Top health officials acknowledge need to 'refocus efforts' on TB elimination

Top federal health officials want to get tuberculosis elimination efforts "back on track" in Canada post-pandemic, as newly published data show already high rates among Inuit ticked up between 2021 and 2022.

The Trudeau government and national organization Inuit Tapiriit Kanatami (ITK) in 2018 vowed to eliminate the disease across Inuit regions by 2030, while cutting infection rates in half by next year.

Both now promise "to do all we can" to reach those goals following the COVID-19 pandemic, according to a joint statement issued March 24, World Tuberculosis Day.

"The COVID-19 pandemic demonstrated the importance of tailored Inuit-led public health interventions," said ITK President Natan Obed and Indigenous Services Minister Patty Hajdu in the statement.

"TB is severe, but it is preventable and curable."

The statement sets the stage for next month's federal budget, where ITK seeks $131.6 million for tuberculosis eradication, following a $16.2-million envelope last year.

In 2021, the rate of active tuberculosis among Inuit in Canada was 676 times that of Canadian-born, non-Indigenous people, according to government briefing documents from May 2023.

Last week Indigenous Services Canada updated its website with the numbers from 2022, which say the active tuberculosis rate among Inuit was over 455 times higher than that of Canadian-born, non-Indigenous people that year.

The tuberculosis rate among Inuit still rose to 136.7 per 100,000 population in 2022, from 135.1. However the non-Indigenous rate also rose to 0.3 per 100,000 from 0.2, explaining the shortening of the gap.

The tuberculosis rate among Inuit in Canada in 2022 was comparable to that of Ghana or Kyrgyzstan, which reported rates of 133 and 130 per 100,000 population respectively, according to World Health Organization estimates.

In a statement also issued on World Tuberculosis Day, top federal doctors acknowledged "the need to refocus efforts both globally and domestically" to reach the elimination targets.

"We are committed to getting back on track towards TB elimination after the COVID-19 pandemic," said Dr. Theresa Tam, chief public health officer at the Public Health Agency of Canada, and Dr. Tom Wong, chief medical officer at Indigenous Services Canada.

Indigenous Services Minister Patty Hajdu was not made available for an interview to discuss the numbers, and the department didn't respond to a request for further comment by deadline.

High rates linked to social determinants

Between 2015 and 2019, the reported incidence rate of active tuberculosis among Inuit living in Inuit Nunangat, the traditional northern homelands, was about 300 times higher than Canadian-born, non-Indigenous people.

"These high rates of TB across Inuit Nunangat reflect the socioeconomic disparities like overcrowded housing, food insecurity, barriers to health care, and poverty," said Obed and Hajdu in the statement.

In an interview last week, Jesse Mike, director of social and cultural development with land claim management organization Nunavut Tunngavik Inc., said Ottawa is on pace to miss the elimination targets.

"Once they start showing up the way they showed up for COVID, hopefully then I'll have a different answer," she said.

"But at this rate, with the amount of funding that is approved compared to the amount that's requested, we're not going to be able to reach that."

Mike said dedicated tuberculosis eradication efforts are only part of the battle, with chronic underfunding in other areas contributing to the disproportionately high rates.

New Democrat members of Parliament also recently raised concerns about access to medication hindering progress, which they urged the ruling Liberals to address.

The government promised to support access to critical life-saving drugs in a statement to CBC Indigenous last week.