The Political and Ethical Challenge of Multi-Drug Resistant Tuberculosis

Abstract

This article critically examines current responses to multi-drug resistant tuberculosis and argues that bioethics needs to be willing to engage in a more radical critique of the problem than is currently offered. In particular, we need to focus not simply on market-driven models of innovation and anti-microbial solutions to emergent and re-emergent infections such as TB. The global community also needs to address poverty and the structural factors that entrench inequalities-thus moving beyond the orthodox medical/public health frame of reference. The problem of drug-resistant tuberculosisTwenty years after tuberculosis (TB) was declared a global public health emergency, it remains a leading infectious cause of death worldwide. TB also remains primarily a disease of poverty; higher rates of incidence follow in lock step with social and economic disadvantage. Two billion people are known to be infected with Mycobacterium tuberculosis. In its most recent report, The World Health Organization (2012) estimated that 8.6 million people develop TB each year and 1.3 million people die from active infection -the vast majority amongst the poor and marginalized in low-and middle-income countries.Data from surveillance programs and drug resistance surveys suggests that almost 4 percent of newly diagnosed cases and 20 percent of re-activated infections are caused by multi-drug resistant strains [MDR-TB] of the bacterium. About 630,000 (roughly 10 percent) of these MDR-TB cases exhibit extensive drug resistance [XDR-TB], which means that at least one of the two most potent first-line TB medications

Beyond Biomedicine: Relationships and Care in Tuberculosis Prevention

“…contemporary approaches. The reductionist approach of personalized medicine aimed at disease elimination will undoubtedly need to turn to more complex models of disease care and prevention that incorporate sociallyinformed perspectives (Farmer 2003;Degeling et al 2015). With the potential of climate change to compromise food security and push human populations into even more overcrowded urban centres, particularly in the poorest regions of the world, the urgency to address infectious diseases such as TB is heightened.…”