There were 77 active cases of tuberculosis diagnosed in Nunavut in 2021, more than twice as many as the year before – an increase that calls into question Canada’s pledge to eliminate the infectious disease in Inuit communities by 2030.
The year-over-year increase came as no surprise to experts on tuberculosis, or TB, who noted that case counts were unusually low all over the world during the first year of the COVID-19 pandemic, when the focus of front-line health workers was diverted to tracing that disease.
But Nunavut also saw more cases of TB last year than any recent year with the exception of 2017, when 101 cases were logged across the territory – most of them connected to a large outbreak in the Baffin Island community of Qikiqtarjuaq.
This year and last, another Baffin Island hamlet, Pangnirtung, has been grappling with a TB outbreak. On Friday, Nunavut’s Health Department said two new active cases and 21 new cases of latent TB infection had been identified in the community of 1,500 since August. This brings the total to 184 cases since January, 2021.
“The numbers aren’t increasing as fast as they once were,” said Michael Patterson, Nunavut’s Chief Medical Officer of Health, in an interview before the territory released the Pangnirtung update. “But there are individuals newly diagnosed with latent and active TB in the past few months. And that’s par for the course with TB outbreaks. They typically go on for at least a couple of years.”
In Nunavut, medical staff saw signs of a devastating TB outbreak. The government didn’t
TB is caused by airborne bacteria that most often lodge in the lungs, where they can cause weight loss, sweating, fever, fatigue and a relentless, sometimes bloody cough. The disease can be fatal if left untreated. When the TB bacteria first enter the body, they usually cause a latent infection that isn’t contagious and doesn’t make patients sick, but which puts them at risk for active disease in the future.
When public-health officials speak of TB rates, they generally refer to active cases. Thirty-seven active cases have been reported in the Pangnirtung outbreak.
In 2019, the last year before the pandemic, the rate of active TB cases diagnosed in non-Indigenous people born in Canada was 0.4 per 100,000 people. In Nunavut, where roughly 85 per cent of the population is Inuit, the rate in 2021 was 193 cases per 100,000. (National TB statistics for last year have not yet been released.)
That extreme disparity prompted the federal Liberals in 2018 to join with national organization Inuit Tapiriit Kanatami in promising to halve TB rates in Inuit lands by 2025 and eliminate the disease there by five years thereafter.
“People getting newly infected with TB shouldn’t be happening in Canada. We’re one of the wealthiest countries in the world,” said Elizabeth Rea, the chair of Stop TB Canada and Toronto’s associate medical officer of health. “So what that speaks to is ongoing challenges of inequities in the basic determinants of health, especially in Nunavut.”
On Monday, Nunavut Health Minister John Main and Aluki Kotierk, president of Nunavut Tunngavik Inc., signed a TB information sharing agreement that will see the territorial government disclose details about where the disease is spreading in confidence to the Inuit organization. The two parties promised to develop a framework for what TB data would eventually be released to the public.
For now, the territorial government is declining to divulge TB case counts in hamlets that are not in the midst of declared outbreaks, citing concerns that entire communities could be stigmatized if such numbers were released. That makes it difficult to say which Nunavut hamlets outside Pangnirtung account for the other cases identified in 2021.
One local leader in Nunavut who has been open about his community’s fight against TB is Joe Savikataaq Jr., the mayor of Arviat, a hamlet of about 2,800 on the western shore of Hudson Bay. He lamented the territorial government’s refusal to share TB numbers with him or the broader community as it did with COVID-19 cases during the worst of the pandemic.
“It’s not a privacy issue at all,” Mr. Savikataaq Jr. said in an interview in Arviat last month. “When you just put a number out there, you have no clue who those are. It’s for people’s safety.”
In response to an access-to-information request from The Globe and Mail, Nunavut’s Department of Health released more than 400 pages of internal documents discussing efforts to keep TB in check in Arviat. Every reference to the number of TB cases was blacked out.
Among the documents was a summary of a review of Arviat’s TB program conducted in November, 2020, that concluded front-line work such as identifying and treating active cases, screening and promptly treating contacts was “well done.” It also said that crucial positions in the territorial and regional TB programs were, at the time, vacant and needed to be filled swiftly.
Carl Le Roux, Arviat’s main family doctor, said nurses and other health centre staff have done a good job of curbing TB in a community where overcrowded housing, poverty and chronic illness make residents particularly vulnerable to the disease.
“I feel that TB has always been in Arviat for a long time,” he said in October. “COVID took a lot of the resources from TB, but despite that, I feel we’ve done really quite well keeping a lid on it.”