Drug-Resistant Tuberculosis: Security, Ethics and Global Health

Global Society

Volumn 27, Issue 2, 2013, Pages 159-177

  Enemark, Christian ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

DISEASE CONTROL; DISEASE SPREAD; DRUG RESISTANCE; ETHICS; PUBLIC HEALTH; TUBERCULOSIS;

EID: 84875381760     PISSN: 13600826     EISSN: 1469798X     Source Type: Journal    
DOI: 10.1080/13600826.2012.762345     Document Type: Article

References (85)

1. United Nations, "Security Council Resolution 1308 (2000), " available:, http://www.un.org/ga/search/view_doc.asp?symbol=S/RES/1308(2000). (accessed 27 January 2013).
2. Anonymous, "About PEPFAR, " US State Department, available:, http://www.pepfar.gov/about/. (accessed 24 March 2012).
3. United States Congress, "PublicLaw 108-25 (2003), " available:, http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=108_cong_public_laws&docid=f:publ025.108.pdf. (accessed 28 January 2008).
4. World Health Organization (WHO), A Safer Future: Global Public Health Security in the 21st Century (World Health Report 2007) (Geneva: World Health Organization, 2007), p. 45.
5. United States Government, "National Security Strategy, " The White House, May 2010, available:, http://www.whitehouse.gov/sites/default/files/rss_viewer/national_security_strategy.pdf. (accessed 17 September 2010).
6. Barry Buzan, Ole Waever and Jaap de Wilde, Security: A New Framework for Analysis (London: Lynne Rienner, 1998), p. 5.
7. Barry Buzan, Ole Waever and Jaap de Wilde, Security: A New Framework for Analysis (London: Lynne Rienner, 1998), p. 5.
8. Ulrich Beck and Edgar Grande, "Cosmopolitanism: Europe'sWay Out of Crisis, " European Journal of Social Theory, Vol. 10, No. 1 (2007), pp. 67-85.
9. Stefan Elbe, "Should HIV/AIDS Be Securitized? The Ethical Dilemmas of Linking HIV/AIDS and Security, " International Studies Quarterly, Vol. 50, No. 1 (2006), p. 128.
10. Ulrich Beck and Edgar Grande, "Cosmopolitanism: Europe'sWay Out of Crisis, " European Journal of Social Theory, Vol. 10, No. 1 (2007), pp. 67-85.
11. Charles B. Smith, Margaret P. Battin, Jay A. Jacobsen, Leslie P. Francis, Jeffrey R. Botkin, Emily P. Asplund, Gretchen J. Domek and Beverley Hawkins, "Are There Characteristics of Infectious Diseases that Raise Special Ethical Issues?, " in Michael J. Selgelid, Margaret P. Battin and Charles B. Smith (eds.), Ethics and Infectious Disease (Malden: Blackwell, 2006), p. 21.
12. WHO, "Tuberculosis Factsheet, " World Health Organization, March 2010, available:, http://www.who.int/mediacentre/factsheets/fs104/en/index.html. (accessed 29 September 2010).
13. WHO, Global Tuberculosis Report 2012 (Geneva: World Health Organization, 2012), p. 1.
14. WHO, Global Tuberculosis Control 2011 (Geneva: World Health Organization, 2011), p. 61.
15. XDR-TB is defined as resistance to isoniazid and rifampicin (i.e. MDR-TB) plus resistance to a fluoroquinolone and at least one second-line injectable agent (amikacin, kanamycin and/or capreomycin). WHO, Global Tuberculosis Control 2010 (Geneva: World Health Organization, 2010), p. 7, note 5.
16. World Health Organization (WHO), A Safer Future: Global Public Health Security in the 21st Century (World Health Report 2007) (Geneva: World Health Organization, 2007), p. 45.
17. Ulrich Beck and Edgar Grande, "Cosmopolitanism: Europe'sWay Out of Crisis, " European Journal of Social Theory, Vol. 10, No. 1 (2007), pp. 67-85.
18. Ulrich Beck and Edgar Grande, "Cosmopolitanism: Europe'sWay Out of Crisis, " European Journal of Social Theory, Vol. 10, No. 1 (2007), pp. 67-85.
19. World Health Organization (WHO), A Safer Future: Global Public Health Security in the 21st Century (World Health Report 2007) (Geneva: World Health Organization, 2007), p. 45.
20. World Health Organization (WHO), A Safer Future: Global Public Health Security in the 21st Century (World Health Report 2007) (Geneva: World Health Organization, 2007), p. 45.
21. Anonymous, "Frequently Asked Questions-XDR-TB, " World Health Organization, 26 January 2012, available:, http://www.who.int/tb/challenges/xdr/faqs/en/index.html. (accessed 24 March 2012).
22. Jon Cohen, "Extensively Drug-Resistant TB Gets Foothold in South Africa, " Science, Vol. 313 (15 September 2006), p. 1554.
23. World Health Organization (WHO), A Safer Future: Global Public Health Security in the 21st Century (World Health Report 2007) (Geneva: World Health Organization, 2007), p. 45.
24. Anonymous, "Frequently Asked Questions-XDR-TB, " World Health Organization, 26 January 2012, available:, http://www.who.int/tb/challenges/xdr/faqs/en/index.html. (accessed 24 March 2012).
25. Neel R. Gandhi, N. Sarita Shah, Jason R. Andrews, Venanzio Vella, Anthony P. Moll, Michelle Scott, Darren Weissman, Claudio Marra, Umesh G. Lalloo and Gerald H. Friedland, "HIV Coinfection in Multidrug-and Extensively Drug-Resistant Tuberculosis Results in High Early Mortality, " American Journal of Respiratory and Critical Care Medicine, Vol. 181, No. 1 (2010), pp. 80-86.
26. Results from a study of 654 patients with MDR-TB (272 patients) and XDR-TB (382 patients) in a setting (Tugela Ferry, South Africa) with high HIV co-infection rates showed that the one-year mortality for MDR-TB was 71%, and that of XDR-TB was 83%. Gandhi et al., pp. 80-86.
27. Amy Maxmen, "Fighting the Monster, " Nature, 15 July 2010, p. S19.
28. Anonymous, "Anatomy of a Pandemic: Tuberculosis Today, " World Policy Journal, Vol. 27, No. 2 (2010), p. 8.
29. Anonymous, "In South Africa, XDRTB and HIV Prove a Deadly Combination, " Science, Vol. 319 (15 February 2008), p. 894.
30. WHO, Multidrug and Extensively Drug-Resistant TB (M/XDR-TB): 2010 Global Report on Surveillance and Response (Geneva: World Health Organization, 2010), p. 2.
31. Barry Buzan, Ole Waever and Jaap de Wilde, Security: A New Framework for Analysis (London: Lynne Rienner, 1998), p. 5.
32. Kai Kupferschmidt, "Taking a New Shot at a TB Vaccine, " Science, Vol. 334 (16 December 2011), pp. 1488-1490.
33. Anonymous, "Lawmakers: Tuberculosis in Ukraine Threatens National Security, " The Body, 20 May 2003, available:, http://www.thebody.com/content/world/art28023.html. (accessed 10 September 2010).
34. Anonymous, "TB Poses Security Threat in Russia, Official Says, " Kaiser Network. org, 23 September 2008, available:, http://www.kaiserhealthnews.org/daily-reports/2008/september/23/dr00054604. aspx. (accessed 27 January 2013).
35. Anonymous, "Ghana Should Declare TB as a National Security Threat-Mr Gidisu, " GhanaWeb.-com, 23 March 2010, available:, http://www.ghanaweb.com/GhanaHomePage/health/artikel.php? ID=179057. (accessed 27 January 2013).
36. In the United States, from 1985 to 1992, TB cases increased by almost 20%. See Lee B. Reichmann, "Defusing the Global Timebomb, " Journal of Public Health Policy, Vol. 26, No. 1 (2005), p. 115.
37. Liz Hunt, "Rise in TB Declared a Global Emergency, " The Independent, 24 April 1993, available:, http://www.independent.co.uk/news/uk/rise-in-tb-declared-a-global-emergency-1456999.html. (accessed 27 January 2013).
38. Anonymous, "Emergence of XDR-TB, " World Health Organization, 5 September 2006, available:, http://www.who.int/mediacentre/news/notes/2006/np23/en/index.html. (accessed 23 February 2012).
39. World Health Organization (WHO), A Safer Future: Global Public Health Security in the 21st Century (World Health Report 2007) (Geneva: World Health Organization, 2007), p. 45.
40. In the United States, from 1985 to 1992, TB cases increased by almost 20%. See Lee B. Reichmann, "Defusing the Global Timebomb, " Journal of Public Health Policy, Vol. 26, No. 1 (2005), p. 115.
41. Anonymous, "WHO Warns TB Disaster Possible, " Sydney Morning Herald, 12 November 2007, available:, http://www.smh.com.au/news/World/WHO-warns-TB-disaster-possible/2007/11/12/1194766555830.html. (accessed 31 October 2011).
42. David Brown, "The Two Faces of Tuberculosis, " Washington Post, 19 June 2007, p. HE01. 42. RossUpshur, Jerome Singh and Nathan Ford, "Apocalypse or Redemption:Responding toExtensively Drug-Resistant Tuberculosis, " Bulletin of theWorld Health Organization, Vol. 87, No. 6 (2009), pp. 481-483.
43. Barry Buzan, Ole Waever and Jaap de Wilde, Security: A New Framework for Analysis (London: Lynne Rienner, 1998), p. 5.
44. Wendy Parmet, "Legal Power and Legal Rights-Isolation and Quarantine in the Case of Drug-Resistant Tuberculosis, " New England Journal of Medicine, Vol. 375, No. 5 (2007), p. 433.
45. Kathleen Swendiman and Nancy Lee Jones, "Extensively Drug-Resistant Tuberculosis (XDR-TB): Quarantine and Isolation, " CRS Report for Congress, 5 June 2007, available:, http://www.fas.org/sgp/crs/misc/RS22672.pdf. (accessed 26 September 2010).
46. Jia Rui-Chong, Dozens Exposed to TB While on Flight', Los Angeles Times, 3 January 2008, available:, http://articles.latimes.com/2008/jan/03/science/sci-tb3. (accessed 1 November 2011).
47. David P. Fidler, Lawrence O. Gostin and Howard Markel, "Through the Quarantine Looking Glass: Drug-Resistant Tuberculosis and Public Health Governance, Law, and Ethics, " Journal of Law, Medicine and Ethics (Winter 2007), p. 618.
48. Johanna Neuman and JoelHavemann, "Lawmaker SaysUS 'Dodged a Bullet' in TB Case, " Los Angeles Times, 6 June 2007, available:, http://www.latimes.com/travel/la-trw-na-tb7jun07,0,1735996.story. (accessed 26 September 2010).
49. Government Accountability Office (GAO), Public Health and Border Security: HHS and DHS Should Further Strengthen Their Ability to Respond to TB Incidents (GAO-09-58) (Washington, DC: GAO, 2008), p. 23, note 27. 49. AmandaGardner, "U.S. Barred33TB-InfectedPeople fromFlying overPastYear, "ABCNews, 19 September 2008, available:, http://abcnews.go.com/Health/Healthday/story?id=5836417. (accessed 1 November 2011).
50. S. Penfield, J. Flood, W. Lang, M. Zanker, M.B. Haddad, F. Alvarado-Ramy, L. Leidel, G. Fowler, S. Modi, C. Brown, F. Averhoff and M.S. Cetron, "Federal Air Travel Restrictions for Public Health Purposes-United States, June 2007-May 2008, " Morbidity and Mortality Weekly Report, 19 September 2008, available:, http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5737a1.htm. (accessed 16 May 2012).
51. Philip Alcabes, Dread: How Fear and Fantasy Have Fueled Epidemics from the Black Death to Avian Flu (New York: Public Affairs, 2009), p. 54.
52. Anonymous, "GreggWantsMoreAnswers onTBSecurityBreach', Boston Globe, 12 June 2007. Available to subscribers to the Factiva data base, http://global.factiva.com/aa/?ref=APRS000020070612 e36c00du1&pp=1&fcpil=en&napc=S&sa_from. (accessed 27 January 2013).
53. Eileen Sullivan, "Report on TB Case Cites Security Gaps, " USA Today, 9 September 2007, available:, http://www.usatoday.com/news/washington/2007-09-09-3880389993_x.htm. (accessed 7 November 2011).
54. Johanna Neuman and JoelHavemann, "Lawmaker SaysUS 'Dodged a Bullet' in TB Case, " Los Angeles Times, 6 June 2007, available:, http://www.latimes.com/travel/la-trw-na-tb7jun07,0,1735996.story. (accessed 26 September 2010).
55. Mario Christodoulou, "The Stigma of Tuberculosis, " The Lancet Infectious Diseases, Vol. 11, No. 9 (2011), p. 663.
56. "Isolation" (as a term of art) involves "separating, for the period of [disease] communicability, known infected persons from the community, " whereas "quarantine" involves restricting the movement of persons "exposed, or potentially exposed, to infectious disease. " See Fidler et al., The Lancet Infectious Diseases, p. 620 (original emphasis).
57. Brian Knowlton, "2 Flights Carried Man with Deadly TB, " New York Times, 29 May 2007, available:, http://www.nytimes.com/2007/05/29/health/29cnd-tb.html. (accessed 7 November 2011).
58. David Fidler, "Architecture amidst Anarchy: Global Health's Quest for Governance, " Global Health Governance, Vol. 1, No. 1 (2007), p. 3.
59. Adele Baleta, "Forced Isolation of Tuberculosis Patients in South Africa, " The Lancet Infectious Diseases, Vol. 7, No. 12 (2007), p. 771.
60. Zoe Alsop, "Dealing with Drug-Resistant Tuberculosis in Africa, " The Lancet, Vol. 372 (6 September 2008), p. 793.
61. Fiona Lloyd-Davies, "Life in the Shadow of Deadly New TB, " BBC News, 14 November 2008, available:, http://news.bbc.co.uk/2/hi/africa/7729184.stm. (accessed 1 November 2011).
62. Ulrich Beck and Edgar Grande, "Cosmopolitanism: Europe'sWay Out of Crisis, " European Journal of Social Theory, Vol. 10, No. 1 (2007), pp. 67-85.
63. Anonymous, "Kenya: Two Jailed for Failing to Take TB Drugs, " AllAfrica. com, 24 August 2010, available:, http://allafrica.com/stories/201008240729.html. (accessed 29 September 2010).
64. Travis C. Porco and Wayne M. Getz, "Controlling Extensively Drug-Resistant Tuberculosis, " The Lancet, Vol. 370 (27 October 2007), p. 1464.
65. Wendy Parmet, "Legal Power and Legal Rights-Isolation and Quarantine in the Case of Drug-Resistant Tuberculosis, " New England Journal of Medicine, Vol. 375, No. 5 (2007), p. 433.
66. WHO, "Ethical Issues in Tuberculosis Prevention, Care and Control, "World Health Organization, January 2011, available:, http://www.who.int/tb/publications/ethics_in_tb_factsheet_28jan11rev. pdf. (accessed 23 February 2012).
67. Keertan Dheda and Giovanni B. Migliori, "The Global Rise of Extensively Drug-Resistant Tuberculosis: Is the Time to Bring Back Sanatoria Overdue?, " The Lancet, Vol. 379, No. 9817 (2012), p. 773.
68. Andy Coghlan, "TB We Can't Treat Is Spreading in India', New Scientist, 21 January 2012, p. 8.
69. WHO, Guidance on Ethics of Tuberculosis Prevention, Care and Control (Geneva:World Health Organization, 2010), p. 22.
70. Ulrich Beck and Edgar Grande, "Cosmopolitanism: Europe'sWay Out of Crisis, " European Journal of Social Theory, Vol. 10, No. 1 (2007), pp. 67-85.
71. John Harris and Soren Holm, "Is There a Moral Obligation Not to Infect Others?, " British Medical Journal, Vol. 311 (1995), pp. 1215-1217.
72. Jerome Amir Singh, Ross Upshur and Nesri Padayatchi, "XDR-TB in South Africa: No Time for Denial or Complacency, " PLoS Medicine, Vol. 4, No. 1 (2007), p. 0021.
73. Ulrich Beck and Edgar Grande, "Cosmopolitanism: Europe'sWay Out of Crisis, " European Journal of Social Theory, Vol. 10, No. 1 (2007), pp. 67-85.
74. Georgina Kenyon, "Russia's Prisons Fuel Drug-Resistant Tuberculosis, " The Lancet Infectious Diseases, Vol. 9, No. 10 (2009), p. 594.
75. Richard Coker, Marianna Thomas, Karen Lock and Robyn Martin, "Detention and the Evolving Threat of Tuberculosis: Evidence, Ethics, and Law, " Journal of Law, Medicine and Ethics (Winter 2007), p. 612.
76. Richard Coker, Marianna Thomas, Karen Lock and Robyn Martin, "Detention and the Evolving Threat of Tuberculosis: Evidence, Ethics, and Law, " Journal of Law, Medicine and Ethics (Winter 2007), p. 612.
77. Brian McDonald, "TB Sufferer Kept under Guard, " The Independent, 5 July 2010, available:, http://www.independent.ie/national-news/tb-sufferer-kept-under-guard-2246286.html. (accessed 30 September 2010).
78. World Health Organization (WHO), A Safer Future: Global Public Health Security in the 21st Century (World Health Report 2007) (Geneva: World Health Organization, 2007), p. 45.
79. Anonymous, "Siracusa Principles on the Limitation and Derogation Provisions in the International Covenant on Civil and Political Rights, " Human Rights Quarterly, Vol. 7, No. 1 (1985), p. 6.
80. Richard Coker, Marianna Thomas, Karen Lock and Robyn Martin, "Detention and the Evolving Threat of Tuberculosis: Evidence, Ethics, and Law, " Journal of Law, Medicine and Ethics (Winter 2007), p. 612.
81. David P. Fidler, "SARS and International Law, " American Society of International Law, April 2003, available:, http://www.asil.org/insights/insigh101.htm. (accessed 10 October 2005).
82. Jerome Amir Singh, Ross Upshur and Nesri Padayatchi, "XDR-TB in South Africa: No Time for Denial or Complacency, " PLoS Medicine, Vol. 4, No. 1 (2007), p. 0021.
83. Wendy Parmet, "Legal Power and Legal Rights-Isolation and Quarantine in the Case of Drug-Resistant Tuberculosis, " New England Journal of Medicine, Vol. 375, No. 5 (2007), p. 433.
84. Richard Coker, Marianna Thomas, Karen Lock and Robyn Martin, "Detention and the Evolving Threat of Tuberculosis: Evidence, Ethics, and Law, " Journal of Law, Medicine and Ethics (Winter 2007), p. 612.
85. World Health Organization (WHO), A Safer Future: Global Public Health Security in the 21st Century (World Health Report 2007) (Geneva: World Health Organization, 2007), p. 45.