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How to trigger a tuberculosis outbreak in the supply chain?

· Public Health,TB,EHS

This article is originally written by Stephen Frost, first post by GoBlu.

Last week, Inno Community Development Organisation (Inno) in China tackled with a troubling case related to the handling of tuberculosis (TB) in a supplier factory. Since it involves a top Chinese supplier to a luxury brand, the situation would appear to have implications for any brand sourcing from suppliers in China.

TB is an infectious airborne disease and is easily transmitted in crowded environments, such as factory workplaces, dormitories, and offices. It is spread through the air when people who have an active TB infection cough, sneeze, or otherwise transmit respiratory fluids through the air. Most infections do not have symptoms, known as latent tuberculosis. About one in ten latent infections eventually progresses to active disease which, if left untreated, kills more than 50 per cent of those so infected. China has the world’s second largest tuberculosis epidemic (after India), with more than 1.3 million new cases reported every year. Of the 37 notifiable communicable diseases in China, tuberculosis ranks first in terms of notified cases and deaths.

In the spirit of SDG 3 (to ensure healthy lives and promote well-being for all at all ages), Inno seeks to raise awareness on TB in the supply chain, and the procedures that should be in place to ensure a timely and adequate response to TB should it arise in factories.

The case: TB in a Chinese supplier

Last month, Inno’s Handshake Workers Hotline received a call from a mid-level factory manager who related the following case.

In June 2016, the manager went to the Philippines on an extended business trip. In October, he fell ill, the main symptom of which was a fever. The factory in the Philippines arranged for him to visit a doctor in Angeles City, where he was diagnosed with a common local infection disease (not TB). The manager was hospitalised for three days, and upon release took sick leave for approximately two weeks, during which time he maintained regular contact with the Angeles City hospital. At the end of two weeks, he was certified fully recovered. In November he returned to China and to work.

In early 2017, during the Lunar New Year, the manager returned to his hometown to celebrate with his family. Whilst there, he ran a fever and upon visiting a doctor was diagnosed with TB. The hospital told him his condition was neither serious nor infectious. As is commonly the case in China, the doctor told him that he could receive free health checks and medicine, but only at the hospital servicing his household registration area, and that such services would not be available to him when he returned to the factory. (This situation arises as a consequence of China’s household registration system, or hukou, which denies services such as state healthcare to non-registered residents.)

1 March: the manager applied for annual leave to return to the place of his registration to take advantage of free health checks and medicine. He informed the factory of his situation and applied for annual leave. A week later (8 March), having learned of the TB diagnosis, the factory asked him to voluntarily resign within two days or be fired with a one-month severance package.

10 March: the manager contacted Inno’s Handshake Workers Hotline, which within 24 hours notified the brand to which the factory supplied.

11 March: at the factory’s suggestion, the manager went to another hospital for tests, and then returned to the factory where he was confined to a room of his own (which he already had since he was a manager).

13 March: the hospital confirmed the manager had secondary tuberculosis of the lung, and that the possibility of infecting others was not high. There was no mention of isolating the manager, and simply stated he would require monthly check ups That afternoon, the manager left the factory to return to his registered residence. The factory deferred a decision on its next step.

14 March: With the report details in hand, Inno contacted the brand in question. The brand contacted the factory on the same day, asking for a complete report.

15 March: Inno contacted the factory noting the following points:

  • The case is not simply a private health issue, but one of public concern. The factory cannot deal with TB like other non-transmissible diseases
  • The factory did not have a systematic regime in place to deal with infectious or chronic diseases
  • China has provided relatively generous resources to deal with TB, but when TB becomes an issue in a labour disputes, the government may find itself hindered in providing solutions

21-22 March: With the brand’s intervention, the factory understood the necessity of placing a public health risk above an issue of workplace compensation, and the issue was resolved. The factory set in place a means by which to inform workers about TB prevention, and also took disinfection measures.

Lessons

From the time the factory first learned the manager had TB (1 March) until a week later (8 March), took no precautionary action to safeguard public health. Neither GoBlu nor Inno seeks to apportion blame here, but it is clear the factory had no procedure in place by which it could take appropriate steps. It will take a coordinated effort between community organisations such as Inno, brands and suppliers (and perhaps also the Chinese government if necessary) to ensure adequate procedures are in place.

Brands and supplier factories should take measures now. At the very least, the following should be in place:

  • Brands should ensure they have appropriate clauses in codes of conduct dealing with TB as a public health issue and ensure the clauses are in place and implemented
  • Suppliers should develop adequate internal and external communication mechanisms, and draw up specific action plans with appropriate managerial responsibilities assigned

If you would like to know more about this issue, please contact us.

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