A super-lab to fight superbugs

OTTAWA -- The federal government is studying a proposal to build a $300-million expansion of the National Microbiology Laboratory in Winnipeg for a one-of-a-kind bench-to-bedside research facility in hospital superbugs.

The Level 5 Laboratory Infectious Disease Control Campus would aim to prevent and control hospital-borne bugs, which affect more than 250,000 Canadians each year and result in more than 8,000 deaths.

It would be the only facility of its kind in the world and would help solidify Winnipeg as an international centre for infectious disease research.

In the original proposal for the project, the partners called it a "quantum leap in Winnipeg's and Canada's existing leadership in the science and control of infectious diseases."

It would create up to 400 research and commercialization jobs and put $176 million into the province's economy each year. It would aim to cut the spread of hospital-acquired infections such as Clostridium difficile (C. difficile) and methicillin-resistant Staphylococcus aureus (MRSA) by 20 per cent across Canada in less than a decade.

The project, known colloquially as L5L, would include research on superbugs like C. difficile and MRSA, with a focus on preventing their spread and treating them with everything from better drugs and new vaccines to improved ventilation systems and maybe even bacteria-resistant bed sheets and window coverings.

Sources have told the Free Press Manitoba regional minister Vic Toews is solidly behind the proposal, although Toews would not speak to the Free Press about it. His office directed questions to Health Minister Leona Aglukkaq.

An Aglukkaq spokesman said no decision has been made yet on funding.

"The government of Canada is looking at various options for a research facility and this is one of a number of proposals that have come forward," said her spokesman, Tim Vail.

Multiple sources aware of the L5L plans said the project has Toews' attention. "The regional minister has made it a priority," said a source at one of the partners involved in the project.

The existing National Microbiology Laboratory in Winnipeg is the legacy of another Manitoba regional cabinet minister, Tory Jake Epp, who initiated plans for the lab in 1987 when he was the federal health minister. It was, in part, a consolation prize for the CF-18 fiasco, which saw Manitoba lose an aircraft maintenance contract to Quebec despite having a cheaper and better bid.

Some wonder if the latest expansion may, in fact, be the consolation prize for Winnipeg losing out on a bid for a pilot HIV vaccine manufacturing facility.

That facility, part of the Canadian HIV Vaccine Initiative, was believed to be destined for Winnipeg last summer after the International Centre for Infectious Diseases was told informally it had the best bid of the four finalists. But last month, ICID CEO Heather Medwick was told, along with the other three finalists, they hadn't won after all.

It's unknown at the moment what is happening with the vaccine facility. But some fear its demise is due to local and national politics, including the Liberal ties of ICID's former CEO and Quebec-based pharmaceutical companies balking at losing lucrative HIV vaccine contracts to a non-profit facility with ties to generic drug manufacturers.

A presentation on L5L was made to Finance Minister Jim Flaherty when he was in Winnipeg for pre-budget consultations last month.

As well, the proponents on Jan. 20 registered the name L5L Life Sciences as a business with the Manitoba Companies Office. It's believed Western Economic Diversification has tentatively agreed to a $3-million initial funding.

The concept of L5L has been in discussion for years but was first officially proposed to Ottawa in December 2008 in a letter to Prime Minister Stephen Harper, signed by University of Manitoba president David Barnard, Winnipeg Regional Health Authority CEO Dr. Brian Postl, then-International Centre for Infectious Diseases CEO Terry Duguid and Smith Carter Architects CEO Scott Stirton.

That proposal was subsequently presented to a number of cabinet ministers early in 2009, including ministers of health, infrastructure, and industry. The response was positive but there was a major snag to it getting funding in the federal budget last year.

The focus of the 2009 budget was economic stimulus and there was more than $12 billion set aside for new infrastructure, including $250 million for national laboratory upgrades.

However, all the projects had to be completed by March 2011 and the L5L proposal was definitely not "shovel-ready."

So the Jan. 25, 2009 budget came and went without mention of L5L.

It didn't ever die completely but it was shelved temporarily when it didn't get funding. In the fall, it was resurrected with the backing of Toews and Dr. Frank Plummer, scientific director at the National Microbiology Laboratory and scientific adviser at the Public Health Agency of Canada. Former chief innovation officer at the WRHA, Harry Schulz, is reportedly helping drive the project. He now works under Plummer at PHAC. Jo Kennelly, one-time senior political adviser to former federal health minister Tony Clement, is also among the project's lead drivers.

Negotiations to get the project back on track took place between Plummer, Schulz, Kennelly and the ICID last fall. However, ICID's Medwick said her organization isn't involved any longer.

"In the past month or so it has changed," she said. "I honestly don't know what is going on with L5L."

Medwick said there were three options to fund and operate L5L initially -- totally private, totally public or mostly public but operated by ICID as a non-governmental agency.

She said she no longer is aware which option is being investigated. Other ICID sources say the agency was interested but the board had concerns about the lack of a business plan for the new proposal, which included a partnership with a U.S. property developer and funding from PHAC, to be recouped by the government over 25 years through leases from tenants such as the U of M, WRHA and private biotech companies.

Premier Greg Selinger said he is aware of the L5L proposal, although he has not been told about how it would be financed, including details of a possible public-private partnership.

Selinger said an expansion of the federal laboratory would be welcomed in Manitoba, which has been working hard to solidify its reputation as a centre of excellence in microbiology and virology.

"I definitely want to see that cluster grow," Selinger said, "but we just haven't seen details on the financing arrangements. We need more information."

Winnipeg NDP MP Judy Wasylycia-Leis agreed expanding the lab is good for Manitoba, but expressed concern there has been no public information about L5L Life Sciences and no public discussion about whether a public-private partnership is appropriate for this kind of development. She also said the federal government should not be giving out a sole-source contract to any group without proper scrutiny.

"This is a very cloudy situation," said Wasylycia-Leis, who sits on the federal health committee.

Manitoba NDP MP Pat Martin, who submitted a letter of support for the original proposal in December 2008, said Friday he is extremely excited about the whole prospect. "It puts Manitoba on the map," Martin said.

Heidi Graham, spokeswoman for the Winnipeg Regional Health Authority, said the WRHA is still very much "interested and involved" in the project, but said Postl was not available to comment. She referred further questions to Plummer, who is at the helm of the proposal. Digvir Jayas, vice-president (research) at the University of Manitoba, said the U of M is participating in ongoing discussions "with great interest."

"The Level 5 Laboratory initiative offers an exciting opportunity for this community," Jayas said.

The National Microbiology Laboratory is already a crown jewel in Winnipeg, employing more than 400 people, including 100 research scientists. It has been on the front line of a number of international infectious disease projects, most recently helping to identify the H1N1 virus and develop a vaccine for it.

mia.rabson@freepress.mb.ca dan.lett@freepress.mb.ca

What are superbugs?

Also known as hospital-acquired infections, they're acquired by patients in hospital undergoing treatment for something else, often surgery. The Canadian Institute for Health Research estimates one in 10 adults and one in 12 children who enter a hospital will get an infection. A 2003 study in Canada found 220,000 patients developed a hospital infection and 8,000 Canadians died from one.

The most severe of these infections are resistant to antibiotics and are very difficult to treat. Many cause patients severe stress, prolong hospital stays and in extreme cases result in the closure of hospital wards. Some say the cost to Canada's health-care system each year from infections is more than $1 billion.

The worst of these bugs include methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococcus (VRE), and C. difficile.

Infections are transferred to patients from any number of sources, including telephones, call buttons, sheets, towels and surgical instruments.

The incidence of MRSA increased 17-fold in Canada between 1995 and 2006.

In Great Britain, the Journal for Infection Prevention reports MRSA was listed on one in 500 death certificates between 2001 and 2005 and C. difficile was listed on one in 250 death certificates.

MRSA

Methicillin-resistant Staphylococcus aureus (MRSA) is a bacterium found commonly on the skin and in the nose of one in three healthy people. However, when it enters the body through breaks in the skin, such as surgical wounds, it can cause a broad range of symptoms, including redness, swelling, boils and fever. It is resistant to antibiotics and some infections can be fatal.

An outbreak at Concordia Hospital in Winnipeg in 2007 affected 42 people.

C. difficile

Clostridium difficile is sometimes known as hospital diarrhea. It usually causes mild symptoms but can lead to serious illness and death. It is not resistant to antibiotics in most cases, but stronger versions of the bacterium are being discovered. One Quebec study found C. difficile responsible for the deaths of more than 100 patients in hospital in a six-month period.

In Winnipeg, outbreaks of C. difficile at Grace Hospital affected 15 people in 2007 and 33 in 2008.

L5L

"ö Level 5 Laboratory Infectious Disease Control Campus

"ö $300-million capital cost

"ö 305,000-square-foot expansion of the National Microbiology Laboratory on Arlington Street

What we stand to get in return:

More than 400 high-skilled scientific and commercial jobs

$176-million annual economic impact in Winnipeg and Manitoba

Construction phase would result in 800 jobs and a $1.1-billion economic impact in the province.

THREE MAIN COMPONENTS:

Discovery Research and Bio-Containment Facility

"ö 45,000 square feet ($63 million)*

New level 2 and level 3 lab space added to the NML. Would include advanced imaging for respiration-borne infections, capacity for testing personal protective equipment, facilities to identify new diagnostic targets and screening for new drugs and vaccines.

LL Host: Practice Research and Innovation Facility

"ö 240,000 square feet ($220.2 million)*

A new facility for applied research in infection control, including a new level 5 lab and a mock hospital ward for simulation research. It would include commercialization research for controlling infections, including new building designs, ventilation and air-flow systems, new textiles, surface materials and medical devices that can help combat antibiotic resistance. It would include space for outside agencies, including universities, non-government organizations and private companies to design and test new products. It also would have new space devoted to combating bioterrorism.

The Winnipeg Ward: "Live" Working Hospital Ward

"ö 20,000 square feet ($16.8 million)

A new hospital facility at the Health Sciences Centre with a live ward for the isolation of patients with highly infectious diseases. The research and technology developed in the other two facilities would be used in practical applications on the ward.

*all cost estimates taken from December 2008 proposal to Prime Minister Stephen Harper

Republished from the Winnipeg Free Press print edition February 6, 2010 A6