The World Health Organization recommended substandard care to people with multidrug-resistant tuberculosis living in developing countries, according to a new paper published in the Health and Human Rights Journal. Between 1993 and 2002, the WHO made treatment recommendations in low-income countries based on cost – treatment that was deemed substandard in wealthy countries. The action violated patient rights and was in opposition to the very standards set out and enforced by the WHO, researchers from Duke University and Harvard Medical School said.
“Simply put, it’s not OK to give people substandard (we’re not even talking suboptimal here) care because they are poor,” said lead author Thomas Nicholson in an email to Humanosphere.
Partners in Health reported an outbreak in Lima, Peru, of multidrug-resistant tuberculosis (MDR TB), in 1995. The government worked with the WHO to develop guidelines for treatment to prevent the spread of the airborne disease. Initially, the country added an antibiotic to the existing treatment for non-resistant TB. That did nothing to protect patients and only added to the development of resistance.
Two years later, new guidelines were developed with the help of the WHO. The final policy called for the use of drugs different from those recommended in Europe because they were 80 percent cheaper. Other protocols for care that were standard at the time were relaxed. As a result, only 48 percent of patients with MDR-TB were cured, many died, and others developed more drug-resistant strains.
“The shroud of cost-effectiveness thrown over this bad treatment was not one the WHO had always used – it was more or less in 1991 when it was out of money and allied with the World Bank that it really began to prioritize such analysis,” Nicholson said. “It’s waned in popularity over the last decade but is still very much in use.”
Similar events played out in India, Russia and Belarus at around the same time. Major international bodies like the WHO are meant to protect the rights of individuals, especially the world’s most poor and vulnerable. The authors argue that rights should be considered ahead of things like cost. Nicholson cited the idea of “preferential option for the poor,” an ethic popularized by Peruvian Catholic priest Gustavo Gutierrez, who also is a major influence on Partners in Health co-founder Paul Farmer.
The issue remains important as TB continues to kill some 1.5 million people per year and outbreaks of Ebola and Zika have forced the WHO and other health organizations to issue rapid guidelines for mounting a response. A more subtle double standard for TB care still exists, said Nicholson. New guidelines for treating patients with latent TB urge wealthy countries to use new regimens and drugs, while poorer countries are advised to maintain previous guidelines.
“Recommendations should never preclude a country, district health office or local public health agency from going for the highest standard of health for their people if and when they so choose,” Nicholson said. “I think that humanity, with all its potential and ingenuity, can certainly muster the resources to provide high-quality health care for an infectious, airborne disease that is curable.”
