Tuberculosis (TB) still imposes a huge burden of ill health, premature death and emotional suffering on the developing world. Over the past 30 y it has been greatly neglected by those concerned about international public health and there are now nearly 8 million new cases annually and 1.86 million deaths. An epidemic of HIV-associated TB is now affecting Africa and threatening parts of Asia. Multidrug-resistant TB has emerged as a huge threat in Russia and its former satellites. However, with the advent of the directly observed treatment, short-course (DOTS) strategy in 1995, high-burden countries have started to seriously address the problem. Recent political commitment on the part of the rich nations, together with significant increases in funding from private foundations and great scientific advances in our understanding of Mycobacterium tuberculosis, give rise to cautious optimism that TB will be controlled during this century.