We Can End the TB Crisis

By Kate Harvey

Tuberculosis in Canada 

Tuberculosis (TB) has had a known cure since the 1950’s. Even now, seven decades later, it continues to claim more than 1 million lives worldwide every year, and is, by all measures, the single deadliest infection known to humans. For this reason, elimination of the disease remains an urgent public health priority, both in Canada and globally. 

There are about 5 new cases of TB reported per 100,000 population each year in Canada. However, this fact hides the extreme inequity in the distribution of the TB burden, including the fact that Inuit experience TB disease at a rate that is more than 400 times greater than that of the non-Indigenous Canadian-born population. For this reason, the government of Canada has committed to partner with the body representing Canada’s Inuit population (Inuit Tapiriit Kanatami) to eliminate TB in Inuit communities by 2030. However, progress towards this goal to date has been far too slow—in fact, evidence shows that the trend is moving in the wrong direction. 

Medical colonialism and Indigenous realities 

Understanding the specific health challenges faced by Inuit first requires an examination of medical colonialism and the historical role it has played in shaping the present-day TB crisis. Medical colonialism can be understood as a set of practices implemented by colonial governments to exert power over a group by restricting access to health and healthcare services. This mandate for control began with the Indian Act of 1876 and has been repeatedly reinforced through legislation passed in the century and a half since. 

Throughout Canada’s history, Indigenous peoples have continually experienced harms from oppressive health and social policy that has resulted in poor access to healthcare. The legacy of colonialism in the Canadian medical establishment is responsible for the TB crisis that is ongoing to this day. Children in the residential school system were intentionally malnourished and forced to live in extremely overcrowded conditions, which, in the absence of medical treatment, allowed TB to proliferate. The final report by the Truth and Reconciliation Commission found that nearly 50% of deaths in residential schools were attributable to TB disease. Generations of colonial practices have led to a shortage of adequate housing, food insecurity, and poor health service coverage, creating the social and economic conditions that allow the disease to spread. 

These are just a few examples of the structural and systemic racism that has allowed TB to proliferate and cause harm to Indigenous communities. This has been followed by the continued neglect of Indigenous health issues and lack of acknowledgement of past and ongoing harms by the government. Taken together, colonial practices have contributed to one of the highest rates of TB in the world among Canada’s Inuit population. 

An imperative for better treatment access 

Treating TB is a complex process that requires several drugs taken over the course of many months. It is absolutely essential that TB patients are connected with appropriate treatment right away, because any delays can result in life-threatening complications. For one, if left untreated, TB can develop drug resistance, rendering many of the best available drugs ineffective. It is also well known that interruptions to drug regimens can significantly increase the risk of treatment failure—this can have catastrophic consequences for TB patients as well as their families. 

To put an end to the TB epidemic in Inuit Nunangat, patients must have reliable and consistent access to these drugs. Encouragingly, there has been recent progress in treating TB, with safer and shorter drug regimens now available and recommended by the World Health Organization (WHO). Yet, there have been several shortages of these drugs in Canada in the past several years; at the same time, some pharmaceutical companies have discontinued the manufacturing of these very same drugs because they are not profitable. In some cases, patients can’t access the medicines they need because they have not been approved for sale in Canada. Many essential TB drugs can only be accessed temporarily on an individual basis by request of a physician, assuming that certain conditions are met. These restrictions create needless hurdles, in addition to the many other systemic barriers to care that already exist, often resulting in poor outcomes for patients. 

Given the consequences of inaction, the urgency of expanding access to safe and effective TB drugs cannot be overstated. Improved access to these life-saving medicines will make sure that patients can complete treatment without delay or disruption. This would mean fewer TB-related hospitalizations, fewer opportunities for spreading the disease, and ultimately, better outcomes for patients. It is therefore essential that TB programs across the country provide reliable and consistent access to TB drugs. 

Canada’s roles and responsibilities 

The fact that TB is a curable disease is simultaneously a miracle and a tragedy. It means that we could end the crisis if we wanted, but that we have simply chosen not to. It also means that we can—and must—start making different choices. As World TB Day approaches, we can take a moment to reflect on the failures and lessons of the past, and where we stand today; perhaps now more than ever, we have an opportunity to push for change. In the broader context of the global TB crisis, Canada has an opportunity to lead by example, and to make the case for equitable access to life-saving care at a time when TB programs around the world are being gutted. 

As a collaborator in ending the TB crisis, the Canadian government must do its part by supporting access to safe and effective drugs across Inuit Nunangat. Health Canada, the body that oversees drug regulations and approvals in the country, has a responsibility to ensure timely access to TB treatment, by granting approval to the life-saving medicines that have already been endorsed by WHO and are currently in widespread use in other countries. Sustained access could be facilitated by maintaining a stockpile of essential drugs and scaling up partnerships with drug manufacturers. Alternatively, the ability to access TB medications through the Global Drug Facility in Canada would provide patients with more options, as is currently done in countries like Sweden and Australia. 

Given that the TB crisis was caused by colonial settlers, it is self-evident that the responsibility to repair the damage it caused should also fall on the government. In a country that claims to offer universal health coverage to its citizens, however, there are continued and glaring shortfalls in the healthcare services available to the Indigenous population. The continued failures with respect to access to TB medicines shows a disregard for the lives of those who bear the burden of the disease. A health system that excludes the most historically disadvantaged and oppressed is not one that we can accept—we must demand access to the best available standard of care for all Canadians, and settle for nothing less. 

Kate Harvey

is a first-year master’s student in​ epidemiology at McGill, with a background in biomedical engineering from the University of Waterloo. She is interested in studying infectious diseases in a global health context, and evaluating interventions to reduce the burden of tuberculosis among underrepresented groups. Kate’s work is guided by a passion for health equity and improving access to care for communities globally.