Global elimination of tuberculosis: implementation, innovation, investigation.
The elimination of a public health menace such as tuberculosis is always an attractive proposition. Is it realistic to consider? Selecting elimination as a target engages commitment, identifies challenges and stimulates critical evaluation. Challenges are numerous, including the large pool of latent infection, the long incubation period, the inadequacy of present tools and strategies, poverty and its relation to tuberculosis, the dependence on declining health services, the negative impact of human immunodeficiency virus infection, and the long-term commitment required with present approaches. Although tuberculosis has a tragic impact in causing death and chronic illness, the target for elimination must remain preventing infection, and the aim to achieve a generation free of infection. Targeting decreased mortality or improved health will not be sufficient to guide the critical reflection required to eliminate the causative organism; this can only be achieved by focusing on preventing and eliminating infection. While we have an international consensus on the strategy for controlling tuberculosis, we must also keep in mind that it is not sufficient. We must improve the current strategy as well as develop new tools on which we can base a new strategy if we hope to achieve the objective of elimination of tuberculosis. Reaching the target will require commitment to implementing what we currently have, improving on it in every way possible and keeping our minds and imaginations open to new ways to approach the fight against tuberculosis.