Issues

The global tuberculosis (TB) response is at a crossroads. In recent years, new ideas, technologies, and political commitments have reinvigorated the fight against this age-old disease that kills more people each year than HIV and malaria combined. But with key indicators just beginning to recover after moving in the wrong direction during the COVID-19 pandemic, hard-earned gains are at stake. In this rejuvenated yet challenging context, we critically review an idea and practice at the heart of the TB response—directly observed therapy or DOT. First, we explore DOT’s controversial method and history as a component of the World Health Organization’s recommended TB strategy. Second, we outline a rights-based disease response and examine DOT through the lens of human rights and related principles. Third, we review the evidence for DOT’s effectiveness. Fourth, we highlight DOT’s most salient and enduring problems. Finally, we propose two essential principles for the way forward to protect and promote the rights of people affected by TB.

A key thesis of this article is that since renewable energy is quintessentially a public good both in constitutional and macroeconomic terms, its availability without restrictions to all people is a true manifestation of economic self-determination, ultimately entailing what this author calls “energy equality.” Although this equality is dictated by the nature of renewable energy as a public good, it risks being eroded by the rush to implement the Paris Agreement. This is certainly one of the shortcomings of the Paris Agreement. With nation states eager to meet their targets and energy concessionaires given unprecedented financial and other incentives, we are witnessing not only the infiltration of criminal elements in the licensing of renewable projects, but also an absence of appropriate impact assessment. In the process of energy transition, the absence of a robust business and human rights framework is giving rise to irreparable damage to the natural environment and social livelihoods. It is suggested that many states, particularly in the industrialized world, are obsessed with their energy grids because the energy grids allow them to sell energy at monopolistic prices, impose taxes through it, as well as exert control over their citizens. With this in mind, national grids adversely impact the socio-economic and developmental rights of the poor and the middle class and prevent them from living decent lives in many cases. The transition to zero carbon economies and the availability of cheap renewable resource harnessing devices for the first time in history can promise energy equality in a sustainable manner. The poor can enjoy the fruits of energy in the same manner as the rich. The article therefore suggests that whatever investment on national energy grids, this should not be made compulsory by states and concessionaires on individual households and communities.