When Mario Raviglione joined the World Health Organization (WHO) in 1991, tuberculosis (TB) control was a global patchwork of ineffective treatments, poor surveillance and disconnects between researchers, doctors and health agencies. Some countries ignored TB altogether.

Much has changed 16 years on. The WHO's main strategy against TB, directly observed treatment short-course, or DOTS for short, was launched in 1995 and is being implemented in 183 countries. Case detection rose from 12% in 1995 to 53% in 2004, and yearly TB deaths dropped from 3 million to about 2 million.

If only one community pushes it, you can't do anything. Mario Raviglione, WHO's Stop TB program

But Raviglione, who became director of the WHO's Stop TB department in 2003, says this is just the start. When others in the global health community were content with DOTS, he was already pushing for more. “In the beginning, the focus was on DOTS,” Raviglione says. “People would say, 'Don't insist on anything else, because we have to do the basics first.'”

Under the new Stop TB strategy, DOTS is one element of a much larger plan. The strategy addresses problems DOTS ignores, such as the rapid spread of TB in those infected with HIV and the disconnect between researchers and public health officials. It also asks companies and local communities to play a larger role in TB control.

“DOTS was a biomedical intervention,” Raviglione says. “This is a health system intervention.”

Much of the new strategy is uncontroversial, but convincing the TB and HIV public-health communities to cooperate may prove difficult. Raviglione, who started out in HIV research, says those in charge of fighting HIV haven't yet acknowledged “that TB kills up to half their patients.”

“If only one community pushes it, and you're talking about joint interventions that require participation from doctors in programs dealing with both,” says Raviglione, “you can't do anything.”