In May 2014, the World Health Assembly officially approved the Draft Global Strategy and Targets for Tuberculosis Prevention, Care and Control after 2015. 1 The target of the strategy is the elimination of tuberculosis as a public health threat by 2035. This target is ambitious, but the commitment to the end of tuberculosis is laudable. The recently published 19th WHO global tuberculosis report 2014, 2 provides an opportunity to think once again on the global tuberculosis strategy, and to assess just how much further effort is needed before global tuberculosis control can be achieved.

Previously, 3 we declared that the 1· 3 million deaths per year from tuberculosis reported in the 2013 WHO global tuberculosis report was unacceptable in the 21st century. The latest 2014 WHO global tuberculosis report has revised its estimates of new tuberculosis cases worldwide from previous years, and now shows that almost half a million more cases of tuberculosis occurred worldwide than in their 2013 estimate. 4 Of an estimated 9 million people who developed tuberculosis in 2013, 1· 5 million people died (deaths up from 1· 3 million estimated in 2012). The 2014 WHO report also states that the problem of drug-resistant tuberculosis is worsening, with an estimated 480 000 new cases of multidrug-resistant (MDR) tuberculosis in 2013. This number too might be an underestimate, since estimates for the true burden of drug-resistant tuberculosis across sub-Saharan Africa, Asia, and eastern Europe are impaired by the fact that drug-resistance testing and treatment services are generally unavailable at most health-care facilities. 5, 6 Perhaps even more concerning was that, of the nearly half a million estimated cases of MDR tuberculosis worldwide, only 136 000 cases were officially diagnosed. The outlook for these patients is bleak, with treatment completion rates remaining at 48% and a widening gap between people who are diagnosed and those who receive treatment. Furthermore, 9% of people with MDR tuberculosis are estimated to have extensively drugresistant (XDR) tuberculosis—ie, nearly 50 000 people worldwide have a form of the disease that, at present, cannot be treated.