Double Standards in Global Health: Medicine, Human Rights Law, and Multidrug-Resistant TB Treatment Policy

摘要

The human rights arguments that underpinned the fight against HIV over the last three decades werepoised, but ultimately failed, to provide a similar foundation for success against multidrug-resistantTB (MDR-TB) and other diseases of the poor. With more than 1.5 million deaths since 2000 attributedto strains of MDR-TB, and with half a million new, and mostly untreated, MDR-TB cases in the worldeach year, the stakes could not be higher. The World Health Organization (WHO), whose mandateis to champion the attainment by all peoples of the highest possible level of health, recommendedunsound medical treatment for MDR-TB patients in resource-poor settings from 1993-2002. Citing costconsiderations, WHO did not recommend the available standard of care that had been successfully used tocontain and defeat MDR-TB in rich countries. By acting as a strategic gatekeeper in its technical advisoryrole to donor agencies and countries, it also facilitated the global implementation of a double standardfor TB care in low- and middle-income countries (LMICs), upending important legal and scientificpriorities. This raises serious questions about whether the organization violated international humanrights standards and those established in its own constitution. While calling for additional analysis anddiscussion on this topic, the authors propose that policymakers should reject double standards of thiskind and instead embrace the challenge of implementing the highest standard of care on a global level.