When confronted with microscopic pathogens, one of humanity's few predators, the most robust health systems are only as strong as their weakest neighbours, and pathogens care very little for migration formalities. To compound the challenges faced by unprecedented human movement, national health systems are mired by the old-school practice of politicking, rather than being propelled by evidence and action centred on a long-term strategic vision for the public's health. Given these realities, why is communicable disease control confined within geo-political boundaries that are no longer representative of population movements? Tuberculosis is one example with complications arising from human mobility, where migrants acquire infection in one country, and then travel elsewhere. Individuals may become lost to follow-up in national health systems as they move into and out of respective countries, and the receiving country may or may not be aware of the infectious status of the migrant. The World Health Organization (WHO) is one option for combating state-centred public health, and to a certain extent some tremendous gains have been achieved since its inception. Some of the significant challenges facing the WHO reside in the lack of statutory power to collect quality-assured data and to enforce measures for the control of infections. Some might argue that this failing is essentially positive by design. Is it truly possible (or desirable) to have a global body with statutory powers for the enforcement of disease control? In a world of 195 countries representing thousands of living languages, a global public health agency would likely not have the cultural sensitivity requisite to prove effective on a local-level. Conversely, in an attempt to please all constituents a global agency might be rendered ineffectual in its quest for inclusivity. A compromise might be found in supra-national public health regions. Such agencies could be grouped along meaningful geo-cultural-political boundaries (e.g. Arabic Middle-Eastern countries), and these regional bodies would effectively assume the statutory communicable disease control functions of national or sub-national agencies. There is no doubt that this process of alignment would require substantial consideration and debate, far beyond the confines of this article. Even if this herculean feat of cooperation were to be realised, how then do we overcome the political agendas of member states? Certainly regional disease control agencies should be funded by participating member states, but there is much to be said for keeping them at arm's-length from any one national government. The benefits would include enhanced patient confidentiality from non-health actors; long-term strategic planning; a continuity of surveillance and treatment across a much broader terrain; and coherent international standards of prevention, disease control and treatment. …