While many people in the West consider tuberculosis (TB) a disease of a bygone era, the devastating human toll taken by the disease is increasing worldwide, particularly in developing countries with high HIV prevalence. Every year, TB kills nearly two million people while an estimated nine million develop the disease. An additional 450,000 new cases of multi-drug resistant (MDR) TB are seen every year.

This frightening situation became even worse in 2006 when a survey of 544 TB patients in Kwazulu Natal, South Africa, found 10 per cent had developed extensively drug resistant tuberculosis (XDR TB) (The XDR-TB emergency will require new strategies and new tools: business as usual would be fatal), a strain of TB that is resistant to both first-line antibiotics as well as to two classes of second-line drugs. Almost all of these patients died, and the extent of the outbreak remains unknown.

Even so, the drugs in today's standard TB treatment were developed in the 1950s and 1960s, while the most commonly used TB test - sputum microscopy - was developed in 1882 and only detects TB in half of the cases. Existing TB treatments and diagnostics are even less adapted for use in people living with HIV/AIDS, even though TB is their number one killer.

The years of neglect are underscored by the fact that, of the 1,556 new chemical entities marketed worldwide between 1975 and 2004, only three were for TB. Even though some initiatives are underway, efforts need to be significantly increased in order to respond to the disastrous impact of TB. None of the drugs currently in development, however promising, will be able to drastically improve TB treatment in the near future.

"That TB destroys millions of lives around the world every year shows that the current approach is just not working," said Dr. Tido von Schoen-Angerer, Director of MSF's Campaign for the Access to Essential Medicines. "The tools we have to treat and diagnose TB are woefully inadequate and outdated, and we're not seeing the necessary urgency to tackle the disease."