Tuberculosis: Trends and the twenty-first century

The global burden of tuberculosis is enormous, even if estimates are somewh at uncertain. The forces counteracting control measures, namely demographic factors, drug resistance, HIV, migration, poverty and marginalization, are enormous as well. With accelerated reforms in tuberculosis programs import ant progress can be made towards the control of tuberculosis early in the 2 1st century. This is confirmed by studying reports from countries where con trol measures have been implemented and sustained. Well-functioning program s can make good use of technological progress, such as improved tools for d iagnosis and treatment, when these become available at an affordable cost. It is important now to use the opportunity of increased resources in order to reform tuberculosis programs. The biggest impact on global tuberculosis control in the 21st century can be made in Asia. Success in this part of th e world depends on political commitment. Elsewhere, the main forces counter acting control measures are HIV in Africa and multidrug resistance in parts of Europe and the former Soviet Union. Here solutions are still on the dra wing board. The long time-frame for tuberculosis control when using the cur rently recommended strategy, the uncertain impact of "improved" tools on th is time-frame and the constant threat that political commitment will not be sustained are reasons why field workers look towards new technology in hop e of progress in vaccine research. Here, the prospects are uncertain and th e forecasted time-frame is long. Skeptics even doubt that an effective vacc ine can be developed. However, when predicting progress it is important to realize that it is for the most part unpredictable.