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 2022, an estimated 10.6 million people developed active TB. Of this number:

• 5.8 million were men
• 3.5 million were women
• 1.3 million were children

People living with HIV/AIDS are 16 times more likely to develop TB due to a weakened immune system. TB is the leading cause of death among people with HIV. In 2022, TB caused:

• 1.3 million deaths among HIV-negative people
• 167,000 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. The impact of the COVID-19 pandemic on TB has been profound, posing significant challenges to TB control and elimination efforts worldwide. The diversion of healthcare resources, disruption of essential TB services, and delays in diagnosis and treatment initiation due to the pandemic have led to a setback in TB control progress. Additionally, the measures implemented to contain COVID-19, such as lockdowns and social distancing, hindered TB case detection and treatment adherence. Addressing the intersecting challenges of COVID-19 and TB is requiring innovative strategies, strengthened health systems, and sustained investment in TB prevention, diagnosis, and care.

Canada's priorities

The international community, including Canada, has agreed to end TB by 2030. It is one of the targets set out in the UN's Sustainable Development Goals. Canada and other countries reaffirmed this commitment in 2023 at the UN General Assembly High-Level Meeting on the fight against tuberculosis, which was the second UN high-level meeting on TB. Canada recognizes the urgent need to control TB.

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 committed $241.5 million since 2010, including $25.5 million for the period from 2023 to 2025, 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 3 million people with TB. It has further prevented more than 15 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 seventh largest donor. Since its creation in 2002, Canada has committed over $4.1 billion to the organization, including the latest pledge of $1.2 billion for the 2023 – 2025 period, making it Canada’s largest annual health investment. Approximately 18% of the Global Fund's financing goes toward fighting tuberculosis. In 2022, the Global Fund treated 6.7 million people with TB. To this day, the Global Fund continues to invest heavily in improving case detection, diagnosis and treatment.