New vision needed for combating and preventing TB among migrants

May 19, 2010

Commentary: 'Tuberculosis anywhere is tuberculosis everywhere'

Tuberculosis (TB) is an enormous global public health problem. Migration and failure by governments and the public health community to adequately treat and prevent TB among migrants is an important barrier to TB control.

To reduce the incidence, spread and severity of tuberculosis, government policies must ensure that all patients have easy access to diagnosis and treatment, according to a commentary entitled "TB on the Move" in this month's The Lancet.

Henry M. Blumberg, MD, professor of medicine (infectious diseases) at Emory University School of Medicine and Grady Memorial Hospital was lead author of the commentary in a special Lancet series on tuberculosis. Other contributors were from the WHO Collaborating Center for TB and Lung Diseases, the Care and Research Institute, Partners in Health, and the Norwegian Institute of Public Health.

Nearly one billion people - or one in seven globally - are migrants, say the authors, with 740 million internal migrants and 200 million international migrants. Most of the international migrants (130 million) are moving from a developing to a developed country.

"Migrants are disproportionately affected by TB, a reflection of the high rate of disease in their country of origin due to poverty and made worse by limited health-care and public health infrastructure," says the commentary.

High-income countries have a low incidence of TB, and most cases in these countries, including multi-drug resistant TB, now occur in migrants. Thus enhancing global TB control is in their self-interest and is cost-effective.

"Unfortunately, governmental public policies towards migrants have been antagonistic to TB control efforts by furthering stigma and marginalization," say the authors. Most migrants are missed by TB screening programs, leading to much worse outcomes and cure rates.

"A new vision on health and migration is necessary if we want to go beyond what (little) is done today," states the commentary. "Each country should first ensure that, everywhere, all patients with tuberculosis have easy access to diagnosis and treatment free of charge, and that undocumented migrants are not deported until completion of treatment, as stated by the International Union Against Tuberculosis and Lung Disease."

This new vision must help prevent inequalities in health outcomes by increasing surveillance (with built-in confidentiality), early diagnosis and treatment, and investment in new drugs, diagnostics and a vaccine.

Finally, the authors state, "In view of globalization and migration, the mantra 'tuberculosis anywhere is tuberculosis everywhere' rings true."

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The Robert W. Woodruff Health Sciences Center of Emory University is an academic health science and service center focused on missions of teaching, research, health care and public service. Its components include the Emory University School of Medicine, Nell Hodgson Woodruff School of Nursing, and Rollins School of Public Health; Yerkes National Primate Research Center; Winship Cancer Institute of Emory University; and Emory Healthcare, the largest, most comprehensive health system in Georgia. Emory Healthcare includes: The Emory Clinic, Emory-Children's Center, Emory University Hospital, Emory University Hospital Midtown, Wesley Woods Center, and Emory University Orthopaedics & Spine Hospital. The Woodruff Health Sciences Center has $2.3 billion in operating expenses, 18,000 employees, 2,500 full-time and 1,500 affiliated faculty, 4,500 students and trainees, and a $5.7 billion economic impact on metro Atlanta.

Emory University

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