The spread of multi-drug-resistant tuberculosis (MDR-TB) in Russia is by no means unstoppable (Nature http://doi.org/rf3; 2014). MDR-TB epidemics have been prevented and/or reversed in Latvia, Estonia, Hong Kong and the United States, and even in the hard-hit Russian provinces of Orël and Tomsk, by using evidence-based policies and patient-centred care.

Containing the airborne spread of MDR-TB requires transmission to be interrupted, treatment of active disease with the right antibiotics for the correct amount of time, treatment of latent infection, and locating cases and their contacts.

As a result of political determination and a series of intervention programmes, the Tomsk Oblast TB services, in conjunction with Partners In Health, based in Boston, Massachusetts, reduced MDR-TB prevalence from an estimated 823 cases in 2002 to 328 in 2012. These reductions were the result of structural changes (better facilities, treatment sites and community-based care), clinical improvements (individualized drug regimens and aggressive management of adverse events) and social interventions (treatment incentives and assistance with food and transportation).

The complexity and expense of MDR-TB treatment take a huge toll on patients and carers. We urgently need better diagnostics, shorter and less-toxic treatments, and more research and resources. Even with existing resources, much more is possible.