Sarah McGregor, Mail & Guardian
South Africa's outbreak of extreme drug resistant tuberculosis (XDR-TB), which has killed at least 74 people in the last several months, may force authorities to override patients' personal rights in favour of the greater public's health, the study in the journal PLoS Medicine said.
XDR-TB represents a major threat to public health. If the only way to manage it is to forcibly confine then it needs to be done, said Jerome Singh, study co-author and lawyer at Durban's Centre for the Aids Programme of Research in South Africa.
Ultimately in such crises, the interests of public health must prevail over the rights of the individual.
TB, an airborne bacillus spread through coughing or sneezing, can usually be cured through treatment. However, the XDR-TB strain may have mutated when patients skipped treatment or were dispensed inadequate antibiotic cocktails.
South Africa has logged almost 400 cases of XDR-TB, which is virtually impervious to treatment by most common TB drugs, and an unprecedented 30 new cases are diagnosed every month, according to the study.
The outbreak has alarmed medical experts who say XDR-TB poses a particular danger to HIV-positive people whose immune systems are already severely compromised by the Aids virus.
South Africa has one of the planet's highest HIV/Aids caseloads with about 5,5-million people infected in a population of 45-million. Most of those who died of XDR-TB have tested positive for HIV.
South Africa's highly mobile workforce, rising overseas tourism, and the prevalence of XDR-TB in Johannesburg, the main transportation hub, increases the chance of XDR-TB spreading past national borders and into other African countries struggling with high HIV/AIDS infection rates, Singh said.
South Africa's post-apartheid Constitution contains some of the world's strongest safeguards of individual liberties and the government has thus far been silent on whether it may isolate XDR-TB patients. Singh said it is the public's duty to press the government into opening the debate.
In South Africa, XDR-TB patients may visit hospitals as out-patients and then go home, which means they can easily pass the disease in their community, the paper said.
XDR-TB patients at the rural hospital in the eastern province of KwaZulu-Natal, where the super bug was first detected, sleep in a special room but are free to move around the TB ward and even allowed to leave on a day pass.
However, the challenge to control XDR-TB requires not just policy changes but also more state spending, the paper said.
Long-term hospital stays increase the national health-care tab and burden overstretched clinics particularly in rural areas with heavy patient loads, said Singh, adding hospitalised XDR-TB patients should automatically qualify for a social grant.
The World Health Organisation has called for the world to prioritise XDR-TB on par with bird flu and recommended governments in impoverished sub-Saharan Africa develop one strategy to deal with the twin challenges of HIV and TB.
Further complicating the XDR-TB problem is that diagnosis and treatment of the disease is time-consuming and costly, surveillance often inadequate and no new drugs have been developed in 40 years. - Reuters
(Source: Sarah McGregor, Mail & Guardian - 22 January, 2007)