It is worth noting that the experience of TB patients’ interests being subordinated to national interest has sometimes been a distressing one. In 2007, for example, thirteen multi-drug resistant-TB patients in South Africa who had forced their way out of a hospital and demanded to be treated as outpatients were ordered back to their beds by an interim court order. Against the argument of provincial health authorities in favor of forced isolation, the patients claimed (to no avail) that this would result in them losing their jobs and welfare benefits. Following this incident a protest by MDR- and XDR-TB patients at a Johannesburg hospital, who were calling for an end to “prison-like” conditions there, became violent, and one patient was shot. By 2008, when twenty MDR-TB patients being confined at another South African hospital attacked a nurse and security guards, uprisings of this kind were becoming commonplace in that country. Afterward, the doctor in charge of Port Elizabeth’s Jose Pearson Hospital, which has guarded gates and a perimeter fence topped with razor wire, told a BBC journalist that forced isolation was the only option: “MDR and XDR, if not controlled, are almost like biological warfare against the population.”
Although such dramatic framing of the issue can serve to legitimize strict social distancing as a biosecurity practice, there is also the risk that the perceived severity of those measures might be counterproductive to disease control. Long-term isolation might well be regarded as an effective and inexpensive response to the grave risk posed by drug-resistant TB. However, any immediate good that is achieved is probably outweighed by the long-term harmfulness of such an extreme measure. The horrific prospect of forced isolation works to drive symptomatic TB sufferers underground, away from the attention of clinical caregivers and public health practitioners, because of a “loss of community trust.” Inasmuch as those distrustful patients opt for inadequate TB drug treatment through unofficial channels, the result is likely to be an exacerbation of the very conditions that occasioned the development of drug resistance in the first place.
Enemark, Christian. Biosecurity Dilemmas : Dreaded Diseases, Ethical Responses, and the Health of Nations. Georgetown University Press, 2017.
Editor’s note: ‘social distancing’, as used here, is closer to the term ‘quarantine’ in common usage during the coronavirus outbreak. The prospect of quarantine is possibly leading to under-reporting, at least when it comes to self-reporting.