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On Target: A Tuberculosis Control Strategy Whose Time Has Come
A decade ago, the Centers for Disease Control and Prevention's Advisory Council for the Elimination of Tuberculosis (ACET) audaciously called for the elimination of tuberculosis in the United States: The goal was 1 case per million by 2010, with an interim target of 3.5 cases per million by 2000 (1). This call was audacious because at the time, the United States was in the throes of the AIDS epidemic (AIDS being the most potent facilitator of tuberculosis ever known) and was just beginning to recover from its grievous failed exercise of ending federal support for categorical national and state tuberculosis programs (2). Now, on the 10th anniversary of that call, ACET is once again renewing its commitment to elimination of tuberculosis (3).
Looking back, it is obvious that such a call was anything but audacious. In both plans, ACET (1, 3) couched its call in the fact that tuberculosis was and is discerned to be retreating into well-defined risks groups that can be targeted for control efforts. Consequently, strategies dealing with these groups may effectively reduce the ever-embarrassing burden of cases from this preventable and curable disease. In other words, given that the well-defined high-risk groups disproportionally contribute to tuberculosis morbidity, concentration of strategies on such targets will disproportionally decrease morbidity. Since the first ACET report (1), such targeting has been sporadically applied. Even though tuberculosis rates have been gratifyingly lower 6 years in succession, progress still seriously depends on persistent political will …
