Tuberculosis in developing countries

Tuberculosis (TB) is a contagious and bacterial airborne disease. It is 1 of the top 10 leading causes of death worldwide, and is the second leading cause of death from a single infectious agent behind only COVID-19 and ranking above HIV/AIDS. According to the World Health Organization (WHO), around 1.8 billion people are infected with TB, most of whom have the inactive form of the disease. In 2020, approximately 10 million people developed active TB. Of this number:

• 5.6 million were men
• 3.3 million were women
• 1.1 million were children

People living with HIV/AIDS are 15 to 22 times more likely to develop TB due to a weakened immune system. In 2019, TB caused:

• 1.23 million deaths among HIV-negative people
• 214,000 deaths among HIV-positive people

TB causes a high number of deaths despite being a preventable and curable disease due in large part to the fact that globally more than 4 million people who developed TB per year are being missed by public health systems.

Finding the missing cases

These missed people do not receive the treatment and care they need. Many of these untreated cases occur in vulnerable and at risk populations due to:

• their physical health conditions
• their living and working environments
• their legal, social or economic standing within society
• the fear of stigma
• discrimination

People who have untreated TB are more likely to infect others. Key groups at risk include:

• people who are poor
• people who are malnourished
• people living with HIV/AIDS
• people living with immunodeficiency disorders or other co-morbidities
• miners
• prisoners
• women and children
• ethnic minorities
• refugees and migrants, especially those coming from high burden countries
• homeless people
• people addicted to drugs and other substances

Many of these factors are also the same as those that lead to an increased chance of being infected with COVID-19. It is especially serious when this limits a person's ability to access health services. Before the COVID-19 pandemic, worldwide rates of TB infection, death and TB-related illnesses were declining; now, the pandemic threatens to reverse this progress globally. In many countries, resources essential to TB services have been reallocated to the response to COVID-19. COVID-19 could cause an additional 6.3 million active TB cases globally between 2020 and 2025 (source: Stop TB Partnership).

Canada's priorities

Canada and the global community have agreed to end TB by 2030. It is 1 of the targets set out in the UN's Sustainable Development Goals. Canada and other countries reaffirmed this commitment in 2018 at the UN's High-Level Meeting on Fight to End TB, which was the first-ever UN high-level meeting on TB. Canada recognizes the urgent need to control TB, and it is the second largest donor country for global TB programming, following the United States.

Canada's global priorities on TB include:

• supporting innovative approaches to finding and reaching poor and vulnerable populations, including women and children
• promoting the empowerment of women and girls as agents of change within their communities, which will help to make TB responses more effective; this is especially effective in finding individuals with TB who have not been diagnosed
• strengthening the financial sustainability of key TB stakeholders and improving coordination between them
• supporting the greater engagement of civil society and community-based actors—including people in TB-affected communities—to ensure accountability at all levels

Canada's engagement

The Stop TB Partnership, founded in 2001, is a key partner of Canada in the fight against TB. Established as a global coordinating mechanism, its objective is to motivate and facilitate global efforts to stop the spread of TB. The Stop TB Partnership works closely with many other key TB stakeholders. Canada is a member of the organization's Board and Executive Committee.

TB REACH is an initiative under the Stop TB Partnership. Launched in 2010, TB REACH supports innovative projects. Its goal is to improve the detection and treatment of TB in targeted vulnerable populations, including women and girls. Canada has provided $2016 million since 2010, including $85 million for the period from 2017 to 2021, making Canada a leading contributor to the TB REACH initiative. Canada's support to TB REACH has contributed to the detection and treatment of nearly 2.6 million people with TB. It has further prevented more than 13 million new infections.

Canada also supports the Global Fund to Fight AIDS, Tuberculosis and Malaria (also known as the Global Fund). Canada is the Global Fund's sixth largest donor. Since its creation in 2002, Canada has committed over $3.9 billion to the organization, which represents Canada's largest contribution to any multilateral health institution. Approximately 18% of the Global Fund's financing goes toward fighting tuberculosis. In 2020, the Global Fund treated 4.7 million people with TB. To this day, the Global Fund continues to invest heavily in improving case detection, diagnosis and treatment.