Globally TB is one of the top infectious causes of death. In 2021, an estimated 10.6 million people fell ill with tuberculosis(TB) worldwide. Six million men, 3.4 million women and 1.2 million children. Tuberculosis (TB) is caused by bacteria (Mycobacterium tuberculosis) that most often affect the lungs. Today the incidence of tuberculosis (TB) is high among migrants arriving in countries such as Ireland. In 2020, 87% of new TB cases occurred in the 30 high TB burden countries. Eight countries accounted for more than two thirds of the global total: India, Indonesia, China, the Philippines, Pakistan, Nigeria, Bangladesh and the Democratic Republic of the Congo. Many migrants are arriving in Ireland from some of those highly infected areas and since 40% of those arriving have destroyed their passports, they could be from anywhere. With no screening, no monitoring and no treatment protocol in place, Ireland could be inviting migrants into a TB death trap that could spread to the general population.
A Past Not to Be Repeated
We don’t want to invite a repetition of the past. TB killed more people in Ireland in the mid-20th century than the Covid outbreak, the 1919 Spanish Flu and all other flu’s since 1919 combined. The scourge of TB ravaged Ireland for much of the 20th century killing over 10,000 people a year. More than half of them were children. This highly infectious disease thrived in crowded city tenements and in poorly ventilated and thatched cottages in rural Ireland. Thanks to Dr Noel Brown, by the end of the 1950’s the epidemic had been eradicated. Ireland’s present free for all migration invasion and nationwide distribution of people with a high incidence of TB is spreading the risk of a major TB outbreak among the general population.
A Lesson from The Past
Dr. Noel Brown’s elimination of TB in Ireland by the 1950’s was a momentous task in the last century. From the conditions in migrant settings such as “Direct Provisions” centers, should an outbreak occur it will be difficult to contain. It may prove even more difficult to prevent it from spreading into the general population unless the HSE takes measures to address and contain the high prevalence of TB and other virulent diseases among the rapidly growing migrant population. A starting point would be a screening process for all migrants and those in close contact with them.
Irresponsibility of the Absence of Control
The challenges posed by the absence of migration control, vetting and medical screening especially given the absence of TB and infectious disease monitoring of undocumented migrants entering Ireland stands at an unprecedented level. This is ticking time bomb that is presently being ignored by the Irish government and the Irish health authorities with the potential to result in an epidemic of disease. Among arriving migrants, there is a high risk factor for the prevalence of TB, exposure to TB and HIV. This is made worse because of malnutrition, substance abuse, non-diagnosis, lack of education, poor hygiene, no health-screening, cultural factors, stigma and marginalization.
Irelands Health Service in Denial
The absence of TB screening and care, social barriers, and a health services in denial may also contribute to the high prevalence of migrant TB. The absence of health screening and control measures among vulnerable migrants in cramped “Direct Provisions” settings create additional vulnerability and exposure to TB and other infections. This in turn exposes the community at large to the greatest risk of a TB outbreak in Ireland since the 1940’s with the additional risk of multidrug-resistant TB (MDR-TB). Diagnosing multidrug-resistant and other resistant forms of TB as well as HIV-associated TB can be complex and expensive. Tuberculosis is particularly difficult to diagnose in children. A health service in denial is doing nothing to prevent a looming health disaster.
TB The Real and Present Pandemic
Tuberculosis (TB) is a chronic infectious disease caused by mycobacterium bacteria (Mycobacterium tuberculosis) which is transmitted by coughing, sneezing and spitting. The main source of infection is patients with smear-positive TB. On exposure everyone is vulnerable to being infected with mycobacterium TB. About one-third of the world’s population are presently infected with TB. Does that not constitute a pandemic?
Breeding Grounds for Disease
The current prevalence of TB infection among vulnerable migrants coming from and living in immune compromising conditions indicates a high risk of TB reactivation among those already infected. Conditions contributing to a compromised immune systems are caused by the trauma of migration and the crowded conditions of makeshift migrant “Direct Provisions” centres which are the perfect breeding grounds for TB. Globally TB is recognised as a leading infectious cause of death with an estimated 10 million people falling ill with TB annually. The strongest risk factor for TB is HIV. Nearly half a million new cases of TB’s multidrug-resistant variety (MDR-TB) occur every year, with only about a quarter of them reported. This typifies the profile of the present migrant invasion of Ireland, which given the prevalent conditions could also be described as a TB invasion.
Current TB Prevention and Control
Current methods for the prevention and controlling of TB includes DOTS (Directly Observed Treatment Short course); contact tracing; vaccination; control measures in vulnerable areas such as migrant and refugee centres, hospitals, work places and prisons.
In those areas; surveillance; environmental measures such as ventilation, airflows of TB source; wearing protective equipment; respiratory hygiene, cough ethics; and the pasteurizing of milk.
The total absence of any such measures being implemented by the Irish department of health for migrants can only be described as criminal negligence. The Irish health authorities have no excuse following the track record of their draconian Covid measures. Yet TB is a far greater threat than Covid ever was to the health of Irelands migrants and the general population. This is being ignored at present lest the authorities offend the sensibilities of the growing migrant population. Because of this pussy footing, the addressing of TB care among marginalized group such as migrants is not being properly implemented if at all.
A Worldwide Disaster
At the 2018 United Nations (UN) General Assembly Meeting on TB in New York, the world’s leaders endorsed the UN Political Declaration on TB “United to End Tuberculosis” an Urgent Global Response to a Global Epidemic. The UN declared that a vision of “United to End Tuberculosis” is a world free of TB. That means, a world with zero TB deaths, disease or suffering resulting in its elimination. The aspiration of this strategy is to end the ongoing global TB epidemic. Targets for 2035 are the reduction of TB deaths by 95%, the reduction of TB infection by 90% and no families facing catastrophic costs due to TB. The principle “End TB” recommendation’s in the strategy are applying DOTS (Directly Observed Treatment Short course), government stewardship, accountability, monitoring and evaluation, strong coalition with civil organizations and communities, protection and promotion of human rights, ethics and equity and adapting the strategy and targets at country level, with global collaboration. Addressing proper TB care among migrants is related to protection and promotion of the human rights, ethics and equity components in the principles of the End TB strategy. Pillars of the End TB strategy which applies for migrants too are integrated, patient-centred care and prevention, having bold policies and supportive systems and intensified research and innovations.
Despite Ireland’s representatives being present and their endorsement of these proposals, their implementation is completely missing in Ireland’s dealings with the current TB crisis at every level. Are the Irish government inviting migrants into a TB death trap?
