To coincide with a U.N. high-level meeting on tuberculosis, the O’Neill Institute for National and Global Health Law at Georgetown University Law Center released two reports on TB and human rights, including one that details how migration laws are undermining efforts to fight TB. Infectious Disease News asked O’Neill Institute associates Drew L. Aiken, JD, LLM, and Eric A. Friedman, JD, how the laws are impacting efforts to fight drug-resistant TB.
Migrants and refugees are at high risk for tuberculosis throughout the migration process, including at their place of origin, in transit, at their destination and upon their return, as well as in migration detention for those who are detained. Vulnerability can also persist for many years beyond the migration journey itself. Many factors contribute to vulnerability among migrants and refugees, including overcrowded transit and living conditions, poverty, poor nutrition, poor working conditions and limited access to TB and other health services.
Broken continuity of care (when the full course of treatment is not completed) can lead to drug-resistant forms of TB. Like other forms of TB, MDR-TB can be directly transmitted from patient to patient. A sound public health approach to prevent the spread of TB — and to preserve the human rights to life and health — is to ensure universal access to voluntary and rights-based TB diagnostics; affordable, high-quality treatment; and support.
One of the main legal tools that states use with the aim of protecting public health is to bar entry, stay or residence of people with TB. Yet this approach ignores the reality that TB can be treated and cured, that such blunt measures fail as an effective response to TB and that this approach violates the rights to health and nondiscrimination, which apply equally to refugees and all migrants, regardless of their documentation. Entry restrictions, deportation of people with TB and legal frameworks that fail to adequately ensure that people with TB have a continuous supply of medicines throughout the migration process can lead to poor health outcomes and, where continuity of care is broken during the migration process, migrants may develop MDR-TB. A more effective approach would ensure that everyone has access to voluntary testing (including with diagnostic tools that test for drug resistance) and treatment for latent and active TB (including bedaquiline and MDR medicines with fewer side effects) regardless of location or migration status, and with legal protections against adverse immigration consequences.
Laws limiting access to medical care for migrants or failing to adequately ensure access to TB services in migration detention, and requirements that mobile populations with TB undergo coercive TB treatment, violate the rights of migrants and refugees and impede the TB response, including the response to MDR-TB. Further, because TB knows no borders, regional approaches, such as cross-border referral mechanisms and harmonizing treatment regimens, must be an urgent priority.
- Aiken D, Isbell M. Migration, Tuberculosis and the Law: An Urgent Need for a Rights-Based Approach. Washington, D.C.: O’Neill Institute for National and Global Health Law; 2018. http://oneill.law.georgetown.edu/media/Migration-Tuberculosis-and-the-Law-An-Urgent-Need-for-a-Rights-Based-Approach.pdf. Accessed on October 1 2018.
Disclosure: The migration report was funded by the Stop TB Partnership.