Yesterday was the first-ever UN High Level Meeting on Tuberculosis. After much build-up, advocacy, and negotiation throughout the last year, the Political Declaration includes some critical commitments to scale up access to diagnosis and medicines, including by reaffirming the TRIPS Agreement and the Doha Declaration (para 19) and committing to providing diagnosis and treatment to 40 million people with TB between 2018-2022 (para. 24). The Declaration also includes commitments to: adapt and implement the End TB Strategy; develop community based health services which protect and promote equity, ethics, gender equality and human rights; make improvements in policies and systems towards achieving and sustaining universal health coverage; and to protect and promote the right to the enjoyment of the highest attainable standard of physical and mental health, including by addressing social determinants and by “removing discriminatory laws, policies and programmes against people with tuberculosis, and through the protection and promotion of human rights and dignity…” (para 37).
While these commitments are critical, specific and concrete actions at the national, regional and international levels must be taken to end TB, including full implementation of a human rights-based approach. On Monday we launched two reports which show that while there has been significant progress in the fight against TB, a rights-based approach is critical to protect the most vulnerable and to end TB as a public health threat.
Migration, Tuberculosis and the Law: An Urgent Need for a Rights-Based Approach highlights that migrants and refugees are vulnerable to TB throughout the migration process. Yet, many countries from all regions are failing to apply sound and human rights-based TB control in the context of migration. There is an urgent need to replace discriminatory approaches with rights-based approaches, including laws: restricting entry, stay and residence on the basis of TB or health status; limiting access to medical care for migrants; requirements that mobile populations with tuberculosis undergo coercive TB treatment; as well as laws which allow for deportation without continuity of care and those that fail to adequately ensure a rights-based approach to migration detention.
An effective response to tuberculosis requires protection of core rights as a key component of public health. However, in Coercion and Criminalization in TB-Related Public Health Laws Insufficient and Inconsistent Rights Protections in 20 High-Burden Countries, our review of laws in 20 high-burden countries found a troubling incongruence between the commitment to a “rights-based” approach and domestic legal frameworks governing public health and the TB response.
It is critical that states move away from rights-impeding, discriminatory, coercive and punitive approaches to TB and implement laws and policies which ensure access to voluntary TB prevention, treatment and support for all, regardless of where individuals are located and legal status. Regional approaches, such as cross border referral mechanisms and harmonization of treatment regimens, should be fully implemented at all levels, including at national levels, to ensure that individuals have full access to continuous TB treatment across borders and throughout the migration process. Such an approach recognizes the reality that TB and other infectious diseases do not stop at borders; nor should responses.