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 October 8, 2022
Domestically focused
Recommendation 1:
The Government should fund the development of a National Tuberculosis Elimination Strategy, and, in partnership with provincial, territorial, and Indigenous leaders, establish a National Tuberculosis Elimination Oversight Committee to implement this strategy, with a mandate to eliminate tuberculosis (TB) in all regions of Canada.
Recommendation 2:
The Government should fund and implement a robust, modern, timely national tuberculosis (TB) surveillance infrastructure.
Recommendation 3:
That the Government continues to fund and support the ongoing work of the Pan-Canadian Health Data Strategy, integrating tuberculosis data.
Recommendation 4:
The Government must improve access to TB drugs not formally available in Canada, be it via means like accessing the Global Drug Facility, or by ensuring that funding includes ties to drug access.
Recommendation 5:
The Government should increase investment into domestic TB research and development efforts.
Globally focused
Recommendation 6:
The Government should reaffirm its commitments to ending TB globally by investing in research and development, implementing programs, and mechanisms necessary to get back on track to TB elimination; and improve accountability measures to ensure TB commitments become realities.
Recommendation 7:
The Government must commit to increasing its International Assistance Envelope (IAE) each year over the next three years to reach a minimum of CAD 10 Billion in the 2025-26 budget, in line with the government’s own commitment to increase international development assistance every year toward 2030 to realize the United Nations Sustainable Development Goals (SDGs).
About domestically focused recommendations 1 - 5
1: The Government should fund the development of a National Tuberculosis Elimination Strategy and establish a National Tuberculosis Elimination Oversight Committee with a mandate to eliminate tuberculosis (TB) in all regions of Canada.
Tuberculosis (TB) continues to affect communities across Canada, yet Canada’s approach to addressing TB remains segregated between jurisdictions. To address current shortcomings, we urge the Government of Canada to develop a National TB Elimination Strategy in collaboration with the provinces and territories, who carry out the majority of TB prevention and care services, as well as with Indigenous leaders and affected communities. Funding the collaborative development and implementation of a National TB Elimination Strategy will be essential for Canada to meet its TB elimination targets and ensure health equity for all.
Prior to COVID-19, TB 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, as well as First Nations and Inuit communities. In 2018, Canada became a signatory to the United Nations Political Declaration on the Fight Against Tuberculosis and committed publicly to reducing TB in Inuit Nunangat by 50% by 2025, and eliminating TB in the Inuit homelands by 2030. A National Tuberculosis Elimination Oversight Committee should be established to implement this strategy, with a mandate to eliminate TB in all regions of Canada.
2: The Government must fund and implement a robust, modern, timely national tuberculosis (TB) surveillance infrastructure.
Up-to-date epidemiologic and laboratory data on TB are critical to ensure TB prevention and care, especially to those most at risk. Alarmingly, such data are currently lacking in Canada. If we are to evaluate and mitigate the impact of the COVID pandemic on our collective work towards TB elimination, a formal public commitment by the Federal Government is needed.
The TB surveillance system in Canada has been underfunded and under-developed for many years - the last national annual TB report was published in 2019, presenting minimal data from 2017. Since then, a short summary report presenting high-level data 2010-2020 was published in July 2022. This gap in critical data drastically hampers Canada’s efforts to eliminate TB. Communities and individuals affected by TB and the 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.
3: The Government should continue to fund and support the ongoing work of the Pan-Canadian Health Data Strategy, integrating tuberculosis data.
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.”
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.
4: The Government must improve access to TB drugs not formally available in Canada.
Rifapentine, a drug found on the World Health Organization’s Model List of Essential Medicines, plays an important role in TB prevention and care around the world. However, Canadians are currently denied full use of this valuable tool, as Rifapentine is not approved in the country. The recently released Canadian TB Standards also recommend Rifapentine as a preferred treatment option for latent TB infection. Thus, a drug recognized in national and international guidelines as the drug of choice is not formally available to Canadians, not because it is not safe or effective, but because profits were put above people.
Although Canada has a low incidence of TB overall, some communities in the country - specifically Indigenous and newcomer populations - shoulder an extremely high burden of the disease, and this must be taken into account when considering whether to make life-saving TB drugs available in otherwise ‘low-incidence’ country markets.
The Government must therefore improve access to TB drugs not formally available in Canada, be it via means like accessing the Global Drug Facility, or by ensuring that funding includes ties to drug access. For example, ensuring that Canada’s investment in manufacturing facilities, like Sanofi, also support initiating the process of bringing rifapentine to the Canadian market, possibly through domestic manufacturing. Greater investments are needed to ensure that people affected by TB in Canada can access the essential medicines they need.
5: The Government should increase investment into domestic TB research and development efforts.
We call on the Government to increase investment into domestic TB research and development (R&D) efforts to enable Canada-based research programs to continue their important contributions towards TB elimination. TB R&D continues to be underfunded, impeding Canada’s ability to influence scientific advancements for TB on the global stage. Canada should therefore provide the funds necessary to support researchers based in Canada. For example, the Federal Government should support TB vaccine development research that is being undertaken at McMaster University - which was leveraged as a critical “ready to pivot” investment when COVID-19 hit. Funding Canadian research towards the development of a new TB vaccine would enable Canadian researchers to contribute meaningfully to TB elimination globally.
About globally focused recommendations 6 & 7:
6. The Government must reaffirm its commitment to ending TB by investing in research and development, and implementing programs, and mechanisms necessary to get back on track to TB elimination.
6.1: Invest Canada’s fair share in TB research and development
At the United Nations High-Level Meeting (UN-HLM) on TB in 2018, member states, including Canada, committed to funding US$2 billion annually to research and development (R&D) for TB. To meet this goal, the “fair share” targets were established, which call on countries to invest at least 0.1% of their overall R&D spending into TB research. Canada has failed to meet this target in recent years, by an additional amount of US$ 5 million each year.
TB R&D has long been underfunded, demonstrated by the archaic tools that continue to be the only option in addressing this ancient disease. The only vaccine against TB is over 100 years and of limited effectiveness, and current widely available treatment options are long, complicated, and toxic. Now is the time to invest in the tools to not only get back on track to ending TB, but to build the infrastructure necessary to be better prepared for future threats. Recent history proves that investments in TB R&D are investments in pandemic preparedness and response.
Canada’s TB R&D investments can be made in existing global R&D efforts, such as in Product Development Partnerships like TB Alliance and FIND, which show the value of cost-effective, purpose-driven R&D, or by investing in Canada’s market development (see point 4 and 5 above) to contribute to the global R&D agenda. With the next UN-HLM on TB taking place in September 2023, we are calling on Canada to invest its fair share (totalling $25,300,000, which requires Canada to invest an additional US $5 million per year) in TB R&D.
6.2: Invest in multilateral mechanisms that support country-level health systems strengthening
As a result of limited ODA resources, most replenishments of global health financing mechanisms in the past year have missed the mark, whether for maternal and child health, or fighting AIDS, TB and malaria. We call on the government to increase ODA to devote global health security funding in proven global mechanisms that prioritize strengthening country-level capacity and health systems that can identify and respond to existing epidemics like TB and new disease threats. Health systems, particularly primary healthcare and community systems, continue to be chronically underfunded, disjointed, and inequitable worldwide. Health systems strengthening should therefore be Canada’s central focus while funding mechanisms like the GFATM, Global Financing Facility, FIND, the global alliance for diagnostics, and the new Financial Intermediary Fund for Pandemic Prevention, Preparedness, and Response. With the UN High level meetings on UHC, Pandemic preparedness and TB all planned for 2023, it is urgent for Canada to be forward planning in terms of engagement in these policy fora, with health systems strengthening at the centre.
Canada must also consider multi-year funding for mechanisms complementing large multilateral funds as the GFATM focused on TB, like TB REACH, an innovative financing mechanism aimed at improving access to TB diagnosis and treatment. Since its establishment in 2010, TB REACH grantees have saved 1.3 million lives.
In 2015, Canada committed a 5-year award of CAD $85 million to TB REACH, and in March 2022, the Government pledged a new investment of CAD$11 million. This one year investment however is not sufficient to sustainably support TB REACH programs and longer-term commitments are essential. A 5-year award of CAD$ 50 million would show continuity and support essential community health systems to get back on track.
7: The Government should commit to increasing its IAE each year over the next three years to reach a minimum of CAD 10 Billion in the 2025-26 budget, in line with the government’s own commitment to increase international development assistance every year toward 2030.
The government set a very laudable commitment to increase ODA levels each year in its last Speech From the Throne. It is indeed important to underscore that despite inevitable setbacks, international cooperation has been an incredibly successful investment, resulting in significant gains for human development since the 1990s.
Such investments are needed now more than ever. The world is reeling from a convergence of crises of climate, conflict, and COVID-19, which has had a particularly devastating impact on the fight against TB. Deaths from the disease have risen for the first time in more than a decade, driven by a surge in undiagnosed and untreated cases. This not only means we must invest now to reclaim gains lost, it means the global health security threat of TB has increased.
Based on the funding model proposed by the Brookings Institute and the London School of Economics to calculate donor contribution increases required to reach the Sustainable Development Goals (which Canada has endorsed), the current crises that have increased the need for international development, and the Government’s commitment to increasing the IAE annually, there should be regular increases in Canada’s budget in order to reach an IAE of $10 billion by 2025-26.