125 years after Robert Koch's discovery of the tubercle bacillus: the new XDR-TB threat. Is “science” enough to tackle the epidemic?

March 24, 2007 will mark the 125th anniversary of Robert Koch's discovery of the tuberculosis (TB) bacillus (figs 1⇓ and 2⇓). This anniversary comes after a year of major achievements for the international TB community. Fig. 1— Robert Koch (1843–1910), who discovered Mycobacterium tuberculosis in 1882. Nobel Laureate Physiology or Medicine, 1905. Fig. 2— The title page of Robert Koch's original article published in Berliner Klinische Wochenschrift on April 10, 1882 1. This journal is no longer in existence. Provided courtesy of H.L. Rieder (Tuberculosis Division, International Union Against Tuberculosis and Lung Disease, Paris, France). Firstly, in 2006, the new Stop TB Strategy was launched by the World Health Organization (WHO), following intensive exploration and discussion with TB control programme managers in high burden countries and partner organisations, including technical agencies and donors 2. The DOTS strategy (consisting of five key elements: government commitment, diagnosis through microscopy, standardised and supervised treatment, uninterrupted drug supply, and regular programme monitoring), which greatly contributed to the improvement of global TB control over the last 10 yrs 3, was revisited to pursue DOTS expansion while making explicit six additional components that must be implemented to reach the 2015 Millennium Development Goals (MDGs) relevant to TB control. Thus, the new Stop TB Strategy consists of: 1) the pursuit of high-quality DOTS expansion and enhancement; 2) addressing TB/HIV, multidrug-resistant (MDR)-TB and other challenges; 3) contribution to the strengthening of health systems; 4) engaging all care providers; 5) the empowerment of people and communities with TB; and 6) enabling and promoting research. The MDGs relevant to TB aim at combating HIV, malaria and other diseases. Its target 8 consists of halting TB by 2015 and beginning to reverse the incidence of disease; indicator 23 addresses TB prevalence and mortality; and indicator 24 is the proportion of cases detected …