The beginning and the end of the 20th century were marked by great pandemics: influenza and AIDS. Medical journals do not describe any major tuberculosis (TB) pandemics in the 20th century. Yet TB likely was responsible for more deaths in the last 100 years than influenza and HIV combined. Steadily, insidiously, millions of people die from TB every year. Even under optimal TB control conditions, it is estimated that more than 50 million people will die from TB between 1998 and 2020. Under current TB control conditions, the number is closer to 70 million. It is long past time that the global community committed to a serious program to eliminate tuberculosis mortality. Such a program would require making treatment universally available, making prevention accessible to those in poor countries as well as affluent, addressing the interaction between HIV and TB, and setting serious verifiable goals. A global 5 x 7 initiative that calls for treating an additional 5 million active TB cases per year, and for screening up to five contacts of every TB case, by 2007 would offer an important beginning. With the sustained effort that comes from public commitment, TB can be changed from one of the most important causes of preventable death worldwide to a historical cause of death. Without this effort, TB will remain the silent, steady killer it has been for centuries. The rationale for action, potential and need for success are detailed in this article.