Developing a Rights-Based Approach to Tuberculosis

The IHR Clinic, in partnership with the All India Institute of Medical Science, launched its “Developing a Rights-Based Approach to Tuberculosis” project at a conference at the University of Chicago Center in Delhi, India in December. IHR Clinic Acting Associate Director Brian Citro worked alongside two University of Chicago Doctors, Evan Lyon and Kiran Raj Pandey, and Health Policy Advisor of Save the Children UK, Mihir Mankad, to organize the two-day conference. The conference initiated a dialogue on how the right to health can be used to combat TB and to protect the rights of people living with and vulnerable to TB. Although TB is largely curable, in 2013 there were 9 million new cases and 1.5 million deaths from TB. TB disproportionately affects low and middle-income countries, as well as specific populations, including the poor, people living with HIV, prisoners, and migrants.

A rights-based approach to TB focuses on the rights of those living with and vulnerable to TB. It focuses on the underlying social and economic determinants of the infection, and places legal responsibilities on governments and non-state actors to address the underlying causes of TB, and to safeguard the rights of people living with and vulnerable to TB.

One of the project’s goals is to examine and articulate how the right to health can be used to increase access to treatment and testing for TB in India. This includes multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR). The right to health is articulated in a number of international instruments, most significantly article 12 of the International Covenant on Economic, Social and Cultural Rights (ICESCR). The right to health is recognized as a constitutional right in India, and is broad in scope. Included within the right to health is the right to available, accessible and acceptable good quality health facilities, foods and services.

Another goal of the project is to articulate the human rights obligations of governments and non-state actors in regard to TB. The project will examine the role of the state and non-state actors in regulating and financing public and private testing and treatment for TB in India.

Additionally, the project aims to identify the role that the right to health can play for people living with or vulnerable to TB, in terms of securing their right to be free from discrimination, to participation, to access health information and to informed consent.

The project seeks to formulate benchmarks associated with the prevention and treatment of TB in India and the protection of the rights of people living with and vulnerable to TB. As of 2012, an estimated 26% of TB cases occurred in India. More can be done in terms of prevention; in the last forty years there has been only one novel drug approved for the treatment of TB. A rights-based approach will address factors associated with the costs and availability of medicine and diagnostics, including patent and intellectual property laws, pricing and regulation, and funding for research and development.

The final goal of the project is to develop methods with which a rights-based approach to TB can be implemented in India, as well as in other low and middle-income countries. Methods include pilot projects, litigation and advocacy. A similar approach has been taken throughout the world in regard to the rights of people living with HIV. The rights-based approach to HIV will serve as a model for creating a rights-based approach to TB.

The four organizers of the Delhi conference now plan to guest edit a special issue of the Health and Human Rights Journal at the Harvard School of Public Health, focusing on TB and the right to health. Additionally, they have requested funding to conduct a judicial sensitization workshop at the Center in Delhi on the relationship between TB and human rights. Further, Students Paul and Cerami have drafted the legal section of an advocacy handbook to be used by the Indian Parliament to advocate for a rights-based approach to TB.