The global tuberculosis (TB) pandemic continues despite living in the era of the greatest advances in human medicine. Severe TB in the form of meningitis and miliary TB kills and disables people around the world every day. It disproportionately affects the most vulnerable populations, especially children. Diagnosis and treatment are challenging, and most have poor outcomes, often never receiving treatment at all. Dedicated TB researchers continue to make improvements in the management of severe TB, but the long-term success will require a global commitment to improving health care for poor people around the world.