In the remote and icy region of Nunavut, Canada, an unexpected resurgence of tuberculosis (TB) has become a severe health concern. Despite Canada's low overall TB rate of 4.8 active cases per 100,000 people, Nunavut stands as a significant outlier with approximately 1 in 500 individuals affected by active TB in 2021.

The recent wave of infections started in Pangnirtung in January 2021 and has subsequently spread to Pond Inlet and Naujaat over the course of two years. According to government reports issued in mid-April, 82 people have been diagnosed with active TB, while an additional 502 individuals have been diagnosed with latent TB, which means they are infected but do not exhibit symptoms or spread the disease.

This resurgence of TB comes as a setback following Canada's commitment in 2018 to eliminate TB among the Inuit population by 2030. While TB is a curable disease, the challenges persist due to inadequate housing, poverty, food insecurity, and stigma surrounding testing and treatment in the region.

The introduction of TB to the Inuit population can be traced back to outside traders around 1919, which quickly spread through the Arctic Indigenous communities. However, through concerted efforts, the rate of TB cases in Nunavut had been reduced to 1 in 3,200 by 1997. Unfortunately, the persistent issues of housing, poverty, and stigma have contributed to a resurgence of the disease.

Overcrowded housing, poor ventilation, and reliance on expensive heating oil further exacerbate the spread of respiratory illnesses like TB. Limited access to healthcare, with remote communities lacking regular access to doctors, also poses a barrier to timely treatment and testing.

To combat the outbreak, pop-up clinics have been deployed to Nunavut, aiming to test and treat as many individuals as possible. For instance, Pangnirtung launched a 10-week clinic that screened over 1,100 residents and discovered six active and 55 latent cases. In Naujaat, local government offices have been transformed into a clinic to screen at least 1,000 residents over a temporary period.

Efforts are also being made to deliver TB care within the communities themselves, reducing the need for medical evacuation. However, the long-term goal of eliminating TB in Nunavut remains challenging, requiring widespread screening and community involvement.

Wastewater sampling has emerged as a valuable tool in tracking TB outbreaks within communities. By monitoring the presence of TB in wastewater, outbreaks can be identified in their earliest stages, allowing for more efficient and cost-effective responses.

Addressing the underlying issues of poverty, overcrowding, and historical trauma is essential to fully eradicating TB in Nunavut. The government's commitment to eliminate TB must be sustained, with a focus on community empowerment and providing appropriate resources to support healthcare infrastructure in the region.

Tuberculosis remains a formidable foe in the Canadian Arctic, but with continued efforts and collaboration, there is hope for a future free from this deadly disease.