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 February 25, 2022

Domestically focused

Recommendation 1: 

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

Recommendation 2:

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

Globally focused

Recommendation 3: 

While responding to COVID-19 we must not forget about other infectious respiratory diseases like tuberculosis (TB). Canada must reaffirm its commitments to ending TB by investing in the proven mechanisms, including research and development, TB REACH, and the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM). With the replenishment of the GFATM on the horizon, we urge larger investments.

Recommendation 4: Increase Canada’s International Assistance Envelope by CAD $1.5 billion above the current 2020-21 financial commitments to reach CAD$9 billion in Budget 2022.

About domestically focused recommendations 1 & 2

1: Fund a robust, modern, timely national tuberculosis (TB) surveillance infrastructure

The COVID pandemic has made the Canadian public intensely aware of the value of transparent, timely, accessible, user-friendly data on infectious diseases. 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. For example, if Nunavut 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 and has committed publicly to eliminating TB in Inuit Nunangat specifically by 2030.

Timely, high quality epidemiologic and laboratory data on TB cases and contacts across Canada are 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). Alarmingly, such data are currently lacking, and it is even more essential now. 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 is needed.  

The TB surveillance system in Canada has been underfunded and under-developed for many years - the last national TB report was published in 2019, presenting minimal data from 2017. 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-19 pandemic has disrupted TB programs and care across Canada, with the majority of TB healthcare workers being redeployed to COVID-19 work, and TB contact follow-up essentially halted. Globally, an estimated 12 years of progress to bring TB under control have been lost during the pandemic, with global TB notifications dropping dramatically, suggesting a large number of TB cases going undiagnosed and untreated. We lack the data required to fully assess the damage COVID-19 has inflicted on TB management in Canada, and critically need timely TB surveillance to evaluate and mitigate this damage.

2: Fund and support the ongoing work of the Pan Canadian Health Strategy

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.

About globally focused recommendations 3 & 4:

The COVID-19 pandemic is devastating tuberculosis (TB) programs worldwide. As national budgets are diverted, healthcare workers are reassigned, and resources are redirected to address the COVID-19 pandemic, progress towards eradicating ancient diseases has been massively disrupted. Given the similarities between COVID-19 and TB as airborne infectious diseases, existing TB infrastructure played a critical role in enabling the rapid global response to COVID-19. However, this diversion of resources, coupled with inadequate research and development and outdated vaccine and treatment options for TB, threatens progress towards the United Nations Sustainable Development Goal of ending TB by 2030 and resulted in the first year-on-year increase in TB deaths since 2005.

While the world’s attention is pulled to the urgent demands of COVID-19, people with TB are continuously being missed. Now more than ever, people affected by TB need high-impact solutions to ensure that they can access the testing, diagnoses, and treatment needed to beat this curable disease. At the United Nations High-Level Meeting on TB in 2018, member states, including Canada, committed to making the necessary investments to end TB, including research and development (R&D), TB REACH, and the Global Fund. Four years later, and with the added demands brought on by COVID-19's disruptions to TB services, we are calling on urgent and sustained action. 

While responding to COVID-19 we must not forget about other infectious respiratory diseases like TB. We therefore make the following specific recommendations, to enable us to get back on track to ending TB at home and abroad.

3.1: Invest Canada’s fair share to TB research and development

At the United Nations High-Level Meeting on TB in 2018, member states, including Canada committed to funding USD$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. 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 100 years and of limited effectiveness, and current treatment options are long, complicated, and toxic. Now more than ever, people affected by TB need solutions. 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. In 2021, Canada met 80% of its fair share, falling short of the USD$25.3 million target by USD$5 million. Canada must, at the very least, commit the missing USD$5 million to TB R&D, as COVID-19 has increased the demand for the tools and treatments necessary to getting back on track to ending TB.

3.2: Reinvest in TB REACH 

Even before the onset of the COVID-19 pandemic, some 3 million people suspected to have TB were missed, increasing the spread and severity of this disease. The pandemic has exacerbated this issue and highlighted the importance of finding the missing millions. TB REACH is an innovative financing mechanism that was launched to demonstrate how targeted interventions could lead to gains in TB case detection. The initiative effectively locates people in hard-to-reach communities so that they can access the care that they need and would otherwise go without. Since its establishment in 2010, with sustained support from the Canadian government, TB REACH grantees have screened more than 40 million people for TB, resulting in over 2.6 million people being diagnosed and put on treatment. Their work has saved approximately 1.3 million lives, and helped stop TB from spreading within at-risk communities.

In 2015, Canada committed a 5-year award of CAD $85 million to the Stop TB Partnership's TB REACH initiative. Other donors of TB REACH include USAID, the Gates Foundation, Indonesian Philanthropic Trust, and the UK Foreign, Commonwealth & Development Office. Canada has provided foundational and leading funding for TB REACH since 2010; however, the funding agreement with Global Affairs Canada (GAC) ended in March 2021 with no news of re-investment. Losing support from GAC would be devastating, especially in light of the disruptions to TB service provision brought on by the COVID-19 pandemic.

Now more than ever, people affected by TB need hope and solutions. TB REACH is well placed to fill gaps in service provision during the pandemic, as the initiative supports community-led programs in isolated communities around the world. We must ensure that Canada re-invest in TB REACH so that millions of people affected by TB will not be missed. 

3.3: Make an ambitious pledge in support of the Global Fund’s 7th replenishment

The Global Fund to Fight AIDS, Tuberculosis and Malaria plays a critical role in the fight to end TB, as it is the largest funder of TB programs globally. The Global Fund’s 2021 Results Report stated that for the first time in the Fund’s history, progress in the fight against HIV, TB and malaria has backtracked. The disruptions caused by COVID-19 in the quest to end these epidemics are devastating, and require action from global leaders like Canada. The Global Fund’s 7th replenishment this year is an opportunity for global leaders to step up and commit to progress towards eliminating TB. In 2019 Canada invested CAD $930.4 million in the Global Fund for their programming from 2021-2023. Now, the funds need to be replenished for programming from 2024-2026, so the United States will be hosting the 7th Replenishment Conference later this year. We urge Canada to make an ambitious pledge in support of the Global Fund this year at its 7th replenishment.

4: Increase Canada’s International Assistance Envelope by CAD $1.5 billion above the current 2020-21 financial commitments to reach CAD$9 billion in  Budget 2022

To respond to the COVID-19 pandemic, recover globally, and prepare for future threats, Canada must increase its International Assistance Envelope (IAE) by CAD $1.5 billion above the current 2020-21 financial commitments to reach CAD $9 billion in Budget 2022. Without an increase in Canada’s IAE, our government will be unable to effectively respond to the pandemic, nor lessen its devastating effects on people affected by TB around the world.