The government of Nunavut is planning to screen everyone in Pangnirtung for tuberculosis this fall as the Baffin Island community grapples with the largest outbreak of TB in the territory in at least five years.
Nunavut’s chief public health officer and Nunavut Tunngavik Inc., the territory’s top Inuit organization, announced Monday that they would run a multimillion-dollar, communitywide TB screening program in Pangnirtung from September to November.
Pangnirtung has a population of about 1,500 people, which makes it the largest Nunavut hamlet in recent memory to host such a screening campaign, a massive undertaking for a remote fly-in community near the Arctic Circle.
“A communitywide screen is something that is only utilized in the event that we find an outbreak is not being controlled by the usual robust contact tracing and case management, and that’s what we’ve found in the case of Pangnirtung,” said Sean Wachtel, Nunavut’s chief public health officer.
The most recent public update on the situation in Pangnirtung, delivered in February, indicated that 39 cases of active tuberculosis disease and 167 latent TB infections have been linked to an outbreak declared in November of 2021.
Dr. Wachtel said on Monday that health workers in the hamlet have continued to find cases that aren’t connected to other known cases, leading the territory to conclude that screening everyone is the best way to ensure every infected resident gets the long course of antibiotics required to cure TB.
Tuberculosis is caused by airborne bacteria that can infect several different organs but most often proliferate in the lungs, where they cause fever, sweating, muscle aches, weight loss and a chronic, sometimes bloody cough. TB germs can lay dormant in the body for years as a latent infection that isn’t contagious and doesn’t make people sick, but which can later turn into potentially fatal active TB disease.
TB is exceedingly rare among non-Indigenous people born in Canada, but that’s not the case for Inuit, who have long suffered the highest rates in the country.
That disparity prompted the federal government to join Inuit Tapiriit Kanatami, a national Inuit organization, in vowing in 2018 to eliminate the illness in Inuit lands by 2030.
The federal government made the promise during the last major TB outbreak in Nunavut in 2017-18 in Qikiqtarjuaq, a community of about 600 people north of Pangnirtung.
In February and March of 2018, the Government of Nunavut, with federal support, set out to screen every resident of Qikiqtarjuaq for TB.
The campaign was the first of its kind to be carried out in such a remote northern community in the middle of winter, and it was held up as an example of how a concerted effort by multiple levels of government could medically control the disease.
A preliminary evaluation of the effort, which The Globe and Mail obtained through an access-to-information request, proclaimed the communitywide screening a success. Ninety-six per cent of eligible Qikiqtarjuaq residents agreed to be screened, and the clinic identified 12 previously undiagnosed cases of active TB – seven in adults and five in children – and 24 new cases of latent TB.
The report also made it plain that finding those cases took a herculean effort.
The territorial government established an incident-command system with six supporting committees. It borrowed the equipment for a portable mini-clinic from the federal government’s National Emergency Strategic Stockpile and set it up in the hamlet’s community hall.
The mini-clinic, normally shipped as 16 prepackaged skids of medical equipment and supplies, had to be broken down and rearranged to fit on a plane small enough to land in Qikiqtarjuaq. At any given time, the Qikiqtarjuaq clinic had on site a commander, three TB nurses, two X-ray technicians, two lab technicians, two or three receptionists, one to three doctors and one epidemiologist.
The first shipment of a then-new medication for latent TB froze in transit. Afterward, southern medical staff carried the pills to Qikiqtarjuaq by hand.
Dr. Wachtel said he expects the screening effort in Pangnirtung to cost several million dollars and involve approximately 50 staff working in the hamlet’s community hall, some of whom will rotate in and out. Nunavut Tunngavik, Inc., the Public Health Agency of Canada and Indigenous Services Canada are funding the communitywide screening, Dr. Wachtel added.
Pangnirtung Mayor Eric Lawlor said he would have preferred widespread screening for TB to start earlier, but he’s glad it’s going ahead in the fall. “It’ll help the community a lot,” he said. “It needs to be done.”
He and Dr. Wachtel both said it made sense to wait until autumn because many residents of Pangnirtung leave the hamlet in the late spring and summer to be out on the land.
The screening campaign can identify cases, but it can’t address the root causes of the TB crisis: poverty, overcrowded housing, lack of access to healthy food and general poor health, with rampant chronic illness and high smoking rates making the Inuit particularly vulnerable.
Another Baffin Island community, Pond Inlet, is fighting a smaller TB outbreak, which Dr. Wachtel said was being controlled through aggressive contact tracing. Three First Nations reserves in northern Saskatchewan are dealing with long-standing tuberculosis outbreaks as well.