able to find out what's going on around you or at that time around the campaign
and see what other sites have been illuminated in blue.
That's fantastic and this is a world, like a global hashtag as far as I know.
So it would be something that you can see other countries participating in as well.
For sure.
Yeah.
And I think one of the key things is that we make sure it's clear why we're going
blue, why these buildings are lit up blue.
Yes.
So that's the opportunity to close the loop and share these photos online, use the
hashtag and explain to everyone why going blue is important to you.
Right.
Yeah and I did see the CN Tower and it was a little bit tricky because this week's
been the Swiftie week as well so it's hard to tell if it's pink or blue at certain
times but I don't know if you guys can tell but I'm wearing blue earrings because I
looked in my entire wardrobe and realized I have no blue clothing except for my
McDavid Oilers jersey and I didn't think that would be appropriate to wear today.
So in terms of moving forward, you talked a little bit about public awareness.
I think that over the last two days is something that even myself, I've reflected
upon and thought about do I do a good job with discussing this with my patients or
their families and how do I communicate effectively and I think all of us have a
lot of knowledge about antimicrobial resistance and we're able to use the
microbiology information that we have and also the organisms and antibiotics and
pharmacists guide us on this as well.
So I think we have a great network in our communities from a healthcare standpoint
but how do we effectively communicate this with the public and so are there
strategies and ways because I struggle with this being in pediatrics and you
know I'm dealing with families where there is obviously serious conditions
sometimes we have oncology patients that will be in for long periods of time
there's resistance developing and you know that it's happening but how do we
effectively communicate this with our families and our patients?
Yeah, it's a great question.
I think there's a lot of opportunity here for improvement.
We know that this is necessary.
It's still an educational gap that needs to be filled right?
Like there's public opinion research from the Public Health Agency of Canada that
shows that about one third of Canadians still believe that antibiotics will help
you know treat viral infections.
So there's obviously some misconceptions we need to address and you know there's a
lot of campaigns that have been launched some of them been studied some of them
haven't been studied the ones that have been mixed results sometimes opportunity
for improvement in terms of the quality of those campaigns so we still don't
really know a whole lot about how to best communicate.
What we kind of have a sense from the literature is it's best to address it from
multiple angles have more active approaches so face-to-face learning is
probably a bit better than mass media alone but the combination might be
better engaging both the prescriber and the patient so the supply side and the
demand side you know coming at it from those angles as well.
I really like this report from the Wellcome Trust in the UK it's called
Reframing Resistance so it's a really nice way to describe resistance to the
general public in ways that it might help to resonate a bit more.
So one thing that they recommend is to frame this problem as something that is
currently happening and that it's happening here so it's currently
undermining modern medicine.
Some people tend to think oh it's a problem elsewhere or it will be a problem
in the future but you have to bring it back to the present that this is an
issue that is happening right now and it could happen to you.
One thing that people tend to not resonate so much that we do a lot is we
throw out very big numbers like oh two million deaths per year due to
antimicrobial resistance.
You know it is obviously important for us to know those figures but from a
general public perspective it's not as resonant if it's not personal.
So one thing they recommend is to make it as personal as possible so use
stories personal stories of people who've had experienced AMR and the
suffering associated with those infections can be more helpful than just
the statistics alone.
And then making it clear that you know this is not all doom and gloom this is
solvable there's things that we can all do and that everyone has a role to play.
So I think those are some tidbits that we've learned about and I think the AMR
Canada campaign has really embodied them in terms of like if you look at their
website there is a page on stories you can look at stories of people who've had
experiences with AMR that can be shared and kind of make it a bit more
personalized.
Yeah and I think often there's that disconnect or that piece of information
that's missing where you know people don't discuss it very often within
families or amongst one another and we I don't know if we're doing a great job
because we're creating that oh asking the questions like have they traveled
been hospitalized in a different country that type of thing to kind of see which
resistant pathogens that we're dealing with so I don't know if that's we've
kind of created that miscommunication but I think you make a really good point
is to to for them to understand that this is not a problem elsewhere it's
happening here it's a concern in our hospitals it's a concern for our patients
and and their families and so I think and like you mentioned the website has I
was able to they have videos and they have written stories on the website so
for I think it's really nice for family other families because we know with
even chronic conditions there's forums other outlet tools for families and so
if they are dealing with a resistant organism or they're not completely
understanding that I think it's nice for them to have that support system and
aimer aware Canada has really given us those tools so that's fantastic one
thing that we hear about you know is a misconception that often needs to be
dispelled is the fact that it's the bacteria it's the microbes that become
resistant and not the patient yeah and you know that's a misconception that's
probably important really important to dispel because it relates to how those
bacteria can then go on to spread to their family and friends and loved ones
so it may make it a little bit more meaningful to address that
misconception as well right yeah and then looking at it from many different
angles like the stewardship standpoint the infection control and I think we've
heard of heard a lot about that over the last two days so it's fantastic in terms
of as health care providers so kind of carrying back to us and not the public
what can we do more at this time so we talked about wearing blue taking pictures
but what else can we do for the awareness I mean I think coming to the
symposium and telling others that we're at the symposium and how fantastic
the talks were over the last two days is helpful but what else can we do to raise
awareness for AMR yeah I think because we're talking about AMR aware Canada
today I think I'm gonna encourage people we have this time of captive
audience here to try to share these resources with people who you think might
find them useful whether it be your colleagues or other people that you
work with people within your team your comms team that they can send these out
during world AMR awareness week I think a lot of the resources here are very
well suited to social media so I'd ask you if you have some time today go on to
whatever your preferred platform is and share AMR aware CA and then use the
symposium hashtag I've got a hash I've got some posts up there already on on
X Twitter previously known as Twitter on blue sky LinkedIn threads under the
hashtag AMR symposium 2024 you'll find some of these posts and resources that
are already there feel free to just retweet them but if you want another
approach is to take some of the images from the campaign material and share
them yourself and I think you know making it personal and sharing about why
you think it's really important to address AMR from your own perspective
that's fantastic thank you so much Brad and I think what I've learned over the
last few days is that we need to educate we need to advocate and then the most
important thing is that we need some action in order for us to combat this
AMR threat and it's really nice to see that there were multiple people in the
room with the same passion and I really look forward to working with everyone
and hopefully we can continue to have symposiums like this I can educate and
there's been some fantastic work going on you're doing some fantastic work with
the stewardship side things so thank you so much and with that I will say thanks
for joining us on the podcast and yeah and it was fantastic and thank you by
mirror for hosting this great symposium