Written Submission for Pre-Budget Consultations for the 2024 Federal Budget
Stop TB Canada recently submitted to the pre-budget consultations in advance of the upcoming 2024 federal budget. The content of the submission is found below:
Written submission for pre-budget consultations for the 2024 Federal Budget
By: Stop TB Canada August 2023
Domestically focused
Recommendation 1:
The Government must fund the development of a National Tuberculosis Elimination Strategy in partnership with provincial, territorial and Indigenous leaders to address the current barriers to TB elimination in Canada, including inadequate TB surveillance infrastructure and limited access to essential TB drugs.
Recommendation 2:
The Government must continue to fund and support the ongoing work of the Pan-Canadian Health Data Strategy, integrating tuberculosis data.
Globally focused
Recommendation 3:
The Government must reaffirm its commitments to ending TB globally by increasing investments in research and development and innovations, implementing programs, and mechanisms necessary to get back on track to TB elimination; and improve accountability measures to ensure TB commitments become realities.
Recommendation 4:
The Government must increase the International Assistance Envelope to at least CA$8.5 billion, keeping with the Government’s commitment to increase international development assistance every year toward 2030 to realize the United Nations Sustainable Development Goals.
About domestically focused recommendations 1 - 2
1: The Government must fund the development of a National Tuberculosis Elimination Strategy in partnership with provincial, territorial and Indigenous leaders to address the current barriers to TB elimination in Canada, including inadequate TB surveillance infrastructure and limited access to essential TB drugs.
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.
TB is the deadliest infectious disease worldwide despite being preventable and curable. TB continues to affect thousands of Canadians, particularly those who were born or have lived outside Canada, as well as First Nations, Métis, 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. While a Inuit Tuberculosis Elimination Framework was developed by Inuit Tapiriit Kanatami, progress towards this goal is deteriorating, as indicated by Canada’s Sustainable Development Goal target tracker (target 3.11.1). A National Tuberculosis Elimination Oversight Committee with a mandate to eliminate TB in all regions of Canada is required.
A National TB Elimination Strategy must include commitments, guidelines, and the funding required to:
1. Improve TB screening strategies among high-priority groups, to improve rapid diagnosis of TB infection and disease, provide medications immediately after diagnosis, and expand preventive therapy to those deemed eligible.
2. Address the social determinants of health and barriers to TB care, which can be achieved through addressing the upstream drivers of TB, including poverty, food insecurity, crowded housing, and houselessness.
3. Improve access to essential medicines for TB treatment, that are recommended by the WHO and the Canadian TB Standards but are currently not formally available in Canada.
4. Implement a timely and robust TB surveillance infrastructure, to provide up-to-date surveillance data, appropriately disaggregated to highlight gaps in TB care.
5. Adopt accountability, monitoring, and evaluation measures for TB programming, through the implementation of the program performance monitoring framework outlined in the Canadian TB Standards.
2: The Government must 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 (PCHDS) 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.”
Advancing tuberculosis elimination is core to achieving health equity in Canada, but the ability to measure progress or identify sticking points along the way is hampered by limited access to information. We strongly support the overarching approach to health data in Canada proposed by the PCHDS. Tuberculosis is a powerful case study for the PCHDS given the fact that all levels of government participate in case management and therefore produce data that have untapped potential for utility. The proposed PCHDS would provide the robust and integrated data urgently needed to design effective solutions against tuberculosis.
About globally focused recommendations 3 & 4:
3. The Government must reaffirm its commitment to ending TB by increasing investments in research and development, and implementing programs, and mechanisms necessary to get back on track to TB elimination.
3.1: Invest Canada’s fair share in TB research and development
Addressing the TB epidemic will depend on the development of new and more effective tools to prevent, diagnose, and treat TB. TB research and development (R&D) has long been underfunded, demonstrated by the archaic tools that are routinely used to address this ancient disease. The only vaccine against TB is over 100 years and its effectiveness is limited. Meanwhile, current widely available treatment options are long, complicated, and toxic.
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 R&D for TB. To meet this goal, the “fair share” targets were established, which Canada has never met - hitting only 67% of the target in 2021. To make matters worse, the annual funding needed for TB R&D has more than doubled due to years of severe underfinancing as well as the impacts of the COVID-19 pandemic on TB programming. The Stop TB Partnership’s Global Plan to End TB 2023-2030 calls on funders to contribute US$5 billion annually for TB R&D. In 2021, only US$1 billion was raised.
Canada must meet the updated “fair share” target of allocating 0.15% of its total R&D expenditure to TB and champion the development of new tools to prevent, diagnose, and treat TB.
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 to contribute to the global R&D agenda. Such investments can support domestic efforts, to enable Canada-based research programs to continue their important contributions towards TB elimination. Funding Canadian research towards the development of a new TB vaccine, for example, would enable Canadian researchers to contribute meaningfully to TB elimination globally.
3.2: Invest in multilateral mechanisms that support country-level health systems strengthening
To end TB, we must first find TB. Canada must continue to support TB REACH, an innovative financing mechanism aimed at improving access to TB diagnosis and treatment for hard-to-reach communities. Canada has supported this mechanism since its establishment in 2010, helping TB REACH grantees save 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$11 million. This one year investment however is not sufficient to sustainably support TB REACH programs and longer-term commitments are essential. A 3- year award of CAD$ 33 million would show continuity and support essential community health systems to get back on track.
4: The Government must increase the International Assistance Envelope to at least CA$8.5 billion, keeping with the Government’s commitment to increase international development assistance every year toward 2030 to realize the United Nations Sustainable Development Goals.
The government set a very laudable commitment to increase ODA levels each year in 2021. 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.
Steady, sustained increases in funding mean that Canada can continue its important development work. An increase to $8.5 billion–a modest amount compared to the 2022-23 IAE which was $8.1 billion, means that Canada’s commitment to international cooperation and global health is not temporary. This increase will make good on a commitment to steady increases and fill funding gaps.
Canada has an opportunity to play a leading role in the fight to end Tuberculosis in Canada and abroad. Ending TB can improve health equity and contribute to the achievement of several Sustainable Development Goals (SDGs), such as:
eradicating poverty (SDG 1),
eradicating hunger (SDG 2),
promoting decent work and growth (SDG 8) and
promoting good health and well-being (SDG 3).
However, to achieve this, the Government must urgently step up to resource the fight to end TB and remain a reliable and consistent partner over the long term.