Tuberculosis, migration, and medical examination: lessons from history

The health screening of migrants, asylum seekers, and other entrants to the UK is currently high on the political and public health agenda. Two features of this debate are worth highlighting—the focus on single diseases such as tuberculosis, and the emphasis on the experience of Australia. In February 2005, the government announced proposals to implement existing powers by screening visa applicants for tuberculosis on “high risk” routes, and requiring those diagnosed to seek treatment before they would be permitted entry to the UK.1 The Conservative party has also announced that visas would be denied to prospective migrants in whom tuberculosis was detected. Michael Howard stated that “the British people deserve the best standards of public health. We need to control who is coming to Britain to ensure that they are not a public health risk and to protect access to the NHS. It’s plain common sense. And it’s exactly what they do in New Zealand, Canada and Australia”.2,3

There is therefore considerable interest in “the Australian model”, and policy in the UK has shifted to pre-entry screening for tuberculosis. The current law cannot be used to remove people once they have arrived, and policies have been drawn up to exclude before arrival. At the same time, it has been argued that there is little evidence on the benefits or drawbacks of a policy of pre-entry screening for tuberculosis, and disease should not be a basis for discrimination.4,5 This commentary reviews current Australian policy, explains its history, and compares it with the development of policy in the UK. The commentary argues that in the absence of scientific …