A supplement on Ethics and TB has been published alongside the June 2020 issue of the International Journal for Tuberculosis and Lung Disease (IJTLD) and is now freely available to read.
The 10 articles address a broad range of ethical and human rights issues that arise in policy development, planning and delivery of health services for people affected by TB. Read the full supplement now.
In June 2017, the World Health Organization issued the Guidelines on Ethical Issues in Public Health Surveillance. Using the frame of public health ethics, the guidance declared that countries have an affirmative duty to undertake surveillance and that the global community had an obligation to support those countries whose resources limited their capacity. The centrality of TB surveillance has long been recognised as a matter of public health practice and ethics. Nevertheless, contemporary global realities make clear that TB surveillance falls far short of the goal of uniform notification. It is this reality that necessitated the paradoxical turn to research studies that require informed consent and human subjects' ethical review, the very burdens that mandated notification were designed to overcome.
Each year, at least one million children become ill with TB and more than 253 000 died of TB in 2016. The ethical issues surrounding childhood TB remain underexplored and established or proposed management strategies are scarce. This paper identifies ethical challenges that are raised by childhood TB. Some of them are familiar from TB in other populations but arise with increased severity in children.
The authors look at the interconnected and mutually reinforcing difficulties clustered around the topics of susceptibility, diagnosis, reporting, service provision, treatment, psychological and social support, and research and development (R&D) neglect. And go onto formulate suggestions on how to address these ethical issues.
Latent tuberculosis infection (LTBI) is increasingly recognised as being a critical element in global progress towards TB elimination. LTBI affects a much larger group of people than active disease, who by definition are asymptomatic. Furthermore, while LTBI represents a state of risk, there remains significant uncertainty regarding which individuals will progress to active disease. Therefore, the development and implementation of LTBI management policies within the End TB Strategy requires careful ethical consideration. This article reviews ethical issues related to developments in LTBI diagnosis and management, including new tools and emerging policies and practice. Implications of LTBI management practices in specific settings are discussed, including healthcare worker infection and management of likely multidrug-resistant (MDR) LTBI. Better prediction of progression to active disease and less burdensome treatments would allow ethically appropriate expansion of testing programmes in future. However, even with existing tools there is a strong ethical imperative to provide the most effective and least burdensome therapy possible to those with LTBI, particularly those at highest risk of progression and/or poor outcomes from active disease. Greater community engagement is required in designing optimal LTBI management programmes, and ensure harms and benefits are appropriately balanced in specific settings.