Adopted by the 57th WMA General Assembly, Pilanesberg, South Africa, October 2006
Revised by the 68th WMA General Assembly, Chicago, United States, October 2017
and reaffirmed with minor revisions by the 221st WMA Council Session, Berlin, Germany, October 2022
According to the World Health Organization, tuberculosis is a significant global public health problem. South East Asian and African countries are most affected.
In developing countries, the incidence of tuberculosis (TB) has risen dramatically because of high prevalence of HIV/AIDS, increasing migration of populations, urbanisation and over-crowding. The incidence and severity of the disease are closely associated with the social and economic living conditions within a population as well as the availability of resources within a health system.
Tuberculosis is also a significant threat to patients with cancers, organ transplants, and those receiving immunologic therapies for various diseases.
The emergence of strains of tuberculosis bacteria resistant to first line drugs have become a major public and global health threat in the forms of multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB). MDR-TB and XDR-TB are indicators of the growing antimicrobial resistance whose drivers are multifactorial and complex and require a multisectoral approach.
Community awareness and public health education and promotion are essential elements of tuberculosis prevention.
Screening of high-risk groups including PLHIV (people living with HIV), health personnel from endemic countries as well as vulnerable populations including migrants, prisoners, and the homeless should be considered within each national epidemiological context as a component of tuberculosis prevention. Systematic screening of contacts of infected persons is also recommended.
Rapid diagnosis with molecular tests and starting supervised daily treatment early should help arrest the spread of disease.
BCG (Bacille Calmette-Guérin) vaccination as early as possible after birth should continue, in line with International Union against Tuberculosis and Lung Disease (IUATLD) criteria, until a new more effective vaccine is available.
Intensified research and innovation are also considered imperative if attempts to address the epidemic and emerging resistance are to be successful.
In line with its “Declaration of Oslo on Social Determinants of Health” and its “Declaration of Edinburgh on Prison Conditions and the Spread of Tuberculosis and Other Communicable Diseases”, the World Medical Association emphasizes that tuberculosis is a disease associated with socioeconomic factors such as poverty, poor housing, malnutrition and stigma, and recommends that these factors are fully considered and integrated in policies to end TB.
The WMA supports WHO “End TB Strategy” and calls upon all governments, communities, civil societies and the private sectors to act together to end tuberculosis world-wide.
The WMA, in consultation with WHO and national and international health authorities and organizations, will therefore continue advocating to generate community awareness about symptoms of TB and increase capacity building of health personnel in early identification and diagnosis of TB cases and to ensure complete treatment utilizing patient-centered treatment support, including Directly Observed Treatment Short course or other appropriate therapy.
The WMA further calls:
1.To ensure equitable access to existing tuberculosis interventions;
2. To allocate adequate financial, material and human resources for tuberculosis and HIV/AIDS research and prevention, including adequately educated health care providers and adequate public health infrastructure;
3. To ensure to health care professionals full access to all required medical and protective equipment to guard against the risk of infection and spread of the disease;
4. To foster efforts to build up the capacity of health care professionals in the use of rapid diagnostics methods, the availability of these methods in the public and private sector and in the management of all forms of TB, including MDR and XDR.
5. To address the burden of MDR and XDR TB in prison populations by ensuring drug susceptibility tests on isolates from patients with active TB are performed as soon as possible, and when patient compliance is a problem, implementing programs of directly observed therapy.
6. To support their National TB Programmes by generating awareness among healthcare professionals about TB management and early reporting of cases in the community.
7. To promote methods of TB prevention including respiratory hygiene, cough etiquettes, and safe sputum disposal.
8. To encourage their members to notify to relevant authorities, about all patients diagnosed with TB or put on TB treatment in a timely manner for initiation of contact screening and adequate follow up till the completion of treatment.
9. To encourage the development of strong pharmacovigilance and active TB drug-safety monitoring and management, to detect, manage and report suspected or confirmed drug toxicities, and encourage all their members to contribute actively to these systems.
10. To co-ordinate with their TB National Programme and promote the adopted guidelines to all members.