In 1992 there was a potential worldwide epidemic of tuberculosis brewing in New York. Multiple drug resistant strains were beginning to show up – the kind that known medications could not treat effectively. TB is a disease of the poor and indigent. Patients regularly moved between the Public Hospitals, Shelter System, and Prisons. The Department of Health was in charge of leading the effort to combat the disease and the Office of Management and Budget needed to be involved to allocate financial resources. These five city agencies were required to create – and then rapidly implement — a Blueprint for TB Control though they had no track record of partnering well in the past. The City was on its way to becoming the epicenter of a global TB epidemic.