Mandatory screening and treatment of immigrants for latent tuberculosis in the USA: just restraint?

A report by the Institute of Medicine, Ending Neglect, and sponsored by the US Centers for Disease Control and Prevention, makes recommendations for achieving elimination of tuberculosis in the USA. Among them is the recommendation that a mandatory screening programme be introduced for latent tuberculosis infection in immigrants from high prevalence countries, and that the provision of a permanent residence card (green card) be linked to the completion of an approved course of preventive treatment. We examine the evidence put forward to support this proposal and assess whether such a mandatory programme for preventive treatment of individuals, who do not pose an immediate risk but could pose a risk in the future, meets internationally recognised standards for coercive public-health measures. We conclude from our analysis that there is reason to question (i) the risk analysis, (ii) the estimates of effectiveness of such a policy, (iii) the cost calculations, and (iv) the operational consequences put forward in the report. Moreover, we show that international standards for mandatory screening and treatment are not met.