COVID-19 pandemic stalled progress on eliminating tuberculosis among Inuit: officials

Nunavut’s health minister says the COVID-19 pandemic has undermined the Inuit community’s efforts to eliminate tuberculosis and questions remain about whether the goal of eradicating the disease will be achieved.

“COVID has had a huge impact on every area of ​​healthcare, including tuberculosis,” said John Main. “While we’ve put a lot of effort into dealing with COVID, we’ve really had to slow down work in other areas.”

Five years ago, Ottawa and the national advocacy group Inuit Tapiriit Kanatami announced plans to at least halve the number of active tuberculosis cases in Inuit Nunangat to no more than 100 cases per 100,000 people by 2025, and bring them to zero by 2030. eliminate. Inuit Nunangat, or Inuit Homeland in Canada, is made up of more than 50 communities in Nunavut, the Northwest Territories, Quebec and Labrador.

According to the Public Health Agency of Canada, between 2019 and 2020, the reported incidence of active tuberculosis among the Inuit dropped significantly from 188.7 to 72.2 cases per 100,000 population. However, health officials in Inuit Nunangat say part of the reason is reduced screening.

Indigenous Services Canada says the Inuit TB incidence rate will rise to 135.1 in 2021.

Nunavut is now “getting things back on track,” Main said. The Territory signed a TB information-sharing agreement with Nunavut Tunngavik Inc., an organization representing the Nunavut Inuit, in November. Main said they are also working towards completing a three-year plan to guide the elimination efforts.

“I’ve become acutely aware of the hardship and stigma associated with TB, and the historical trauma factor associated with TB,” he said. “That’s what we incorporate into our work at all levels, an understanding of our role as health care providers and how sometimes we need to listen and not just talk.”

Main added that the district is strengthening its relationships with communities affected by the disease. Pangnirtung, where an outbreak was declared in November 2021, has provided human support in addition to the Canadian Red Cross, epidemiological analysis, and improved education and outreach efforts.

Whether the 2025 and 2030 targets for eliminating TB will be met is the “big question,” Main said.

“I can’t say at this point, but it certainly won’t stop us from doing everything we can to make it happen,” he said. “I wouldn’t say I can look into a crystal ball to see what’s going to happen in the next two years, but I would say I’m hopeful and cautiously optimistic.”

The Nunavik Regional Health and Social Services Board said the region has resumed community screening and is working to provide better targeted services, including recruiting local public health officials. As of January, all communities in Nunavik provided a vaccine that protects young children from complications and severe forms of TB.

While the risk of developing tuberculosis in Canada is very low, it is higher among Inuit people.

According to Aboriginal Services Canada, between 2015 and 2019, Inuit living on Nunangate Island, Inuit, reported about 300 times the rate of active tuberculosis than Canadian-born non-Indigenous people.

Barriers to healthcare, poverty, food insecurity and overcrowding in poorly ventilated housing contribute to the disproportionate rates. Challenges facing Nunavut include a lack of health care staff and infrastructure, Main said.

The latest federal budget has allocated $16.2 million over three years to fight tuberculosis in Inuit communities. Inuit Tapiriit Kanatami says that’s about a quarter of the resources needed for the next phase of eliminating TB.

“This modest investment in Inuit health priorities does not deliver on our shared commitment with the Government of Canada to eliminate tuberculosis in Inuit Nunangat by 2030,” President Nathan Obaid said in a statement. said in a statement. “But we remain optimistic that future federal budget cycles will unlock the funds needed to meet this commitment.”

A study published in the December 2022 issue of the scientific journal Infectious Disease Modeling evaluated TB elimination strategies in Nunavut. It shows that the 2025 emission reduction target is not achievable under current plans and that TB elimination will extend beyond 2030.

The study identified challenges, including prolonged delays in case detection, limited access to diagnostic tools and services, and insufficient capacity for contact tracing and rapid initiation of treatment.

Indigenous Services Minister Patty Hajdu said the budget’s approach was “incremental but also substantial” and accompanied by other investments such as bilateral health transfer agreements with provinces and territories.

Those goals are ambitious but realistic, she said.

“They are realistic because if everyone is determined to achieve these goals, then we can,” she said. “It’s going to take a lot of focus from everybody.”

This story was produced with funding from Meta and the Canadian Press News Fellowship.

Emily Blake, Canadian Press

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