Paper short abstract:

In 1993, WHO proclaimed tuberculosis to be a global emergency to be attacked through the so-called Directly Observed Treatment, Short Course strategy. This paper will discuss the links between history and memory in the advent of the DOTS strategy looking at the cases of East Africa and India.

Paper long abstract:

In 1993, in the context of the HIV epidemics, WHO proclaimed a global tuberculosis emergency necessitating so-called Directly Observed Treatment, Short Course strategy. Subsequently DOTS became a major component of a global health enterprise, providing solutions to health challenges in Southern countries. Paradoxically, DOTS is not innovative in any biomedical sense but offered a new organizational framework built around older medicines and diagnostic tools.

Looking at the inception and development of the strategy in India and East Africa, this paper will argue that DOTS is a powerful lens to address a rarely discussed dimension of global health: the return of "vertical" programs after a period of eclipse in the 1970s and 1980s,. This return could appear as innovative because the memory of (failed) enterprises like malaria eradication had faded away, because tuberculosis had disappeared from the agenda, and because new actors in global health strongly promoted disease-centered therapeutic initiatives.

We will discuss the links between history and memory in the advent of the DOTS strategy in two ways. The case of East Africa it will show how the medical experts in the 1980-1990s mobilized the history of tuberculosis control to design the new strategy. The case of India the implementation of a "Revised National Tuberculosis Program" based on DOTS, will explore the juxtaposition of a strong critic of the past (the "old" National Tuberculosis Program from the late 1960s onward) and of continuities in TB management in India.