Letter to the Minister of Health

Hon. Jean-Yves Duclos, Minister of Health
House of Commons
Ottawa, Ontario,
Canada
K1A 0A6

Dear Honourable Jean-Yves Duclos, September 14, 2021

We are reaching out to you today as the steering committee of Stop TB Canada, a network of Canadians committed to ending tuberculosis (TB) at home and abroad. We wish to draw your attention to the urgent need for Canada to scale up efforts by the government of Canada to act on its commitment to ending TB.

TB is an airborne, bacterial infectious disease that has existed for millennia yet continues to impact every region of the world. Before the COVID-19 pandemic, TB was the world’s deadliest infectious disease, infecting 10 million people and causing 1.5 million deaths every year. This is despite TB being both preventable and curable. Even within Canada, TB remains a concern, affecting certain populations disproportionately, such as Indigenous and newcomer populations. In fact, the incidence of TB among Canada’s Inuit communities is close to 500 times higher than in non-Indigenous population, emphasizing the health inequities that continue to exist.

We urge the government of Canada to develop a national TB Elimination Plan. To be effective, such a plan will need to be developed and implemented in collaboration with the provinces and territories, who carry out the majority of TB prevention and care services in Canada. The federal government made a specific commitment to reducing TB in Inuit Nunangat by 50% by 2025, and eliminating TB in the Inuit homelands by 2030. Currently, only Nunavut has made substantial progress towards a territorial TB Elimination Plan, coordinating with the Inuit TB Elimination strategy developed by ITK. However, none of the other provinces or territories, even those with substantial TB incidence, have a plan in place to support TB elimination. Stop TB Canada has reached out to the Ministries of Health in 4 higher-incidence provinces and found preliminary willingness to develop such plans with the support of the Federal government.

A national TB Elimination Plan will also need robust input from communities and people affected by TB: immigrant Canadians (70% of people with TB), and Indigenous Canadians (20-25% of people with TB) particularly those living in more remote, northern areas. TB elimination will only be possible if prevention and care services are truly accessible and meet the needs of those most at risk.

Progress on TB elimination will require the federal Ministries of Health, Indigenous Services, and IRCC to collaborate and coordinate with provinces and territories to set shared targets and strategies for TB elimination. For example, these will likely include major improvements in access to newer, more accurate TB screening tests such as the IGRA blood test; expansion of shorter, more effective preventive treatments, such as the 12-dose rifapentine+isoniazid regimen; strengthened TB outbreak response capacity; and a strengthened laboratory network for molecular epidemiology and drug resistance testing. The federal government also has the critical role of national TB surveillance, an area which has been substantially under-resourced for many years. Without a strong, timely digital epidemiologic surveillance system linked explicitly to TB elimination goals, it is simply not possible to target TB services and activities effectively.

The federal government also plays an essential national leadership and financing role in the determinants of health which underlie TB, particularly adequate housing, food insecurity, poverty, and access to primary care services. These are especially urgent issues for TB in remote Indigenous communities. 

Canada's federal government has already made substantial contributions to international and Indigenous TB elimination. We urge you as the Minister of Health to lead the development and implementation of a robust national TB Elimination Plan, which will eliminate the burden of TB for all Canadians.

We are enclosing a collection of postcards signed by attendees at the recent International AIDS Conference in Montreal 2022, calling on your government to take urgent action to eliminate TB. We would welcome the opportunity to discuss this letter and how we can support the government in the quest to end TB, at a time convenient to you. 

We look forward to hearing from you. 

Sincerely,

Dr Elizabeth Rea 

Co-chair, Stop TB Canada 

Tina Campbell, RN 

Co-chair, Stop TB Canada