How to hinder tuberculosis control: five easy steps

It is undoubtedly challenging to formulate policies for the optimum control of tuberculosis, especially with limited resources. However, history shows that acting on the basis of urgency or unfounded assumptions rather than evidence, and ignoring realities on the ground, such as perverse incentives and unregulated private practitioners, will lead to squandering of tuberculosis control efforts at best, and causing harm at worst. The repeated call for strong leadership seems especially naive, when that same call repeatedly ignores local contextual priorities and impediments to control. We feel forced to ask whether, in another 30 years, we will look back and say that, despite our knowledge base and experience, we exacerbated the burden of tuberculosis because of our haste simply to act. Perhaps now is a good time to recall the oft-stated maxim “insanity is repeating the same mistakes and expecting different results”.