Canada: Tuberculosis treatment issues raise urgent concerns
According to a report from Stop TB Canada:
In 2018, the Government of Canada committed to eliminating TB by 2030 across Inuit Nunangat, and by 2035 across the country, with a targeted reduction in TB disease of at least 50% by 2025.
The 2024 WHO Global TB Report, however, highlights concerning trends: between 2015 and 2023, the WHO Region of the Americas experienced a +20% net increase in TB incidence, and Canada remains the only high income country in the region with a reported increase of over 5%. Canada is off track to meet its 2025 target by a significant and widening margin.
Over the past decade, the number of people in Canada diagnosed with TB has gradually risen, and publicly available data show that 1,971 people had TB in 2022. Indigenous peoples, who make up less than 10% of the Canadian population, account for nearly a quarter of all people affected by TB. Meanwhile, the remaining diagnoses of TB are predominantly among people born outside Canada. This latter fact underscores the country’s connection to the global TB pandemic. In 2023, over 10 million people worldwide became sick with TB, and the disease claimed 1.25 million lives.
Access to timely and effective TB medicines is critical to preventing and treating TB. Treatment challenges, however, are exacerbated by the growing burden of drug-resistant TB (DR-TB) globally. In Canada, approximately 11% of people affected by TB have strains resistant to at least one antibiotic.
Limited access to essential TB medicines, found on the World Health Organization’s Model List of Essential Medicines, is a critical issue that hinders effective treatment and undermines Canada’s ambitions to eliminate TB.
People in Canada are not benefiting from the tremendous advancements in TB treatment over the past two decades, including the development of safer, shorter, and highly effective regimens. A key barrier is that these newer TB drugs – and several older ones that are integral to these innovative regimens – are not marketed in Canada.
Most survey respondents reported limited or no availability of the essential TB medicines delamanid (90%), pretomanid (88%), and bedaquiline (88%), while rifapentine was somewhat more accessible (49% reporting limited availability).
In addition, Canada lacks child-friendly TB drug formulations of both marketed and non-marketed drugs, resulting in sub-optimal treatment methods that are traumatic and burdensome for children, families, and healthcare workers alike. This contributes to poor adherence and missed doses, undermining the effectiveness of treatment.
There have been multiple shortages of essential TB medicines in Canada in recent years. These have included shortages of marketed drugs such as rifampin, and non-marketed drugs such as rifapentine.
It is a shame that in a wealthy country, like Canada, people are struggling to access essential tuberculosis medicines. This neglect must end. - Professor Madhukar Pai, MD, PhD, FRSC Inaugural Chair, Department of Global & Public Health, McGill University Canada Research Chair in Epidemiology & Global Health