27 & 28 October 2021 — An online public health legislation workshop in the field of tuberculosis control was recently held by the Global TB Caucus. The workshop, 2nd in a 3-part series, was organised within the framework of the TB REP 2.0 project with the participation of legal expert Professor Brian Citro (USA) and Dr. Jennifer J. Furin (USA), PhD in TB from Harvard Medical School.
Members of the workshop discussed these topics at hand: the need to include in the legislation of countries the need for compulsory treatment of patients affected by TB, the continuation of DOTS implementation, and other issues related to legal norms in the context of protecting the rights of patients affected by TB. Members of Parliament (MP) also took the stage to discuss developments in public health legislation, highlighting the challenges and differences in implementation in their respective countries. Other members added certain perspectives of TB legislation, such as that of the patient and of the MP.
Alesia Matusevych, the Caucus' EECA Regional manager, began the workshop by first welcoming the attendees followed by an orientation of the workshop schedule. “The goal of the webinar is not to create a platform to discuss a potential model code but legislative goals for each of your countries in the region,” she says. She then outlined the upcoming speakers for the two-day workshop, with a focus on different perspectives from law, medicine, and civil society.
Prof. Citro, legal expert of the Global TB Caucus, added to this by historicizing the work so far and sharing a framework to move the discussion forward. “The broad goal is to promote rights-based, people-centered public health legislation in the EECA region ,” he says. “These are our priority countries, your countries, that our project is focused on.”
He outlined three primary objectives for legislation addressing TB:
Establish and protect the rights of people affected by TB
Safeguard public health
Grant and define institutional authority and responsibility
Prof. Citro highlighted the importance of not just the passing of laws, but the proper implementation of laws through judicial and enforcement mechanisms available to individuals. “You can have a beautiful law, but if there is no way to enforce it, then it will not be effective,” he says. He explained that this is why public health legislation should establish effective enforcement mechanisms, including access to the courts and other adjudicatory bodies, so individuals may enforce their legal rights.
Finally, Prof. Citro addressed the concern that robust protection for individuals’ rights threatens public health. This is incorrect, he said. Instead, he observes that respect for human rights protects public health. He explained that it’s only when we respect the rights of people affected by TB and provide them people-centred care that we will end the epidemic.
Dr. Jennifer J. Furin outlined the problem of “familiarity” in solving the problem of TB. In her speech, she said that many public health practices are based in tradition. “We do it a certain way because we always have. . . But we must also integrate new innovations,” she says. “TB treatment must not be based solely on tradition; it must embrace new and better ways of doing things.”
Dr. Furin pointed out two outdated traditions that should be reexamined: long-term mandatory hospitalization, and other compulsory treatment. Mandatory hospitalization, according to research Dr. Furin discussed, is costly to both patients and health systems, and promotes the spread of TB infection within hospitals. She recommends considering community-based treatment as an alternative, which could save both lives and money.
Dr. Furin also introduced the idea of partnership-based treatment, as opposed to compulsory or directly observed therapy (DOT). She discussed recent research comparing drug-resistant TB treatment to HIV treatment, which finds better adherence among people living with HIV. “More people adhere to treatment when they are empowered,” Dr. Furin emphasized.
Overall, the discussion was considered fruitful and reached a favorable result among the attendees. As an expected outcome, Professor Brian Citro will be developing recommendations that can be further implemented in the national legislation of the countries of the EECA region.
The meeting on the 27th and 28th of October 2021 was attended by:
Alesya Matusevych, manager for the EECA region from the Global TB Caucus
The heads and members of the national TB Caucuses of the Eastern Europe and Central Asia (EECA) region, namely the countries of Armenia, Belarus, Kazakhstan, Tajikistan, Ukraine, and Uzbekistan:
Hon Jamshed Murtazakulov (Tajikistan)
Hon Zarina Kamasova (Kazakhstan)
Hon Narek Zeynalyan (Armenia)
Hon Oral Ataniyazova (Uzbekistan)
Hon Lada Bulakh (Ukraine)
Civil and community organizations in the field of TB in the EECA region
About the Global TB Caucus
The Global TB Caucus is the world's largest independent parliamentary network with over 2,500 members from over 150 countries. The network covers 4 geographic regions: Europe and Central Asia, Africa, America, Asia-Pacific and 2 language regions - Francophone and Portuguese. Parliamentarians of the Caucus work both collectively and individually to accelerate progress in the fight against TB.
About TB -REP 2.0
Since 2016, PAS has been implementing a regional program funded by the Global Fund to Fight HIV, Tuberculosis and Malaria to promote a people-centered model of quality tuberculosis (TB) care (TB-REP -2016-2018 and TB -REP 2.0 - 2019-2021). The program covers 11 countries in the Eastern Europe and Central Asia (EEAC) region, including the Republic of Moldova, and is implemented in partnership with the World Health Organization Regional Office for Europe, TBEC European Coalition, (TB People ) and the Global TB Caucus, a network of parliamentarians building political will in the fight against tuberculosis.
One of the activities of the program, implemented in conjunction with GTBC, is to mobilise members of parliament from TB-REP countries and advance TB-related issues in the legislative agenda in each of the 11 countries of the EECA Region.