Insecticide resistance is an increasing problem in many insect vectors of disease. Our knowledge of the basic mechanisms underlying resistance to commonly used insecticides is well established. Molecular techniques have recently allowed us to start and dissect most of these mechanisms at the DNA level. The next major challenge will be to use this molecular understanding of resistance to develop novel strategies with which we can truly manage resistance. State-of-the-art information on resistance in insect vectors of disease is reviewed in this context.