The End of TB Strategy. Ethics Guidance for the Implementation of the End of TB Strategy. 3/2017

Published by WHO


The World Health Organization (WHO) End TB Strategy  – adopted by the World Health Assembly in May 2014, with targets linked to the Sustainable Development Goals (SDGs) – serves as a blueprint for countries to reduce the number of tuberculosis (TB) deaths by 95% by 2030 and cut new cases by 90% between 2015 and 2035.

The End TB Strategy builds on three essential pillars:

1. Integrated, patient-centred TB care and prevention.

2. Bold policies and supportive systems.

3. Intensified research and innovation.

These pillars are underpinned by four key principles:

1. Government stewardship and accountability, with monitoring and evaluation.

2. Strong coalition with civil society organizations and communities.

3. Protection and promotion of human rights, ethics and equity.

4. Adaptation of the strategy and targets at country level, with global collaboration.

Building  on  the  original Guidance  on  ethics  of  tuberculosis  prevention,  care  and  control in 2010, this guidance updates and broadens its scope to address the most critical  challenges  being  faced  by  health  care  workers  and  decision-makers  to  ensure that sound ethics underpins the implementation of the End TB Strategy. This document’s structure will therefore follow the pillars and ideas as presented in the End TB Strategy itself, for clarity and ease-of-use.

In the near future, those working in TB will have to address traditional challenges (such  as  promoting  health  seeking  behaviours,  enabling  adherence  to  treatment,  preventing and mitigating stigma and discrimination) alongside new ones, including the use of new tools for diagnosis, treatment, prevention, care and management and the uptake of digital health tools. New tools are required to sustain and accelerate progress, in particular a new vaccine that is effective pre- and post-exposure, better diagnostics, shorter drug regimens, and more effective targeted treatment for latent TB infection. Immediate investment in research and development is thus needed to ensure that these tools become available in time to meet the targets set by the End TB Strategy and the SDGs.

Thus, the goal of this guidance document is to assist those working towards ending TB in the 21st century by proposing practical answers to key ethical questions and enabling patients, families, civil society, health workers and policy makers to move forward  and  address  current  challenges.  This  TB  ethics  guidance  can  then  inform  difficult decision-making processes by providing recommendations and serving as a basis for further analysis of complex ethical challenges.

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