A “Just Transition” for Drug-Resistant Tuberculosis

Tuberculosis (TB) remains a serious health threat and strains of TB resistant to first-line therapies account for significant TB-related morbidity and mortality. Widely recognized as a disease of poverty concentrated in low- and middle-income countries, drug-resistant tuberculosis (DR-TB) is a result of deep-seated deprivation and the shortcomings of under-resourced health systems. Traditionally, the response to TB, and particularly DR-TB, has been focused on dealing with the infection and preventing onward transmission, for example, through isolating people with TB in sanatoria or specialized hospital wards. Recently, activists and policy makers have recognized the need to put people affected by the disease at the center of TB programs, but this is just the beginning of the necessary “just” transition from inequitable and unsustainable approaches to addressing TB to ones that are inclusive, community-centered, and resilient. In this article, we examine antimicrobial resistance in TB and highlight the need for a multisectoral, justice-oriented approach that goes beyond biomedical paradigms—we propose a “just” transition that addresses the unequal burden of human suffering and injustices that have become systemic in TB programs. We see a “just transition” as involving long-term structural changes to technologies, policy, infrastructure, scientific knowledge, and practice.