Latest news with #tuberculosis
CBC
12-06-2025
- Health
- CBC
Nunavik's tuberculosis outbreaks are a result of decades of colonial neglect, professor says
Nunavik is on track to set another record number of tuberculosis cases, which one scholar says is unacceptable in this day and age. There have been 56 cases so far this year of tuberculosis reported in the region, according to Quebec's health department. On Monday, the region's 14 mayors released a letter, calling on the Quebec government to declare a public health emergency over the rates of tuberculosis. The Nunavik Regional Board of Health and Social Services has said the incidence of tuberculosis in the region is 1,000 times higher than among non-Indigenous people born in Canada. Health Minister Christian Dubé told CBC News he "will continue to follow the recommendations of public health experts on the subject," though he stopped short of committing to a declaration. Natasha MacDonald, a McGill University professor from Kuujjuaraapik who researches culturally responsive care for tuberculosis in Nunavik, said she doesn't believe Quebec is treating the tuberculosis situation in Nunavik with the same urgency as elsewhere in the province. This interview has been edited for length and clarity. What do you make of this call from the mayors to declare a public health emergency over the tuberculosis situation? It's unfortunate that we are in a time and place where we have to make such calls to action. Under a number of international, national and provincial jurisdictions, including the Viens Commission, the Quebec government has a responsibility to ensure that health care in our communities is adequate and is on par with those of non-Indigenous populations. Because of the urgent situation that Nunavik is in right now, the mayors have had no choice but to unite together as one voice to demand that the government do its job. Why do you think we're seeing this upward trajectory in cases of tuberculosis, in 2025? What's unbelievable is that we are a first world nation in Canada, and we have a third world disease within Canada. It exists in Nunavik in our Inuit communities, and it's the same strain that has been in Nunavik since 1928. Quebec made efforts with the City of Montreal, not that long ago, to stop the spread of tuberculosis. Cases were found, contact tracing was done, people were isolated and medicated. In Nunavik, it has been left to grow and we have outbreaks in six of our 14 communities. This is unacceptable, and it should not happen. We are part of Quebec, we are part of Canada. You've alluded to the damage that tuberculosis has wreaked on families historically, with Inuit being sent south for care. Given that history, what do you believe we, as a society, still don't understand treating tuberculosis in Nunavik? What's happening in Nunavik is a result of decades of systemic colonial neglect. Inuit are expected to adapt to those systems, rather than the government adapting those systems to meet the needs of Inuit. The way the regional health board has been implanted by the provincial government makes it a very program-centred health-care system and not a person-centred health-care program. One of the infectious disease nurses said at one point, in all of Nunavik, they ran out of sputum testing kits. So she had to beg and plead from the province of Manitoba to send over 40,000 sputum testing kits. Quebec didn't have any and it wouldn't procure more. There aren't even X-rays in most of our communities, much less X-ray technicians in those communities. And Inuit feel uncomfortable going to the clinic or hospital because of decades of mistrust in medical care and the systemic and individual racism that exists. One of the calls to action in the mayors' letter is about Inuit health sovereignty. What does that look like? For things to change in our communities, Inuit need to be the ones who determine how our programs and systems run, so that they are tailored to the way we think and work. Inuit are being expected to move around the calendars and schedules of health-care workers, and they are workers are told they should not be going house to house for testing. If it were Inuit leading our organizations, we would have a better understanding on how to do more screening. It's not somebody from Quebec City who should be dictating how much money should be going toward basic equipment, We should be. We're the ones in our communities. We're the ones that know that the X-ray machine is broken in this one town, or that we have a new graduate who's just finished their radiography course who could be hired into a position within their community. What we are talking about here is structural change. Can you compare what the system looks like now with Nunavik's health organizations, to that ideal vision you've just talked about? Systemic change would come when Inuit are able to create a new system altogether, through self-determination or self-government. Or if we can appropriate the system and have an Inuk lead who can hire resources, because we know best on how to allocate our resources and where the needs are. The midwifery program in Nunavik is a perfect example of that. This is a system where Inuit have designed how our mothers want to give birth in a community with support, in an Inuit way, and it is unbelievably successful. This is not rocket science. We also understand that translators are as key as any doctor or nurse. Right now, you have French-speaking nurses and doctors that come into our community, and English is often the lingua franca because most Inuit in Nunavik still speak Inuktitut. When you're translating, for example, with a term like tuberculosis, you have to be very careful to make the difference between tuberculosis, which is a disease that can kill you, and something like bronchitis. You can't just say it's a lung problem. I understand that we have to collaborate with the Ministry of Health in Quebec, but at the same time, they have to understand we are not just another region within Quebec. We are distinct and we have needs that have not been met for decades. It's also an example of systemic racism because Inuit in Nunavik have been ignored, have been left behind, have been left to die for decades, and this is unacceptable. It was unacceptable after the first TB case. It was unacceptable after the first death. It's unacceptable now when our numbers are record high. We have nurses who are burnt out. And if this were anywhere else in Quebec, there would be an outcry and the government would be immediately addressing this, so we are expecting the same.
CBC
10-06-2025
- Health
- CBC
Quebec 'closely monitoring' tuberculosis in Nunavik, minister says, as doctors call for more resources
Quebec's health minister says the province's public health service is "closely monitoring" the tuberculosis situation in Nunavik, in the wake of a letter from the mayors of the region's 14 Inuit communities calling for the declaration of a public health emergency. "We take this situation very seriously," Health Minister Christian Dubé's office told CBC News. "We will continue to follow the recommendations of public health experts on this subject." Public health experts who spoke with CBC News said they are facing resource shortages and need help in order to adequately address the rising numbers of active tuberculosis cases in the region. Six Nunavik communities currently have outbreaks of tuberculosis, and the region is on track to set a grim record for the third year in a row on the number of cases in the region, said Yassen Tcholakov, the clinical lead on infectious diseases for the Nunavik Regional Board of Health and Social Services. "We have rates that are comparable to the countries with the most [tuberculosis]. If you take certain communities in isolation, those rates are comparable to the most dire setting in countries that have extremely minimal health resources," he said. He said tuberculosis, while treatable, kills most infected patients within a few years if left untreated. Those who are treated are sometimes left with lifelong problems like scarring on their lungs. If nothing changes, he expects the number of cases in Nunavik to keep growing. "When I hear people calling for a public health emergency, I hear a cry for help — and an observation that the health system is not reaching the expectation of what the population would like to see," Tcholakov said. In a separate statement to CBC News, the Ministère de la Santé et des Services sociaux du Québec said it has mobilized teams to determine the best way to follow up on the requests mayors made on Monday. It said that as of June 7, there have been 56 cases so far this year of tuberculosis reported in Nunavik — even higher than the 40 cases the region's mayors referenced in their letter. Neither the minister nor the department committed in their statements to declaring a public health emergency. The department wrote that it is taking "the time to carefully analyze the situation" before acting. "We are aware that the increase in tuberculosis cases adds to the already numerous challenges [Nunavik] faces regarding access to quality, continuous and safe care and services," the department stated. Faiz Ahmad Khan, a respirologist at the McGill University Health Centre who also works at the health centres in the Nunavik communities of Puvirnituq and Kuujjuaq, said there has been a "chronic shortage" of medical resources in general in Nunavik for years — an issue that also impacts the tuberculosis response. "I think the mayors have raised a very legitimate demand," he said, with regard to the call for a public health emergency. Such a declaration would give health centres the ability to request the resources they need, he said. Khan said resource shortages mean that sometimes entire families have to fly out just to get screened for the disease. In some communities, people also have to fly just to get an x-ray in order to be diagnosed. All of that delays treatment. "Sadly, I'm very worried that there could be more deaths on the horizon from [tuberculosis] — which is totally unacceptable in Quebec in 2025," he said.
BBC News
10-06-2025
- Health
- BBC News
TB: India brought forward its tuberculosis elimination deadline - but can it meet it?
Atul Kumar (name changed) anxiously paced the corridor of a public hospital in India's capital Delhi.A small-appliance mechanic, he was struggling to secure medicines for his 26-year-old daughter who suffers from drug-resistant tuberculosis (TB). Mr Kumar said his daughter needed 22 tablets of Monopas, an antibiotic used for treating TB, every day. "In the past 18 months, I haven't received government-supplied medicine for even two full months," he told BBC Hindi in January, months before India's declared deadline to eliminate the infectious to buy costly drugs from private pharmacies, Mr Kumar was drowning in debt. A week's supply cost 1,400 rupees ($16; £12), more than half his weekly income. After the BBC raised the issue, authorities supplied the medicines Mr Kumar's daughter needed. Federal Health Secretary Punya Salila Srivastava said that the government usually acts quickly to fix medicine access issues when Kumar's daughter is one of millions of Indians suffering from tuberculosis, a bacterial disease that infects the lungs and is spread when the infected person coughs or home to 27% of the world's tuberculosis cases, sees two TB-related deaths every three minutes. India's TB burden has long been tied to poor case detection, underfunding and erratic drug this grim reality, the country has set an ambitious goal. It aims to eliminate TB by the end of 2025, five years ahead of the global target set by the World Health Organization (WHO) and United Nations member as defined by the WHO, means cutting new TB cases by 80% and deaths by 90% compared with 2015 visits to TB centres in Delhi and the eastern state of Odisha revealed troubling gaps in the government's TB Odisha's Khordha district, around 30km (18.6 miles) from state capital Bhubaneshwar, 32-year-old day-labourer Kanhucharan Sahu is struggling to continue his two-year-old daughter's TB treatment, with government medicines unavailable for three months and private ones costing 1,500 rupees a month - an unbearable burden."We can't see her suffer anymore," he says, his voice breaking. "We even thought of abandoning her."At Odisha's local TB office, officials promised to review Sahu's case, but a staffer admitted, "We rarely get the medicines we need, so we ration them." Mr Sahu says he hasn't received the promised 1,000 rupees monthly support from the federal government and at the local TB office, officials admit to chronic shortages, leaving families like his adrift in a failing Routray, who runs the patient support group Sahyog, says medicine shortages are now routine, with government outlets often running dry. "How can we talk about ending TB with such gaps?" she are other hurdles too - for example, changing treatment centres involves navigating complex bureaucracy, a barrier that often leads to missed doses and incomplete care. This poses a major hurdle for India's vast population of migrant a hospital near Khordha, 50-year-old Babu Nayak, a sweeper who was diagnosed with TB in 2023, struggles to continue his treatment. He was regularly forced to travel 100km to his village for medicines as officials insisted he collect them from the original centre where he was diagnosed and first treated. "It became too difficult," he to travel so often, Mr Nayak stopped taking the medication altogether."It was a mistake," he admitted, after contracting TB again last year and being his hospital, no TB specialist was available, highlighting another critical gap in India's fight: a shortage of frontline health BBC shared its findings with the federal health ministry and officials in charge of the TB programme in Delhi and Odisha. There was no response despite repeated reminders.A 2023 parliamentary report showed there were many vacant roles across all levels of the TB programme, affecting diagnosis, treatment and follow-up - especially in rural and underserved vaccines help India triumph over tuberculosis?In 2018, when Prime Minister Narendra Modi brought forward India's TB elimination target to 2025, he cited the government's intensified efforts as a reason for optimism. Two years later, the Covid pandemic disrupted TB elimination efforts globally, delaying diagnosis, diverting resources and pausing routine services. Medicine shortages, staff constraints and weakened patient monitoring have further widened the gap between ambition and these challenges, India has made some the past decade, the country has reduced its tuberculosis-related mortality. Between 2015 and 2023, TB deaths declined from 28 to 22 per 100,000 people. This figure, however, is still high when compared with the global average which stands at number of reported cases has gone up, which the government credits to its targeted outreach and screening programmes. In 2024, India recorded 2.6 million TB cases, up from 2.5 million in 2023. Federal Health Minister JP Nadda recently touted innovations like handheld X-ray devices as game-changers in expanding testing. But on the ground, the picture is less optimistic."I still see some patients come to me with reports of sputum (phlegm) smear microscopy for TB, a test which has a much lower detection rate as compared to genetic tests," says Dr Lancelot Pinto, a Mumbai-based tests, which includes RT-PCR machines - widely used to diagnose HIV, influenza and most recently, Covid-19 - and Nucleic Acid Amplification Testing, also examine the sputum sample but with greater sensitivity and in a shorter the tests can reveal whether the TB strain is drug-resistant or sensitive, something that microscopic testing can't do, Dr Pinto gap, he adds, stems not just from lack of awareness but from limited access to modern tests."Genetic testing is free at government hospitals but not uniformly available, with only a few states being able to provide it."In May, Modi led a high-level review of India's TB elimination programme, reaffirming the country's commitment to defeating the the official statement notably skipped mention of the 2025 deadline. Instead, it highlighted community-driven strategies - better sanitation, nutrition and social support for TB-affected families - as key to the government has also prioritised better diagnosis, treatment and prevention at the core of its elimination approach mirrors the WHO's view of TB as a "disease of poverty". In its 2024 report, WHO chief Tedros Adhanom Ghebreyesus called it "the definitive disease of deprivation", noting how poverty, malnutrition and treatment costs trap patients in a vicious cycle. As India pushes toward its goal of eliminating the disease, deep health and social inequalities remain just six months left until India's self-imposed deadline, new complications have fallout from US President Donald Trump's withdrawal from the WHO and suspension of USAID operations has raised concerns about future funding for global TB efforts. Since 1998, USAID has invested more than $140m to help diagnose and treat TB patients in India. However, India's federal health secretary insists there is "no budgetary problem" hope lies on the horizon. Sixteen TB vaccine candidates are currently in development across the world, with the WHO projecting potential availability within five years, pending successful trials.
ABC News
10-06-2025
- Health
- ABC News
Timor-Leste's largest rubbish dump is causing a 'national' health problem
The smoke from burning waste gets so thick at Delfina Martin's home in Timor-Leste, she and her children struggle to breathe. But she says it's not the only way the country's biggest rubbish dump — only 300 metres from her house — damages her family's health. "During the rainy season the children have stomach aches, fever, gastroenteritis," she says. "My mother also suffered from tuberculosis and was treated at the clinic, but in 2014 she died." Rubbish from the capital Dili, home to about 300,000 people, is transported and dumped in the 23-hectare landfill, about 12 kilometres west of the city. Unable to find another home, Ms Martin has lived near the rubbish dump in Tibar, a long-established residential area, for more than 30 years. Flies come into her house from the rubbish dump, spoiling the family's food, she says. Ms Martin is one of many residents who fear the rubbish dump is wrecking their health. Her neighbour, Miranda Dos Santos, says the smoke from burning waste has weighed heavily on her. "I have regular coughs, fevers and stomach pain, and then I contracted [tuberculosis]," she says. "I underwent treatment at the clinic and took medication for six months." Timor-Leste's government responded to residents' concerns by vowing in 2012 to relocate the rubbish dump. But Ms Martin says despite the promise, nothing has happened. "Hospital garbage is also thrown here, people do not bury anything," she says. Waste disposal has been one of Timor-Leste's most visible problems. With scant waste management infrastructure and services, it has mainly disposed of rubbish by dumping and burning at disposal sites, a 2023 analysis from the Secretariat of the Pacific Regional Environment Programme (SPREP) found. SPREP's study also found no landfills or dump sites in Timor-Leste were up to "modern" standards of waste disposal that minimised their impacts on the environment. Researchers found many households and businesses were illegally dumping and burning their waste. Tibar's rubbish dump, which began operating in 1982, is the only controlled landfill in Timor-Leste. This means it is managed with some level of government oversight. Still, the smell of waste there can be overwhelming, Ms Dos Santos says. "Sometimes garbage from the trucks falls on the road, but [garbage collectors] are not interested in picking it up," she says. More than 1,800 people have been treated for acute respiratory infections at the Tibar medical centre over the past year — at least 10 times the national rate. Timor-Leste's National Director of Health covering the Tibar area, Manuel Albino, says the health impacts of the dump are a "national" problem. "In terms of public health, the communities in Tibar are at severe risk from the garbage that comes from the capital," he says. Mr Albino says along with acute respiratory infections like pneumonia, it has caused other common illnesses in the area including diarrhoea. Nuno Vital Soares, Director of Timor-Leste's Laboratory National Hospital, says the high rates of illness in Tibar are undoubtedly because of substandard water and pollution from the dump. "The water consumed can have a negative impact on pregnant women. It can be seen from the respiratory tract," he says. "If the water is contaminated with some chemicals or microbes, there is no treatment for it properly, even if its percentage is small." The Timor-Leste government says it is aware of the problems, and is trying to address them with new technology and waste disposal practices aiming to reduce contamination. "Since 2022 until today, we have stopped burning garbage, started reducing the amount of waste," Domingos Godinho, Director of Water, Sanitation and Environment Services at Dili Municipality, says. He says it uses a new system that prevents rubbish impacting the surrounding environment, including spreading a geomembrane — a large waterproof tarp — along the ground to stop rubbish from contaminating water and soaking into the soil. But Mr Godinho says the government has abandoned the plan to relocate the rubbish dump because it is too expensive. "The government saw the high cost and decided to still maintain the Tibar landfill. So now we deploy this big, new project." But Tibar residents say last month, rubbish started burning once again at the rubbish dump. Mr Godinho says "unknown people" had burnt waste at the site, but the government has reactivated security at the site to stop it. "The government guarantees that people will not burn garbage any more," he says. Environmental experts say something needs to change, to protect residents' health. Local environmental researcher Augustu Almeida da Silva says there is a need for a solution involving both the government and the community. And he says it is urgent. "If it is not resolved, the consequences can reach a point where the whole of Timor will be like a garbage dump," he says. For now, the rubbish trucks continue to hurtle past Ms Martin's home. She says she just wants to see action that would protect her family.
Telegraph
10-06-2025
- Health
- Telegraph
US aid cuts threaten South Africa's status as powerhouse of HIV and tuberculosis research
South Africa risks losing its status as a powerhouse of HIV and tuberculosis research as sweeping American funding cuts jeopardise dozens of experimental trials. At least 27 HIV trials and another 20 TB trials in the country have been put at risk by Donald Trump's deep cuts to foreign assistance and global health spending, new analysis shows. Loss of the trials would hit research projects looking for new vaccines into both infections, as well as new long-lasting protective medicines and studies into the best way to treat children. Having intense HIV and TB epidemics as well as world class universities and research institutes has made South Africa a leader in combating the two diseases. Yet while the research has often been led by South African scientists, it has overwhelmingly been conducted with international funding, particularly with 20 years of generous United States government aid spending. Prof Salim Abdool Karim, director of the Centre for the Aids Program of Research in South Africa, said: 'The US is such a big player in our country – South Africa is a powerhouse in medical research because of what the US spends.' The bulk of funding for research came from the US National Institutes of Health (NIH), with the country receiving an estimated £111m ($150m) each year. Prof Ntobeko Ntusi, the president and chief executive of the South African Medical Research Council (SAMRC), said earlier this year: 'In many ways the South African health research landscape has been a victim of its own success, because for decades we have been the largest recipients of both [official development assistance] funding from the US for research [and] also the largest recipients of NIH funding outside of the US.' Now, unless alternative sources of money can be found, South African academic and research institutes could lose about 30 per cent of their annual income and may be forced to lay off hundreds of staff, the analysis found. 'There's been a huge dependence on US funding. The loss of it for South Africa means the cancellation of a huge amount of research,' said Tom Ellman, director of the MSF's Southern Africa Medical Unit (SAMU). The joint analysis by Treatment Action Group (TAG) and Doctors Without Borders (MSF) of NIH-funded research found 39 TB and HIV clinical research sites are under threat, placing at least 27 HIV trials and 20 TB trials at risk. The effect of cuts could be wider still, with research also funded through other US channels, including the US President's Emergency Plan for Aids Relief (Pepfar), which has been slashed by Donald Trump's administration. Global research 'in peril' Lindsay McKenna, TB project co-director of TAG said: 'Public funding from the US government to South Africa is the scaffold on which pharmaceutical companies, philanthropies, and other governments invest in transformative TB and HIV science.' 'These ongoing funding disruptions by the US government don't just affect US-funded research projects, they put in peril a much wider ecosystem of global research.' Dr Ellman said a combination of the infections found in South Africa, its research base and its strong grass roots activism had combined, with US funding, to make the country so prominent in research. He said: 'For years, South Africa has spearheaded the research and development of critical innovative medical tools for the prevention, diagnosis, treatment and care of HIV and TB which have saved lives not just within South Africa's borders, but also in communities worldwide.' The country has more HIV patients than any other, with an estimated 8 million currently infected and 105,000 deaths annually. The high prevalence of HIV goes hand-in-hand with a high prevalence of tuberculosis, because TB takes advantage of patients' weakened immune systems. Tuberculosis is the biggest cause of death among those with HIV in South Africa, which recorded 54,000 TB deaths in 2023. At the same time, the country has strong research institutions and universities, and a history of medical innovation, including conducting the first heart transplant in 1969. Finally, the history of the apartheid struggle, and later the fight in the early 2000s to get antiretroviral drugs in the face of government AIDS denialism, has produced well-organised and politically-engaged health activists. According to the joint analysis, HIV trials now at risk include studies into using broadly neutralising antibodies (bNAbs) to find a cure, and also trials into long-lasting anti-HIV preventative jabs. The Brilliant Consortium, a collaboration of African researchers led by the SAMRC working to develop an HIV vaccine, lost all funding even as it was about to begin an early stage vaccine trial. Dr Ellman said: 'I think it would be a disaster if we gave up on the hope of finding an effective vaccine for HIV. All of that has been done with South Africa and without access to South African research and communities, it's not going to be possible.' The emergence of some resistance to antiretroviral drugs has also highlighted the importance of trials to find new drugs which can deal with the phenomenon. HIV trials are also looking at honing and improving existing treatment regimes, as well as simplifying and rolling out expensive techniques first used in the developing world. TB trials at risk include studies for new drugs and shorter, safer regimens for treatment and prevention. The cuts have a ripple effect beyond individual trials, because they also weaken research infrastructure which is used and relied on by other funders. That could have a knock-on effect on trials looking at new TB jab possibilities, including the promising new M72/AS01E vaccine candidate. South Africa is now scrabbling for alternative sources of funding to try to salvage as many of the research projects as possible. Dr Ellman said: 'We call on all potential donors to step up, as without sustained investment, we will never end these deadly epidemics.'
