Federal budget lacks meaningful commitments to end TB

On March 28th, the Canadian Government released the 2023 Federal Budget, which (again) lacks meaningful plans and the necessary funds to combat tuberculosis (TB). Canada’s insufficient financing of TB contradicts its commitments to TB elimination both in this country and globally, which are dependent on sustainable funding.

An infectious disease, TB is driven by poverty and thrives on inequity, requiring biosocial solutions that integrate the social and biomedical approaches to effect elimination. In that sense, health in general, and TB more specifically, should appear in all policies, and draw significant investments from other sectors. TB greatly impacts the most underserved members of society and is influenced by actions taken to address the broader social determinants of health, such as availability of nutritious foods, safe housing, and access to health care. As of 2021, Canada has a low overall rate of TB (5.0/100,000 population), but very high population-specific rates among immigrant/newcomer groups, First Nations, and Inuit (13.4/100,000, 16.1/100,000, and 135.1/100,000, respectively). With a new budget focused on improving life for all Canadians, the absence of an agenda for TB signals an apathy towards achieving health and well-being for all. 

We’ve gone through previous budget announcements, section-by-section in an effort to highlight where TB should be specifically noted and funds allocated. Implied or potential funding is not enough - when funds are not protected for TB elimination they become subsumed into the broader budget.

This year, the budget outlines a number of areas that are all fundamental to the health and wellbeing of Canadians. Whether the emphasis is on housing, climate change (‘healthy air is healthy lungs’), catering to the needs of Indigenous communities or building safe and inclusive communities, many chapters in the 2023 Federal Budget are directly relevant to our mission of ending TB at home and abroad. 

However, the only specific investment in TB found in the budget is $16.2 million allocated to “reduce rates of tuberculosis in Inuit communities” in Chapter 4.2: Investing in Indigenous Communities. The wording drew flak from various quarters as it signaled a departure from Canada’s commitment to eliminate the infectious diseases from Inuit Nunangat - the four regions that make up the Inuit homeland - within seven years. The Indigenous services minister Patty Hajdu admitted the Liberal government had made an error by using the word “reduce”, and that the goal has always been to eliminate tuberculosis. On the budget allocation itself, the Inuit Tapiriit Kanatami (ITK), a national organization representing the rights and interests of Inuit in Canada, said the federal government has given only “roughly a quarter” of the money that was requested to eliminate TB in Inuit Nunangat.  

This year, we have more information and tools to guide TB elimination through the 8th Edition of the Canadian TB Standards (TB Standards). The TB Standards provide a roadmap towards eliminating this ancient epidemic but it won’t be successful without a well-funded TB elimination plan. Funds are needed for (1) addressing the social determinants of health closely linked to TB, (2) improved access to TB testing and treatments, (3) adequate staffing resources for TB programs and immigration TB screening, (4) improved TB surveillance and timeliness of data sharing, and (5) meeting Canada’s fair share contribution to TB research and development.

In a further blow to the fight to end TB, Canada cut international aid in Federal Budget 2023 by 15%, which is likely to impact Canada’s contribution to the fight to end TB at the global level. Disruptions to programming and care caused by COVID-19 have resulted in TB deaths increasing for the first time since 2005. In 2021 alone, over 10 million people fell ill with TB, including 3.4 million women, and 1.6 million people died of the disease. Rather than building on past leadership, Canada's commitments have declined to pre-pandemic levels when global needs were much lower. Without a committed global response, by 2030 it is estimated that 28 million people – or approximately one person every 20 seconds –  will die from TB, with an economic toll of close to $1 trillion (USD). 

There’s a strong opportunity in 2023 for Canada to reverse this rollback and step up for communities affected by TB in Canada and abroad. In 2018, at the UN High-Level Meeting (UN HLM) on TB, member states, including Canada, had signed on to a political declaration to confirm their commitment to TB elimination. Canada also announced its Inuit Tuberculosis Elimination Framework developed by ITK. In September this year, countries will gather again for the second UN HLM on TB. We call on Prime Minister Justin Trudeau to participate in this meeting along with a delegation of representatives from affected communities in Canada, and renew our commitment to eliminate TB in Canada and the world. This commitment must include a plan to set up a National TB Elimination Strategy that works side-by-side with Inuit, First Nation, and Métis elimination strategies, provide clear and measurable outcomes, and be adequately funded. 

TB is not a disease of history – it is present, it is here in Canada and around the world. We urge Prime Minister Trudeau to take up the challenge of TB elimination and not rest on the laurels of Canada’s progress to date – now under considerable threat due to disruption of services caused by the COVID-19 pandemic. The convergence of the COVID-19 pandemic, war in Ukraine, and climate crisis mean that because of Canada’s inaction over years past, the resurgence of TB in our lands is becoming a growing and real risk.