Written Submission for the Pre-Budget Consultations

Stop TB Canada recently submitted to the pre-budget consultations in advance of the upcoming federal budget. The content of the submission is found below:

Written Submission for the Pre-Budget Consultations in Advance of the Upcoming Federal Budget

By: Stop TB Canada August 6, 2021

Recommendation 1:

That the government fund and implement a robust, modern, timely national tuberculosis (TB) surveillance infrastructure, in collaboration with the provinces and territories - in support of the federal government’s commitment to eliminate TB in Canada by 2030.

Recommendation 2:

That the government fund and support the ongoing work of the Pan Canadian Health Strategy.

A robust, modern, timely Canadian tuberculosis (TB) surveillance system

The COVID pandemic has made the Canadian public intensely aware of the value of transparent, timely, accessible, user-friendly data on infectious diseases.

Like COVID-19,TB is a true pandemic. Prior to COVID-19, it was the leading infectious disease killer worldwide despite being preventable, treatable and curable. TB continues to affect thousands of Canadians, particularly those who were born or have lived outside Canada, and among Indigenous Canadians in the northern prairies and Eastern Arctic. For example, if Nunvut were a country, the World Health Organization would classify it as a high-TB burden nation, in the same grouping as central Africa. In 2018, Canada became a signatory to the United Nations Political Declaration on the Fight Against Tuberculosis (POLITICAL DECLARATION OF THE UN GENERAL ASSEMBLY HIGH-LEVEL MEETING) and has committed publicly to eliminating TB in Inuit Nunangat specifically by 2030 (The Government of Canada and Inuit Tapiriit Kanatami commit to eliminating tuberculosis across Inuit Nunangat by 2030 - Canada.ca).

Timely, high quality epidemiologic and laboratory data on TB cases and contacts across Canada is critical for federal, provincial and territorial TB programs to work effectively and ensure high quality prevention and care to all Canadians, especially those most at risk (Indigenous peoples living in high-incidence communities, new-comers to Canada, and people experiencing homelessness). It is currently lacking. A detailed understanding of the scope of the TB problem is even more essential if we are to mitigate the impact of the COVID pandemic on our collective work towards TB elimination, a formal public commitment by the Federal government.

The TB surveillance system in Canada has been underfunded and under-developed for many years - the last national TB statistics were published in 2019, reporting on minimal 2017 data. Efforts to improve TB programs outcomes, guide and prioritize interventions, and bring population research to bear on TB elimination are all drastically hampered by this fundamental gap in critical data. Groups such as indigenous Canadians affected by TB have minimal data to influence culturally relevant improvements in TB care, nor participate in better local prevention and outreach efforts. Communities and individuals affected by TB and the many organizations which intersect with TB issues have no access to transparent, publicly available data on the TB situation in their region, to inform their health care and actions.

In addition, the COVID pandemic has disrupted TB programs and care across Canada, with the majority of TB healthcare workers being redeployed for the past 18 months, and TB contact follow-up essentially halted. New-comers to Canada with TB referrals from IRCC have had minimal access to clinical follow up. Globally, an estimated 12 years of progress to bring TB under control have been lost during the pandemic, with a dramatic increase in infectious TB cases going undiagnosed and untreated; because of the dysfunctional TB surveillance system in Canada we have no idea what the current status here is.

Paraphrasing the initial report of the Pan Canadian Health Data Strategy’s Expert Advisory Group:

“Significant gaps remain in Canada's health data ecosystem, from timely reporting of basic data on individual cases and outbreaks, to genomic surveillance, or assessment of (interventions and treatments), safety, and effectiveness in real-time. There is no doubt that our response to the pandemic has been severely limited as a result.”

(Expert Advisory Group Report 1: Charting a Path toward Ambition - Canada.ca)

We strongly support the overarching approach to health data in Canada proposed by the PCHDS. Progress on these goals would help provide the integrated data urgently needed to help with insights for TB prevention and measuring progress across our communities.