Endemic infections

Abstract Stable, familiar endemic infections are rarely seen as health emergencies, even though they kill millions of people each year. But there are ways to remedy the neglect, here illustrated by tuberculosis. Because curative treatment is currently the best form of prevention, the immediate priority for TB control is early diagnosis and chemotherapy, aided by developing novel diagnostics (easier) and therapeutics (harder), and carried out in the context of primary healthcare. This reinforces three major goals of global health at the same time—strengthen primary healthcare, reach Universal Health Coverage (UHC), and put TB on a path to elimination. Other motivating strategies have supporting roles: highlight new dangers from old hazards, such as the emergence of multidrug-resistant strains; neutralize major risks for TB, especially co-infection with human immunodeficiency virus (HIV); and mitigate the large number of weaker TB risks that have co-benefits for other health conditions (diabetes, undernutrition) and for society more widely (homelessness, crowding). Vaccination is the ultimate, transformative, preventive tool for TB but awaits a high-efficacy companion or successor to BCG. Whatever the virtues of new technologies for TB control, none will succeed without understanding the means and incentives for implementing them, as illustrated by the roll-out of antiretroviral therapy for HIV/AIDS and TB control in southern Africa.