In a test run promising to become the
global model for pandemic response, South Africa is recommending that patients infected with
drug-resistant tuberculosis (XDR-TB) be forcibly isolated until they die. "Forced isolation" is framed apologetically, as pitting individual rights
against society's rights. However, the real issue is not
about the individual versus society - it's about international corporate rights
overriding the rights of individuals and society as a whole.
Scientists have long known that industrial activities - like factory farming and chemical pollution - cause micro-environmental changes, which in turn
force microbes to mutate and create new diseases. But despite scientific knowledge and the overwhelming evidence, industrial practices known to create
new diseases have not changed.
Because corporate rights to profit
override public health risks, and cancel out individuals' and society's rights. As a result, the world is
facing a host of emerging untreatable, incurable and potentially deadly diseases.
Extensive Drug Resistant Tuberculosis
(XDR-TB) is man-made - just like H5N1 bird flu, MRSA, E. coli and most other emerging diseases.
Positioned to go pandemic, XDR-TB is highly resistant to most antibiotics, almost incurable, and there are significant dangers associated with the
drugs used for treatment. XDR-TB is airborne and usually fatal, especially in people with compromised immune systems, killing 98% of those infected
within about two weeks. WHO's tuberculosis experts believe XDR-TB is just as serious a threat to global health as bird flu and SARS.
Some say the prevalence of HIV/AIDS in South Africa puts that nation especially at risk from XDR-TB. Disease surveillance, diagnostics and drugs are
woefully inadequate, but a team of 3 doctors recommends forcible detainment of diagnosed XDR-TB patients who refuse the dangerous and ineffective
treatment. Patients would be hospitalized until they die.
The recommendation parallels steps taken in New York City in the 1990's, when people who rejected TB treatment were forcibly detained in Bellevue and
Goldwater hospitals. Some patients were held for as long as two years, and eventually, the number of TB cases diagnosed in NYC dipped.
The dilemma of a deadly disease: patients may be forcibly detained
South Africa is considering forcibly detaining people who carry a deadly strain of tuberculosis that has already claimed hundreds of lives. The strain
threatens to cause a global pandemic, but the planned move pits public protection against human rights.
The country's health department says it has discussed with the World Health Organisation and South Africa's leading medical organisations the
possibility of placing carriers of extreme drug resistant TB or XDR-TB under guard in isolation wards until they die, but has yet to reach a
Pressure to take action has been growing since a woman diagnosed with the disease discharged herself from a hospital last September and probably
spread the infection before she was finally coaxed back when she was threatened with a court order.
South Africa TB Patients May Be Detained
In their paper in the Public Library of Science Medicine journal, physicians Jerome Amir Singh, Ross Upshur and Nesri Padayatchi propose that XDR-TB
patients who refuse treatment be involuntarily detained in hospitals or other health care facilities. Singh and Padayatchi are at the Centre for AIDS
Programme of Research in South Africa, and Upshur is the director of the Joint Centre for Bioethics at the University of Toronto.
In the 1990s, New York City health authorities authorized the forcible detention of people who rejected TB treatment, some for as long as two years,
ultimately leading to a significant dip in cases. The detainees were held in Bellevue or Goldwater hospitals.
Last September, the World Health Organization announced there were 53 confirmed XDR-TB cases in South Africa, of which 52 were fatal. Most of the
patients were also HIV positive. To date, more than 300 cases have been identified, and at least 30 more are picked up each month.
Critics of the recommendation point out that steps should be taken before imprisoning patients.
Some public health experts say South Africa and the international community haven't taken basic outbreak response steps, such as drafting an
emergency plan, conducting a proper investigation and reinforcing surveillance. WHO and its partners have held a flurry of international meetings
since XDR-TB in South Africa was identified, but little has changed for patients in Africa.
"The government hasn't yet done the most obvious things to shut down transmission," said Mark Harrington, executive director of the Treatment
Action Group, a health advocacy group. "Starting to imprison patients is a step very far downstream from where we are now."
Both critics and proponents are focusing on the issue of individual versus society's rights - a red herring that totally ignores corporate
industry's role in creating virulent incurable diseases.
South African law also permits enforced isolation but some lawyers say it comes into conflict with the constitutional guarantees on individual
rights. However, the constitution also guarantees communal rights, including protection from infection and the right to a safe environment.
So if the Constitution protects people from infection and ensures the right to a safe environment - then why aren't they going after the corporate
industries that create and spread
the disease, instead of planning to imprison the victims?
The issue is being "managed."
No one is acknowledging publicly that XDR-TB, like other emerging pandemics, is a man-made disease. Or that industrial practices - like dosing
livestock with human antibiotics - are responsible for their creation. Or that it started in the USA - and could have been prevented. Or that the FDA
recommended stopping the use of human antibiotics in livestock as far back as 1972.
Curtailing antibiotic use in agriculture. It is time for action: this use
contributes to bacterial resistance in humans
One essential course of action is to minimize any and all causes and reservoirs of antibiotic resistance. Besides medical use in humans, there is the
troubling issue of use in agriculture, specifically in livestock production. Antibiotics have long been routinely used not only for the treatment of
infections, but also as a means of getting animals to market faster by growth promotion. Controversies about these practices have resulted in numerous
reports, dating back decades, urging more caution or outright bans on the practice. The World Health Organization and other leading medical and public
health bodies have advised that animals not be dosed with antibiotics used in humans - to little avail here in the United States to date, even though
our own Food and Drug Administration (FDA) took this position as far back as 1972.
1978: Antibiotics in
animal feeds--human and animal safety issues.
1978: Public health
concerns relative to the use of subtherapeutic levels of antibiotics in animal feeds.
1995: Global epidemiology of tuberculosis. Morbidity and mortality of a
worldwide epidemic Drug resistance is a serious problem, especially in the United States. If worldwide control of tuberculosis does not
improve, 90 million new cases and 30 million deaths are expected in the decade 1990 through 1999.
ANTIBIOTIC RESISTANCE: Superbugs on the Hoof?
Disturbing new findings have provided a key link in the chain of evidence connecting antibiotics used on livestock to outbreaks of disease caused
by antibiotic-resistant human pathogens. Now agencies worldwide are beginning to clamp down on antibiotic use in agriculture. The moves have riled
industry officials, who argue that antibiotics are essential to keeping animals healthy and the food supply safe, and that the most serious threat
comes from indiscriminate use of antibiotics in people, not livestock.
In fact, public discussion about how factory farming, pollution and environmental change create disease is kept separate from dialogue about pandemic
prevention and response - another kind of forced isolation, sometimes called censorship or "sanitization" of the issue.
Here is a quick general overview from the US Government's Environmental Health Perspectives
, with a synopsis from Reuters.
Antibiotic Resistance in Livestock: More at Stake than Steak
Imagine, for a moment, this scenario: you, like millions of other people around the world, are lying in a hospital bed suffering from a bacterial
infection. Your doctors have told you that your disease, which once would have been easily treated, no longer responds to available drugs. In addition
to feeling shock and disbelief, you'd probably wonder how this could have happened.
You would not be alone. The specter of antibiotic resistance is considered by many to be one of the most pressing scientific questions today. With
each passing year, former wonder drugs like penicillin, erythromycin, and tetracycline are less effective against strains of treatment-resistant
"superbugs." By decreasing the number of effective drugs in the medical arsenal, antibiotic resistance is making bacterial infections and related
conditions more difficult to treat. Scientists also worry that the spread of resistance genes among even unrelated strains of bacteria could turn what
are now treatable illnesses into killers.
Where are these resistance traits coming from? Certainly overuse in human medicine is an important source. But agricultural uses, particularly
in livestock, also contribute significantly toward the problem of antibiotic resistance, scientists say.
Infectious Disease: The Human Costs of Our Environmental Errors
For a few exhilarating decades in the middle of the twentieth century, it seemed the world might have a reprieve from some major infectious diseases.
After coordinated worldwide efforts had virtually eliminated smallpox and made major inroads against other infectious diseases such as influenza,
tuberculosis, and polio, some public health officials thought we had entered a new era in which infectious diseases would no longer be among the
planet's worst killers. By the 1980s, though, those hopes were dashed, due in large part to the burgeoning AIDS epidemic.
...More than a dozen major factors have been pegged over the past 10-15 years as existing or potential contributors to infectious disease outbreaks.
Microbes continue to evolve rapidly, and human susceptibility to infection is increasing due to malnutrition, weakening of immune systems through
cancer treatments or chronic diseases, and aging of the population in some countries. Extensive poverty and population growth have spawned impacts
such as poor basic public health infrastructure in megacities. Wars result in dislocation of peoples, destruction of public health systems,
malnutrition, and introduction of new microbes by soldiers returning home; bioterrorism raises the possibility of infectious agents being released
upon the population at large. Changing medical technology allows exchanges of microbes through blood transfusions and organ and tissue transplants,
some of which come from animals. Increased international travel and exchange of goods--including animals, plants, and foods that can carry
pathogens--both spread diseases rapidly. Many nations have seen reduced funding for safe water and sewer systems, vaccines, research, surveillance,
prevention, and response, due in part to complacency.
...many environmental factors are playing major roles, including climate change, deforestation, global dust transport, and numerous agricultural
practices. The links between these factors and millions of potential human deaths have often been overlooked or discounted as pollution and
other more obvious concerns have typically drawn the limelight.
...the deadly H5N1 virus is just one of a plethora of diseases threatening animals and people around the world as
global warming, intensive farming, increased travel and trade help dangerous microbes breed and spread.
"Almost every year there is a new disease appearing, and 75 percent of these emerging or re-emerging diseases are coming from animals; 80 percent of
those have zoonotic potential," he said in an interview. ...Le Gall said such zoonoses -- animal diseases that humans can also catch -- included Rift
Valley fever, rabies and anthrax. ..."These could come together to create what the experts are calling 'the perfect microbial
The science is clear: Most emerging diseases are potentially virulent, deadly, incurable - and man-made. Factory farming, increased travel and trade,
changing weather patterns and global warming all play a role in breeding and spreading these new diseases.
But authorities want us to misunderstand the issue - to measure individual rights against society's rights - and ignore the fact that international
corporate rights override both individual and society's rights, and threaten our lives. The "debate" is totally phony - a red herring.
Tuberculosis has been pandemic for a decade or more, and multi-drug resistant tuberculosis was identified as "the norm" before 2002, and classified
as a "global pandemic more deadly than AIDS."
2002: ON MULTI-DRUG RESISTANT TUBERCULOSIS
1) ...Tuberculosis ranks among the most important burdens on human health, not because the total number of cases is especially large (approximately 9
million per year worldwide), but because approximately one-quarter of sufferers die, most of them young adults. Untreated or untreatable disease would
kill more, approximately half of all cases. Globally, the number of tuberculosis cases is rising at 2 percent per year, and the fear is that the
number of cases resistant to antibiotics may be increasing much faster.
2) The perceived threat of drug-resistant tuberculosis is enormous. The biggest menace is multi-drug-resistant tuberculosis, caused by strains
resistant to at least isoniazid and rifampcin, the two principal first-time drugs used in combination chemotherapy. Health warnings have been issued
in correspondingly strong language, not just in the popular press, but also in principal scientific and medical journals. Among various readings of
the evidence, the spread of multi-drug-resistant tuberculosis has been classified as a global pandemic more deadly than AIDS, with the potential to
destabilize society. Drug-resistant mycobacteria are said to be on the rampage, and multi-drug-resistant tuberculosis is thought to have become the
norm. In the year 2000, an estimated 273,000 of 8.7 million new tuberculosis cases were multi-drug resistant, with the highest proportion of
multi-drug resistant new cases in Estonia (14 percent); Henan Province, China (11 percent); Latvia (9 percent); and the Ivanovo and Tomsk provinces in
Russia (9 percent and 7 percent, respectively). Resistance is very unevenly distributed around the world: an estimated 70 percent of new
multi-drug-resistant tuberculosis cases occur in just 10 countries.
So multi-drug resistant TB is not a new crisis; it was classified as a global pandemic around when Bush became President of the USA; and the emergence
of XDR-TB was predicted, with warnings ad infinitem.
Obviously, the goal is NOT to deal with the crisis effectively - if that were the real goal, action would have been taken years ago.
Clearly, the primary objective is population control.
And the corporate strategy is unusually transparent:
The XDR-TB epidemic in South Africa - and the recommendation for forced isolation - is being manipulated to polarize discussion, and to focus the
"court of public opinion" on individuals' versus
society's rights. The public "debate" will proceed in fear, under threat of a deadly
pandemic brewing in South Africa.
Most people participating in the global dialogue will support society's rights over individual rights - and the stage will be set.
The question of corporate rights
will not be addressed in the global debate. Authorities will not acknowledge the fact that the corporate
right to profit
effectively promotes creating deadly diseases, and pits corporate rights against individual and society's rights.
The important questions will not be asked. The real issues will not be addressed. The impacts of "corporate rights to profit" on public health will
not be evaluated.
Once the court of public opinion weighs in against
individual rights, and for
society's rights, a global
precedent will be
firmly established. Without ever considering the real choice.
Numerous diseases are set to go pandemic, not just XDR-TB and H5N1 bird flu. It's not a question of if
a pandemic will happen, but
And when the pandemic does hit, if a policy of forced isolation until death has been enforced in South Africa for XDR-TB, then the same policy will be
the pandemic response-of-choice worldwide. Already decided in the court of public opinion, and supported globally.
As a matter of interest, US legislation allows forced isolation and quarantine under a broad range of circumstances - thanks to a series of laws and
executive orders decreed by President Bush.
Mr. Bush's order added pandemic influenza to the government's list of communicable diseases for which a quarantine is authorized...
The quarantine list was amended in 2003 to include SARS, or severe acute respiratory syndrome, which killed nearly 800 people in 2003. Other diseases
on the list are cholera, diphtheria, infectious tuberculosis, plague, smallpox, yellow fever and viral hemorrhagic fevers.
Jennifer Morcone, a spokeswoman for the health centers, said
Mr. Bush's executive order was intended to
prepare for all options.
But, you say, it's just good common sense: Quarantine is proven
to stop the spread of disease.
In fact, quarantine never
works if you don't clean the barn, as any farmer can tell you. In this case, the barn is the whole planet. Many new
and deadly diseases are now airborne, not just XDR-TB and H5N1 bird flu - and they can be spread around the world by atmospheric winds. Never mind
international travel and trade.
So how do you quarantine the wind?
Rather than isolating and quarantining select human victims, it would be far more effective to change the industrial practices that create new
diseases, and the trade systems that spread them.
Yet instead of tackling the most significant factors and looking at prevention - authorities are focusing solely on person-to-person transmission, and
planning forced human isolation and quarantines. Which a) won't work, and b) will curtail civil liberties. One needs to wonder why.
Since 9/11, Americans have been conditioned to give up their rights and civil liberties for the illusion of safety. New measures - like the Patriot
Act and the President's emergency powers granted to deal with the "war on terrorism" - all infringe on American civil liberties. More to the point,
all these new measures effectively supplant the Constitution and Bill of Rights. The President's recently acquired powers to impose forced isolation
and quarantine are part of the same package.
All that's missing is public support for already-existent
laws allowing forced isolation and quarantine. It's just a political thing - it's
easy to manipulate public opinion, and orchestrate public support. Just watch.
The truth is, H5N1 bird flu did not emerge
in China, and XDR-TB did not emerge
in South Africa; both diseases were created elsewhere,
and imported. Our techno-industrial world promotes mutation in microbes, forces their evolution - creates deadly, untreatable, incurable diseases -
helps them breed, and spreads them around the world. That's
It may seem logical to lock up infected people, and write them off as "unfit for survival." But it's not a solution to the larger continuing
problem. If we do not change our industrial and agricultural practices, new diseases will keep emerging - and creating new pandemics that we cannot
cure or treat.
Soon, we will all face imprisonment in leper colony gulags - where people with untreatable, incurable, man-made diseases are left to die. And the only
"persons" living free on planet Earth will be the corporate variety.
The only way to change the debate's predictable outcome, and protect the future of human society, is to re-frame the question. Honestly.
We are NOT facing a choice between either
the rights of society or
individual rights. We are choosing whether or not to respect the
corporate right to profit over individual rights and
the rights of society as a whole.
Bird Flu - A Virus of Our Own Hatching