Migrants on the move with tuberculosis

EMORY (US)—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 published in The Lancet.

Henry Blumberg, professor of medicine (infectious diseases) at Emory University, was lead author of the commentary in a special Lancet series on tuberculosis (TB). 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,” the commentators write.

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.”

Finally, the authors state, “In view of globalization and migration, the mantra ‘tuberculosis anywhere is tuberculosis everywhere’ rings true.”

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