Pre-Budget Submission in Advance of the 2025 Federal Budget
Stop TB Canada recently submitted to the pre-budget consultations in advance of the upcoming 2025 federal budget. The content of the submission is found below:
Written submission for pre-budget consultations for the 2025 Federal Budget
By: Stop TB Canada August 2024
Domestic recommendations:
Recommendation 1:
The Government must allocate additional resources to strengthening timely and detailed TB surveillance, in order to support the domestic TB elimination goals to which it has committed.
Recommendation 2:
The Government must allocate additional resources to the National Tuberculosis Elimination Task Force and lengthen the duration of this funding to allow the Task Force to effectively address current barriers to TB elimination by partnering with key stakeholders in Canada.
Recommendation 3:
The Government must fund Immigration, Refugees, and Citizenship Canada to overhaul its TB screening program for migrants to Canada and subsequently fund clinical care associated with positive screening tests, and monitor the impact of these changes on TB in Canada.
Global recommendations
Recommendation 4:
The Government must meet its commitment to contribute its fair share investment in research and development for TB, by allocating 0.15% of its total research expenditure, or at least $50 million, to TB annually.
Recommendation 5:
The Government must reaffirm its commitments to ending TB globally by renewing its investment of at least $1.2 billion over three years to support the eighth replenishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria in 2025.
Recommendation 6:
The Government must increase the International Assistance Envelope by $650 million for three-years until 2028/29, in line with the Government’s commitment to increase international development assistance every year toward 2030 to realize the United Nations Sustainable Development Goals.
About the domestic focused recommendations
1. The Government must allocate additional resources to strengthening timely and detailed TB surveillance, in order to support the domestic TB elimination goals to which it has committed.
Publicly released TB surveillance data in Canada is currently delayed by at least 2 years, with only high level analysis. Reporting systems are outdated, slow, and databases non-interconnected. These issues are well recognized across all communicable diseases, highlighted by information needs during the COVID pandemic, and detailed in the Joint FPT Action Plan on Health Data and Digital Health. The government must allocate additional resources to strengthening timely and detailed TB surveillance, in order to support the domestic TB elimination goals to which it has committed. Specifically, to strengthen the quality, timeliness and usability of TB data in Canada, the federal government must:
Earmark funding in federal health transfers to Provinces/Territories/other health jurisdictions to support the hiring of dedicated TB data managers and epidemiologists, as well as IT solutions to reduce the laborious nature of data collection, and improve interoperability of data capture systems across jurisdictions.
Allocate additional resources to the PHAC to expedite consultation with jurisdictions on standardized data definitions and priorities for data collection and key program performance metrics.
Allocate additional resources to the PHAC to work with partners such as the NCCID to improve the dissemination of TB surveillance data. These data must be accessible to researchers, jurisdictional program planners, and civil society.
Allocate specific funding to address TB data issues within the ongoing work of the Joint FPT Action Plan on Health Data and Digital Health.
Strengthening Canadian TB surveillance in these ways will facilitate more effective action and support the communities most affected by TB in Canada. Currently, practitioners and researchers must wait an average of 25 months to obtain the most recent TB statistics. When they do receive this information, it is of limited use because it is outdated and stratified only by basic demographic variables. Aside from the dearth of patient-level TB data in Canada, the lack of robust TB surveillance is also a missed opportunity for TB program performance measurement and monitoring, which is not currently conducted in most regions. This represents an enormous barrier to designing an evidence-informed and adaptable TB response, in turn greatly hindering progress on TB elimination in Canada.
2. The Government must allocate additional resources to the National Tuberculosis Elimination Task Force and lengthen the duration of this funding to allow the Task Force to effectively address current barriers to TB elimination by partnering with key stakeholders in Canada.
TB continues to affect thousands of Canadian households, particularly of First Nations, Métis, and Inuit peoples, as well as those born outside of Canada. Sustained, coordinated, equity-focused action is needed to reduce suffering related to TB; however, Canada’s approach to addressing TB remains piece-meal and segregated. In 2018, Canada became a signatory to the United Nations Political Declaration on the Fight Against Tuberculosis and committed publicly to developing a TB Elimination plan. Critically, Canada committed to reducing TB in Inuit Nunangat by 50% by 2025 and eliminating TB in the Inuit homelands by 2030. While Inuit Tapiriit Kanatami has made significant progress towards these goals, additional support is required. Canada has taken the initial step of forming a time-limited National Tuberculosis Elimination Task Force; however, solutions to eliminate TB take time to develop and must be sustained for long periods to be effective. In part, this is because TB-affected communities have long been mistreated by multiple institutions and are impacted by poverty and lack essential infrastructure. Any equity-focused plan must involve input and commitment from affected groups which requires trusting relationships. The Task Force, whose current mandate is for one year, needs time and funding to consult meaningfully, act accordingly, and monitor and evaluate results.
To see real change, the current iteration of the National TB Elimination Task Force must be transitioned to a standing committee with funds at its discretion for developing an actionable plan and for implementing and evaluating results. A coordinated federal response is needed to:
Strengthen TB screening and subsequent programs for treatment of detected TB infections in high-risk groups
Improve access to essential TB medications which requires Health Canada and Public Health Agency policy change
Act on the social determinants of TB which include poverty, housing, and poor access to quality health services
Rectify long standing inadequacies related to Canadian TB surveillance and program performance measurement
Monitor and evaluate the impact on Task Force recommendations for interventions at the national level
3. The Government must fund Immigration, Refugees, and Citizenship Canada to overhaul its TB screening program for migrants to Canada and subsequently fund clinical care associated with positive screening tests, and monitor the impact of these changes on TB in Canada.
With immigrants representing 70% of TB in Canada, TB screening related to immigration is a key strategy for ending the TB burden in Canada. However, IRCC’s TB screening approach has not changed in over 25 years, despite major changes in clinical TB prevention and in migration patterns, including dramatic increases in the number of individuals undergoing Immigration Medical Exams (IME) within Canada instead of overseas. An evidence-based overhaul of both the IME and the Tuberculosis Medical Surveillance (TBMS) program - in collaboration with the provincial and territorial Ministries of Health - is urgently overdue. Current IRCC screening and post-landing referral policies are inefficient, burdensome on migrants as well as our healthcare system, and do not adequately serve the goal of preventing TB in Canada. The TBMS program in particular is ineffective at preventing TB among migrants and not integrated with domestic TB program efforts towards TB elimination. Strengthening IRCC’s internal data analysis capacity and reporting, integration of IRCC data into national and provincial/territorial TB epidemiologic analyses supporting TB elimination efforts, ongoing TBMS program design and monitoring in collaboration with the provinces and territories, data-sharing agreements and robust interconnected data infrastructure to facilitate such analyses are currently critical gaps. The TBMS system should integrate efficient, evidence-based immigration screening efforts into preventive treatment within the Canadian healthcare system.
About the global recommendations:
4. The Government must meet its commitment to contribute its fair share investment in research and development for TB, by allocating 0.15% of its total research expenditure, or at least $50 million, to TB annually.
At the UN High-Level Meeting on TB in 2018, Canada pledged to contribute its fair share of the US$2 billion annual funding goal for TB research and development (R&D). However, Canada has consistently fallen short of this target.
The fight against TB is hindered by the tools currently available, which are outdated and inadequate. The only existing vaccine is over 100 years old and limited in its effectiveness, while current treatment regimens are lengthy, complex, and come with severe side effects, often leading to patient non-compliance and increased drug resistance. Investing in TB R&D is essential to developing more effective vaccines, faster diagnostic methods, and safer, shorter treatment methods.
The financial need to address TB has been exacerbated by years of underinvestment and the COVID-19 pandemic’s disruption of healthcare services worldwide. Canada now has a unique opportunity to lead the charge in TB R&D by fulfilling its fair share commitment through allocating 0.15%, or CA$50 million, of its research expenditure to TB. Investing in TB R&D will not only drive the improvement in TB prevention, diagnosis, and treatment, but also strengthen health systems as a whole and better prepare the world for future pandemic threats. By funding Canadian researchers and supporting international partnerships, like FIND, Unitaid, and TB Alliance, Canada can participate in groundbreaking initiatives that are cost-effective and purpose-driven while enhancing domestic research capabilities.
5. The Government must reaffirm its commitments to ending TB globally by renewing its investment of at least $1.2 billion over three years to support the eighth replenishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria in 2025.
The Global Fund to Fight AIDS, Tuberculosis and Malaria plays a pivotal role in the global fight to end TB, providing 76% of all international financing for TB. A fully funded Global Fund is therefore essential to enabling TB programs to operate at full capacity and reach the 10.6 million people affected by TB every year. The success of the Global Fund’s upcoming eighth replenishment will largely determine the world’s ability to achieve the 2030 target for TB elimination.
The Global Fund’s eighth replenishment is an opportunity for global leaders to invest in a proven mechanism that promotes health equity and prevents unnecessary suffering. Canada has long supported the Global Fund, most recently with a historic $1.2 billion investment towards its seventh replenishment in 2022. We strongly urge the Government of Canada to maintain its support for the Global Fund as a strategic investment aligned with its commitment to end TB. Beyond its core mission tackling AIDS, TB, and malaria, the Global Fund’s impact extends to promoting human rights, advancing gender equity, and strengthening health systems overall. Investments in the Global Fund therefore support the elimination of the deadliest epidemics confronting humanity, while addressing social determinants of health and strengthening health systems to better prepare for future threats.
6. That the Government commit to increase the International Assistance Envelope by $650 million for three-years until 2028/29, in line with the Government’s commitment to increase international development assistance every year toward 2030 to realize the United Nations Sustainable Development Goals.
In 2021, the Government committed to increase the International Assistance Envelope (IAE) to meet growing global needs and realize the UN Sustainable Development Goals (SDGs) by 2030, which remain off track. The 2023 UN Sustainable Development Report highlights that “progress on more than 50 percent of targets of the SDGs is weak and insufficient; on 30 percent, it has stalled or gone into reverse.” Canada has a longstanding and demonstrated commitment to the SDGs and a world free from extreme poverty, but action must be accelerated and supported by investments which match the scale of the SGDs. To address growing global needs, the IAE must continue to increase year over year, and must do so at an accelerated pace. For this to happen, the government must make clear, detailed, flexible and forward-looking 5-year commitments which meet the best practices and standards recommended by the International Aid Transparency Initiative (IATI). Canada’s IAE should be increased by at least $650 million for three-years until 2028/29 to honour the Government’s commitment and to fill existing funding gaps.