Canada fails to step up at the United Nations High-Level Meeting on TB
This year marked a critical milestone in the quest to end tuberculosis (TB), with the second United Nations High-Level Meeting (HLM) on TB taking place at the halfway point to the Sustainable Development Goal target of ending TB by 2030. With a ‘deadly divide’ between the previous (2018) UN HLM goals set and the (insufficient) investments made to reach them, advocates from around the world were hopeful that global leaders would seize this moment to reaffirm their commitments to ending the world’s deadliest infectious disease. Instead, civil society and affected community members were left disappointed by the missed opportunity and lack of ambition demonstrated by UN Member States, including Canada.
Stop TB Canada and our partners had been calling on Canada to demonstrate its leadership on the global stage by announcing high-impact commitments to end TB domestically and internationally. Instead, Canada's presence and commitments fell short of expectations. While support was shown to ending TB abroad with financial support through Global Affairs Canada, such commitment was not replicated for the domestic agenda, which received a mere message of status quo instead of the necessary coordinated action. Canada's citizens - predominantly Indigenous communities and newcomers - remain vulnerable to TB yet they continue to be neglected.
Requests made by the TB community in Canada are highlighted below along with a description of how and whether they were met at the TB HLM.
Asks vs. reality
1. Ask: High-level political representation
Parliamentarians from around the world gathered in New York city last week for the UN General Assembly to discuss pressing global issues, including health. Although Canadian leaders, including Prime Minister Justin Trudeau and International Development Minister Ahmed Hussen attended other meetings, the lack of ministerial attendance at the TB HLM signaled that TB elimination is not a priority within the Federal government. In fact, Canada was one of a few nations without political representation at the meeting. Instead, Chief Public Health Officer, Dr. Theresa Tam, recognizing her individual dedication to the issue, was designated to make political commitments implicating all levels of government nationwide.
Dr. Theresa Tam, Canada’s Chief Public Health Officer, at the UN High-Level Meeting on TB (2023).
2. Ask: Investment in TB research and development
Despite an urgent need, the Canadian government failed to re-commit its fair share contribution toward TB research and development (R&D). This critical investment was promised five years ago at the first TB HLM, but the government has missed this target repeatedly, with decreasing contributions in recent years, and disappointingly failed to reaffirm. Funding to promote TB R&D is critical to enable the game-changing innovations necessary to ensure a world free from the suffering caused by TB. Although Canada missed the mark at the TB HLM, and we will continue to advocate for funding and infrastructure that supports discovery and development of new tools to prevent, diagnose, and treat TB.
3. Ask: Establishment of a National TB Elimination Strategy
We know that a Canada without TB is possible – but we need a strategy and a plan to monitor progress. This is why Stop TB Canada has been advocating for a National TB Elimination Strategy to address the ongoing epidemic within our country. While Dr. Tam emphasized Canada’s commitment to the principles of TB elimination, her comments lacked specificity about how it would occur. There is little doubt that impediments to elimination are multifactorial, but the TB response at all levels is reactive rather than united and proactive. Unfortunately, the rate of TB in Canada has not declined meaningfully in nearly two decades, suggesting the status quo response is insufficient to achieve elimination. Further, the COVID-19 pandemic has negatively impacted Canada's primary care system, resulting in TB staff being diverted and several recent TB outbreaks in Northern Saskatchewan and Nunavut, for example. At the same time, the influx of immigrants, many with latent TB, requires improved screening strategies and care among high-priority groups.
Since elimination is a political commitment made by the Federal government, we will continue to call on all levels of government to strengthen collaborations in this pursuit. Ending TB in Canada requires a whole-of-government approach including provinces, Health Canada, PHAC, Indigenous Services, Immigration and healthcare providers. Implementation of a nationally-coordinated elimination plan can only succeed in partnership with TB affected people and communities, and must be paired with a mechanism to measure progress and ensure accountability to end-users.
This response comes close on the heels of a recent PHAC report that has highlighted the urgent need for Canada to do more on eliminating TB. To fulfill the recommendations included in this report, we urgently need a taskforce to coordinate action towards TB elimination in Canada.
4. Ask: Involvement of affected community members
Another ask that was not met was for Canada to meaningfully engage individuals with lived experience of TB by including them in its official delegation. This disappointing lack of community engagement is a step backwards from the last TB HLM in 2018 and fails to take the “nothing about us without us” approach to global health.
“As a TB survivor, registered nurse, and Indigenous woman, I am disheartened that Canada did not include those of us with the lived experience of TB in Canada in the delegation,” said Tina Campbell, co-chair of Stop TB Canada. “Without our voices and experience, how can Canada know the best way forward? Considering the high burden of TB on Indigenous communities in the north, this absence speaks volumes to the lack of prioritization for the elimination of TB in Canada’s most vulnerable populations. I join my community in reiterating that there should be nothing about us, without us. Honest reconciliation starts with action.”
Any good news?
1. TB REACH
Earlier this year, we called for Canada to invest $33 million over three years in Stop TB Partnership’s TB REACH initiative - an innovative funding mechanism that works to ensure that people in hard-to-reach communities are not missed by health systems. Last week, Prime Minister Trudeau, in a statement, announced $25.5 million over two years for the initiative. Although the announcement didn’t quite meet our ask, Canada heard our call for a multi-year commitment. Thank you to everyone who took action by getting landmarks lit up in red for World TB Day, writing letters to the editors and op-eds, engaging on social media, and connecting with your Member of Parliament. The impact of this investment is to ensure all people in every high TB incidence nation can access the care they need but would otherwise go without; an achievement for which we are incredibly proud!
2. Political declaration
Canada also pushed for the inclusion of important language on gender, as well as research and development, in the political declaration that came out of the TB HLM. The declaration outlines specific targets and commitments to TB elimination, which we as advocates can use to hold member states, including Canada, accountable. If member states follow through on their commitments, it will put the world on track to ending TB by 2030 and result in saving up to 45 million lives between now and 2027. While we celebrate the adoption of the declaration, we recognize that the language and targets could have been stronger. We will use this declaration as a tool for accountability, noting that the targets agreed upon should be the floor and not the ceiling of how Member States show up for the quest to end TB.
What’s next?
Meeting the global goal of ending TB by 2030 will require strong political will, demonstrated by high-impact commitments and sustained funding. We know that Canada could and should have done more at the TB HLM and continue to call on our leaders to step up for the millions of people affected by TB.
The commitments made at global meetings like the TB HLM must be met with action to be meaningful. Canada confirmed that it is committed to ending TB but failed to adequately match those words with action. We will continue to work with our partners to hold the government accountable to its commitments to end TB domestically and internationally because we know that #YesWeCanEndTB.
We thank our dedicated partners, many of whom we met in New York last week, who remain committed to this important advocacy. The impact of these strong advocates cannot be understated, and we look forward to continuing to work together in the fight to end TB.
TB advocates gathered in NYC for the UN High-Level Meeting on TB (2023).