Pre-Budget Submission in Advance of the 2026 Federal Budget
The 2026 Federal Budget presents a critical opportunity for Canada to demonstrate leadership in the fight against tuberculosis (TB). Despite longstanding commitments, TB continues to cause preventable illness and death in Canada and around the world, disproportionately affecting communities facing systemic inequities. In the submission below, Stop TB Canada called on the federal government to make targeted investments that will accelerate progress toward TB elimination, strengthen public health systems, and uphold Canada’s commitments to Indigenous reconciliation, health equity, and global health security.
Summary of Recommendations
Domestic recommendations
Allocate additional resources to strengthen timely and comprehensive TB surveillance, supporting Canada’s TB elimination commitments.
Allocate additional and extended funding to the National Tuberculosis Elimination Task Force to enable long-term, effective action on TB elimination.
Fund Immigration, Refugees, and Citizenship Canada (IRCC) to overhaul its TB screening program for migrants; support the clinical and social services required following positive screening results; and monitor the impact of these changes on TB rates in Canada.
Global recommendations
Meet Canada’s commitment to contribute its fair share investment in research and development (R&D) for TB, by allocating 0.15% of its global health R&D budget to TB.
Reaffirm Canada’s 10 Year Commitment to Global Health and Rights by maintaining annual investments of at least $1.4 billion annually through to 2030.
Fund Immigration, Refugees, and Citizenship Canada (IRCC) to overhaul its TB screening program for migrants; support the clinical and social services required following positive screening results; and monitor the impact of these changes on TB rates in Canada.
About the domestic focused recommendations
1. Allocate additional resources to strengthen timely and comprehensive TB surveillance, supporting Canada’s TB elimination commitments.
Although Canada improved reporting – the Public Health Agency of Canada (PHAC) released 2024 national TB data with a reduced 12-month lag – surveillance remains delayed, fragmented, and limited in detail. Historically, TB data were released with a 2–3 year delay, and even current outputs provide only high-level summaries. Data systems for disease surveillance remain siloed and poorly interoperable, a challenge highlighted during COVID-19 and detailed in the Joint FPT Action Plan on Health Data and Digital Health.
Practitioners and researchers still wait up to 25 months for usable TB data. When available, data are limited to basic demographics, with minimal information on outcomes for cases, contacts, and outbreaks. In most regions, TB program performance monitoring is also absent. These gaps significantly constrain evidence-based TB response and slow progress toward elimination, hindering progress toward the domestic TB elimination goals that Canada has committed to.
To strengthen the quality, timeliness, and usability of TB data, the federal government must:
Fund provinces, territories, and health jurisdictions through targeted health transfers to hire TB data staff (data managers, epidemiologists), develop modern IT systems, and improve interoperability of data systems across jurisdictions.
Allocate additional resources to PHAC to accelerate work with jurisdictions on standardized data definitions; data collection priorities; and key program performance metrics (e.g. contact and TB preventive treatment follow-up).
Provide additional resources to PHAC to work with partners such as the NCCID to improve dissemination of detailed TB surveillance data, accessible to researchers, jurisdictional program planners, and civil society.
Dedicate specific funding to address TB data issues within the ongoing work of the Joint FPT Action Plan on Health Data and Digital Health.
2. Allocate additional and extended funding to the National Tuberculosis Elimination Task Force to enable long-term and effective TB elimination efforts in partnership with key stakeholders.
TB continues to affect thousands in Canada, particularly First Nations and Inuit peoples, and people born outside of Canada. Despite Canada’s 2018 commitments under the UN Political Declaration on TB – including reducing TB in Inuit Nunangat by 50% by 2025 and eliminating TB in Inuit homelands by 2030 — progress remains fragmented and uneven. While organizations such as Inuit Tapiriit Kanatami have advanced important work, sustained federal support and coordination are still lacking.
The National TB Elimination Task Force is an important step toward a coordinated response, but its current mandate ending in March 2028 is insufficient to achieve long-term elimination goals. TB elimination requires sustained investment to address the ongoing impacts of colonialism, poverty, lack of essential infrastructures, food insecurity, and limited access to healthcare. Meaningful engagement with affected communities also depends on long-term relationships, consultation, implementation, and evaluation.
To be effective, the federal government should transition the Task Force into a permanent body with dedicated and flexible funding to develop, implement, and evaluate a national TB elimination strategy. A coordinated approach across ministries and all provinces and territories is needed to: :
Strengthen TB screening and subsequent treatment programs of detected TB infections in high-risk groups.
Improve access to essential TB medications through Health Canada and Public Health Agency policy changes.
Address the social determinants of TB, including poverty, undernutrition, housing, and poor access to quality healthcare.
Rectify long standing TB surveillance and program performance measurement inadequacies
Monitor and evaluate the impact on Task Force recommendations for national-level interventions
3. Fund Immigration, Refugees, and Citizenship Canada (IRCC) to overhaul its TB screening program for migrants; support the follow-up care required for positive screening results; and evaluate the impact of these changes on TB outcomes in Canada.
People born outside Canada account for approximately 80% of TB cases nationally, making immigration-related TB screening central to Canada’s TB elimination efforts. However, Immigration, Refugees and Citizenship Canada has not substantially updated its TB screening approach in more than two decades, despite major advances in TB prevention and significant changes in migration patterns, including growing numbers of Immigration Medical Exams (IMEs) conducted within Canada instead of overseas.
An evidence-based overhaul of both the IME and the Tuberculosis Medical Surveillance (TBMS) program – developed with provincial and territorial health ministries– is urgently overdue. Current IRCC screening and post-landing referral policies are inefficient, burdensome on migrants and our healthcare systems, and do not adequately support TB Prevention goals. The TBMS program, in particular, has limited effectiveness on TB prevention and remains poorly integrated with broader TB surveillance or care systems.
Critical gaps include limited IRCC capacity for data analysis and reporting,, poor integration of IRCC data into local, provincial, and national TB analyses, inadequate data-sharing infrastructure, and insufficient coordination with provinces and territories on TBMS program design and evaluation.
To address this, the TBMS system should be redesigned to integrate efficient, evidence-based immigration screening efforts into preventive treatment within the Canadian healthcare system.
About the global recommendations:
4. Meet Canada’s commitment to contribute its fair share investment in research and development (R&D) for TB, by allocating 0.15% of its global health R&D budget to TB.
Chronic underfunding for R&D has severely hampered progress toward better TB diagnostics, drugs, and vaccines. Current tools are suboptimal: diagnostics often fail to detect multidrug-resistant TB, treatments are long and cause severe side effects, and the century-old BCG vaccine offers limited protection beyond childhood. Insufficient investments are contributing to the slow pace of innovation, allowing the disease to spread, and perpetuating cycles of inequality and poverty.
Although countries committed at the 2018 and 2023 UN High-Level Meetings on TB to increase global TB R&D funding, targets have not been met. Canada reached only 28% of its fair-share contribution in 2023, while global annual funding needs have risen from US$2 billion to US$5 billion due to years of underinvestment, COVID-19 disruptions, and ongoing global crises. At the most recent UN HLM on TB in 2023, a renewed commitment to this new target was made, which will require member states to allocate 0.15% of their gross expenditure on R&D to TB. With just over US$1 billion raised in 2022, there is an urgent need for donor countries, as well as private and philanthropic organisations, to step up their support.
Progress against TB is limited by outdated tools, Increased investment in TB R&D is essential to develop more effective vaccines, faster diagnostics, and safer, shorter treatments.
Beyond its global health importance, investing in TB R&D delivers clear and strategic benefits for Canada. TB remains a domestic public health concern, disproportionately affecting Indigenous communities and newcomers, and continued innovation is essential to achieve health equity while reducing long-term healthcare costs and system pressures. Increased funding also strengthens Canada’s research ecosystem and economic competitiveness by supporting Canadian scientists, creating high-skilled jobs, and advancing biomedical innovation, while positioning Canada as a leader in infectious disease research.
With TB gains still constrained by years of underinvestment and COVID-19-related disruptions, Canada has a timely opportunity to lead by fulfilling its commitment to allocate 0.15% of its research expenditure to TB, leveraging partnerships with organizations such as FIND, Unitaid, TB REACH, and TB Alliance to drive cost-effective global innovation while strengthening domestic capacity. We call on Canada to invest $130 million over three years to support innovation and improved access to TB tools.
5. Reaffirm Canada’s 10 Year Commitment to Global Health and Rights by maintaining annual investments of at least $1.4 billion annually through to 2030.
Canada’s 10-Year Commitment to Global Health and Rights is one of the country’s most important strategic investments in global stability, health security, and economic resilience. Through sustained annual investments of at least $1.4 billion, Canada supports health system strengthening, disease prevention, and equitable access to care across more than 130 countries - efforts that directly reduce the global burden of infectious diseases such as TB. These systems are the first line of defence against outbreaks that, in an interconnected world, can escalate rapidly into global threats affecting Canada’s own health system, economy, and border health capacity, as seen during COVID-19.
Recent reductions in global health financing – including cuts to key multilateral mechanisms such as the Global Fund to Fight HIV, Tuberculosis and Malaria, the primary financing vehicle for TB control – are already placing pressure on TB and disease programs in high-burden settings. This risks weakening early detection and outbreak containment capacity at the global level, increasing the likelihood of more complex and costly cross-border health threats, including drug-resistant TB strains that are significantly harder to manage. Disruptions undermine program effectiveness and erode gains that take decades to build.
We call on Canada to reaffirm its commitment, as a strategic investment in national resilience. It strengthens global outbreak prevention capacity, protects the integrity of international health systems that reduce upstream risks to Canada, and reinforces Canada’s leadership in global health governance.
6. Commit to safeguarding the International Assistance Envelope at CA$10.6 billion in 2026-27, to protect the value of Canadian investments in our world.
The Government of Canada has previously promised to increase Canada’s international development assistance every year until 2030 to realize the Sustainable Development Goals. Last year, Canada cut its envelope by CA$2.7 billion, endangering the progress made in terms of development and protection of human rights. As other countries also turn inwards and pull back their support for international assistance, Canada must remain a leader to protect hard-won gains in global health and development.
We call on Canada to safeguard and protect its Official Development Assistance (ODA) at no less than $10.6 billion for the 2025-26 fiscal year. The latest Statistical Report on International Assistance (2023-24) pegged Canada’s ODA at $10.2 billion. Adjusting for a modest 2% inflation per year over two years, $10.6 billion preserves Canada’s ability to sustain its global impact. Locking in this baseline is a smart, strategic investment that ensures Canada can meet urgent global needs, uphold its international commitments, and protect its long-term national interests.
7. Establish a protected and expanding core minimum of $5.5 billion annually for poverty focused Official Development Assistance (ODA) within Canada’s overall ODA allocations.
Support for international assistance and overall ODA spending has declined globally, threatening our world’s progress toward ending our world’s hard-won gains in global health and development. Concerningly in Canada, poverty-focused assistance is being crowded out by domestic expenditures. In 2023–24, nearly 30% of Canada’s ODA was spent domestically, mainly on refugee and newcomer support. This marked the first time domestic ODA exceeded Canada’s contributions to Sub-Saharan Africa. Supporting new Canadians is critical, but should be accounted for elsewhere. Canada’s international assistance must remain focused on long-term, sustainable poverty reduction overseas, particularly in the least-developed countries.
We call on Canada to establish a protected and expanding core minimum of $5.5 billion annually for poverty-focused Official Development Assistance (ODA) within Canada’s overall ODA allocations.
Stop TB Canada is a network committed to raising awareness, mobilizing communities, and generating the political will to end tuberculosis in Canada and abroad.