Ethical issues surrounding childhood tuberculosis

Each year, at least one million children become ill with tuberculosis (TB) and more than 253 000 died of TB in 2016. The ethical issues surrounding childhood TB remain underexplored, and established or proposed management strategies are scarce. In this paper, we identify ethical challenges that are raised by childhood TB. Some of them are familiar from TB in other populations but arise with increased severity in children. We discuss interconnected and mutually reinforcing difficulties clustered around the topics of susceptibility, diagnosis, reporting, service provision, treatment, psychological and social support, and research and development (R&D) neglect. We formulate suggestions on how to address these ethical issues. For developing sound research agendas and policies based on the WHO End TB Strategy, it is essential that diagnosis and reporting improve. There is a duty to care for and provide available interventions to children with TB even if they are not a major source of transmission, and therefore no major impact on public health is expected. Treatment should be accompanied by counselling, health education, psychological and material support to TB-affected children and their families. Children need to be included equitably and more systematically into the TB research agenda.