In the lead up to the United Nations High-Level Meeting on Tuberculosis to take place in September, on June 18th the Special Rapporteur on the Right to Health released an open letter emphasizing that states must commit to a rights-based approach to tuberculosis. The letter highlights that current levels of progress levels fail to meet state obligations to progressively realize the right to health and are insufficient to meet global TB targets. Troublingly, at the current level of progress, it will take until 2182 to end TB. This is 152 years beyond the global target to end TB by 2030.
The Special Rapporteur calls for funding commitments which will address R&D and access barriers to new and effective technology and medicines, including for drug-resistant forms of TB, and for the global community to address the high costs of MDR-TB medicines which are driven by non-use of TRIPS flexibilities and other intellectual property barriers. To meet funding requirements of the End TB Strategy for prevention and care, funding should be doubled to at least $13 billion annually, while R&D funding gaps could be closed if states provide .1% of their current annual expenditure on R&D to TB.
TB is a disease of poverty, disproportionately impacting developing countries and the most poor, marginalized and vulnerable people in them, including persons who are homeless, indigenous persons, migrants, persons deprived of liberty (i.e. in prisons and immigration detention), among others. As such, the Special Rapporteur strongly emphasises the need to address human rights barriers for vulnerable populations, which increase the risk of acquiring TB and impede access to TB prevention, testing, treatment and support. To address TB in context of coercive measures, confinement and prisons, the Special Rapporteur calls for inter alia:
- Initiating or accelerating penal reform towards the radical reduction of incarceration decriminalisation of illicit drugs, expand alternatives to incarceration, and rehabilitation, with a strategy, timelines, and targets, developed in collaboration with civil society and other stakeholders;
- Aligning legal frameworks relevant to detention to international standards, including the Mandela standards;
- Aligning law and policy on the use of coercive measures and notification of communicable diseases to international human rights standards, including the rights to liberty and freedom of movement, and the WHO Ethics guidance for the implementation of the End TB Strategy.
In the context of addressing TB and human rights barriers for migrants, the Special Rapporteur calls for states to commit to inter alia:
- Providing TB prevention, testing, treatment and support to migrants and mobile populations with legal protections against negative immigration or other consequences.
- Repealing laws, policies and practices that discriminate against migrants in regards to access to health care; including laws that allow for travel and work restrictions, deportation, or confinement on the basis of TB status.
- Ensuring that laws and policies clearly provide for migrants’ access to TB services in detention and confinement settings.
Addressing these and other human rights barriers would go a long way towards ending TB, a preventable, treatable and curable disease that killed 1.7 million people in 2016, more than HIV and malaria combined. TB is not only driven by poverty, but by rights violations including non-realization of the rights to health, dignity and non-discrimination. If the world is serious about ending this ancient scourge, the political declaration from the High-Level Meeting will include specific, rights-based commitments that address the needs of those most at risk.