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Multidrug-resistant tuberculosis (MDR-TB) not only presents a significant challenge to global TB control, it also raises critical questions about the appropriate balance between individual liberties and public health.
In some settings, public health policies sanction the involuntary detention of patients with MDR-TB and may also fail to meet ethical standards in the conditions, care, and support provided to these patients. Limited resources and lack of political commitment have often stood in the way of implementing good policies that can protect and promote both the human rights of patients ill with MDR-TB and the human rights of others to be protected from infection.
As part of the 39th Union World Lung Conference in Paris, the Open Society Institute and the World Health Organization hosted a satellite session bringing together public health officials, human rights and community activists, and healthcare providers to debate and discuss the ethical and human rights challenges highlighted by the growing epidemic of drug-resistant TB.
Advocates argue that involuntary detention is a misguided strategy, particularly in low-resource settings where international human rights principles—such as humane conditions of confinement, rights of due process, and the use of detention only as a last resort—are unlikely to be respected. In addition, detention alone fails to address much more pressing challenges to drug-resistant TB control, including improving access to effective TB diagnosis and treatment.
TB patients, like all patients, are entitled to treatment that respects their human rights and ensures the most success; that is, avoiding detention of TB patients and developing and using community-based models of care whenever possible. There is increasing evidence of the positive impact of such models, including efforts in Peru, Lesotho, and Kayelitsha in South Africa that have demonstrated impressive adherence and cure rates for even the most virulent forms of multi and extensively drug-resistant TB.
These models emphasize community literacy efforts that empower communities to take care of their health through practical and low-cost infection control measures for themselves and their health workers. Much more can also can be done to improve treatment facilities in areas where community-based care is not yet in place, and to support national scale-up of innovative approaches. With new resources flowing for global disease control efforts, there is a major opportunity to change the status quo in many countries.
The discussion was moderated by Françoise Girard, Director of the Public Health Program of the Open Society Institute.
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