Stop TB Canada’s Response to Federal Budget 2024

The 2024 Federal Budget was tabled on April 16th by Finance Minister, Chrystia Freeland, laying out the government's key priorities over the next fiscal year. The headline? “Fairness for every generation”. Through careful analysis, Stop TB Canada has assessed the fairness of the government’s investment priorities, which omit any mention of tuberculosis (TB) - even as we are seeing active TB outbreaks in Canada’s North, and TB rising through migration. Canada must urgently address the stark contrast in tuberculosis rates, with widespread elimination in most regions but critical persistence in Inuit communities due to historical neglect and insufficient support. With Canada’s current response, we will not meet the TB elimination targets to which  Canada has committed. While we join partners’ disappointments in this lack of direct investment towards TB elimination, our analysis highlights some of the promising investment priorities that could and should be channeled towards the broader determinants that fuel the TB epidemic. 

So, where can this funding come from if not directly through TB investments?

Investments in housing:

One of the top priorities for the government, as articulated by the budget, is improving housing for people in Canada. This includes building more homes, establishing a National Indigenous Housing Centre, investing in Canada’s Homelessness Strategy, and expanding the Housing Assistance Program. The budget also outlines specific funding to implement an Urban, Rural and Northern Indigenous Housing Strategy.

Adequate housing is a critical social determinant of health that directly impacts the burden of TB. Overcrowding and improper ventilation, for example, can increase the risk of transmission between people living in the same household. Addressing the housing issue, particularly in northern communities, would be an important step towards mitigating the spread of TB. In 2018, the Government committed $400million for Inuit housing to eliminate TB, but results to date on actual investments and changes in housing leave much room for improvement.

Investments in health:

While TB is not explicitly mentioned in the budget, the government does plan to invest in the health of Canadians as a whole, presenting opportunities for strengthening the health infrastructure that is necessary to combat not only TB, but a wide variety of diseases. The government announced its plans to invest over $200 billion over ten years to strengthen universal public health care for Canadians.

To mitigate the effects of health product shortages and expedite emergency responses when supply chains fail, the budget outlines $3.2 million over three years to upgrade Health Canada's supply management capacity for drugs and medical devices. Stop TB Canada has long been advocating for improved access to essential TB drugs in Canada and hopes to see some of this funding used to ensure that people with TB in Canada can access the drugs that are readily available elsewhere in the world. Specifically, Canada must improve access to TB drugs currently facing shortages, such as rifampin, and those available only via special access mechanisms, such as rifapentine and components of drug-resistant TB treatment regimens. 

Investments in Indigenous health:

The budget outlines several investments to improve health outcomes for Indigenous Peoples. This includes $2 billion over ten years for a distinctions-based Indigenous Health Equity Fund. This fund is intended to address the unique challenges Indigenous Peoples face when accessing health care services, and support immediate and long-term Indigenous health priorities. With Indigenous communities facing the highest rate of TB in the country, we sincerely hope that this funding will be used in part to address the TB outbreaks currently affecting many communities, and accelerate TB screening efforts in multiple communities in the North to prevent further spread of the disease. 

Another social determinant of health that is intricately tied to TB is nutrition. The budget outlines its support for Nutrition North, Canada's subsidy program to lower the cost of nutritious food and other essential household items. It also outlines over $100 million over three years to support the Harvesters Support Grant and Community Food Program Fund and promote Indigenous communities in implementing culturally appropriate, local solutions to address food insecurity. Improving access to high quality foods for Indigenous Peoples would improve the overall health of these communities, including by reducing the burden of TB. 

In addition to programming directly aimed at addressing some of the key social determinants of health putting Indigenous communities at risk of disease, the budget includes over $100 million over five years for health transformation initiatives to support First Nations self-determination in the design and delivery of health services in their communities. Community-led and -owned initiatives are critical to ensure TB elimination efforts are responsive to unique community contexts and needs, thereby improving the long-term effectiveness and sustainability of interventions.

Investments in research:

Further investments in research and development are essential to achieving domestic and global TB elimination targets. Some of this important research is done here in Canada and needs sustained funding. The 2024 Federal Budget outlines the government’s intentions to support scientific discovery, develop Canadian research talent, and attract top researchers from around the planet to make Canada their home base for their important work and strengthen Canada's global standing in scientific research. This includes the largest bump in pay increases for graduate, PhD, and postdoctoral researchers, the highest in two decades, aimed at enhancing stipends and expanding scholarships. 

While the budget doesn’t include specific funding for TB research, it does outline plans to invest $30 million over three years to support the completion of the University of Saskatchewan's Centre for Pandemic Research at the Vaccine and Infectious Disease Organization in Saskatoon. This investment will enable the study of high-risk pathogens to support vaccine and therapeutic development. Whether TB will be included among the list of high-risk pathogens is unknown; however, it would be a welcome and long-awaited investment given the only TB vaccine currently in use is over 100 years old, and ineffective at preventing the most common form of TB (pulmonary TB) in adults. 

Investments in international assistance:

The Canadian Aid sector responded mostly positively to Canada’s investments in international aid. The budget includes $350 million over two years to respond to large-scale humanitarian crises. The coalition recognizes that this new investment comes in a complex economic environment for Canada and emphasizes the need for the government to continue to play its part on the global stage. It also means the government is returning to its promise to increase aid funding annually. What is missing from the budget, critically, is increased funding specifically for development assistance, the funding Canada uses, for example, to support multilateral organizations working to end TB globally. We continue to call on this funding to ensure that Canada remains a leader on the global stage and contributes its fair share to achieving global TB elimination targets.

Our analysis is an optimistic one: despite the omission of TB throughout the entire Federal Budget, there are glimmers of hope and potential opportunities that could move the needle on TB elimination. This will only be possible if decision makers make the conscious decision to include TB in broader discussions on housing, nutrition, health equity, and research, for example. The return on investment in tuberculosis prevention and treatment not only saves lives, but is clear in the community based systems for diagnosis and care that will be providing measurable results and economic returns. 

Our network reiterates that if you invest in TB, you invest in a multitude of issues - many of which are systemic issues rooted in neglect. Investing in TB is our ticket to making meaningful progress across these deep rooted issues, getting us closer to realizing more people-centred, equity-based services for communities, and helping Canada achieve the Sustainable Development Goals.