Many European Union (EU) Member States show a decline in tuberculosis (TB) incidence and many have low incidence rates (15 countries reported less than 10 cases per 100,000 population in 2006). However, despite the progress in curbing the TB epidemic, the disease remains a public health threat in the EU. The epidemiological patterns are still very diverse between countries and control efforts are challenged by problems such as multidrug-resistant (MDR TB) and extensively drug-resistant tuberculosis (XDR TB), TB/HIV co-infection and the concentration of cases within vulnerable groups.

In this context, in March 2007 the EU Health Commissioner called on the European Centre for Disease Prevention and Control (ECDC) to work on a proposal for an action plan to fight TB in the EU. Following the call, the ECDC has developed a Framework Action Plan to fight Tuberculosis in the European Union [1]. The document covers the essential elements that need to be addressed to control TB effectively and finally to eliminate the disease (defined as less than one case per 1,000,000 population) in the EU. It has been developed by the ECDC Tuberculosis Disease Programme, in close collaboration with the European Commission and with the extensive contribution of other experts from ECDC, the EuroTB network, EU Member States and European Economic Area EEA/EFTA countries, the World Health Organization (WHO) and other key stakeholders. In addition, the Round Table on Health Strategies in Europe organized by the Portuguese Presidency of the EU in July 2007 provided valuable expert input on the topic of MDR/XDR TB.

The long-term goal of the Framework Action Plan to fight Tuberculosis in the European Union is to control and ultimately eliminate TB in the EU. Specifically, the plan aims at:

• Increasing political and public awareness of TB as a public health issue in the EU;
  
• Supporting and strengthening EU Member States’ efforts against TB in line with national epidemiological situation and challenges; and
  
• Contributing to the control of TB in the EU by supporting those countries from which imported cases originate.

The plan is based on four principles: ensuring prompt and quality care for all; strengthening capacity of health systems; developing new tools; and building partnerships and collaboration with countries and stakeholders. Eight areas for strategic development are linked to the four basic principles described in the document. These eight areas (Box 1) recognise the need to consider the heterogeneous epidemiological picture in the EU and to recognise the different needs of those countries with high, and those with low, TB incidences in order to direct actions appropriately. The four principles and the underpinned strategies are in line with the content of the United Nations’ Millennium Development Goals and the WHO Stop TB Strategy and is complementary to the ‘Plan to Stop TB in 18 High Priority Countries in the WHO European Region 2007–2015’ [1].

The plan is meant as a first step in a process that will need to continue over the coming years with more detailed activities implemented at regional, national and Community level. Close collaboration with countries neighbouring the EU and other countries will be essential in the implementation of this plan in order to contribute to the global reduction of TB. The 'Framework Action Plan to fight Tuberculosis in the European Union' is posted on the ECDC website (http://ecdc.europa.eu/pdf/080317_TB_Action_plan.pdf) and will be presented to the European Council in June 2008.

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* Tuberculosis Disease Programme members: A. Amato-Gaucci, K. Fernandez de la Hoz, V. Hollo, C. Kodmon, D. Manissero, A. Nanda, J. O’Toole, A. Ozin, V. Prikazsky, I. Steffens, A. Würz