Tuberculosis (TB) and helminth infestation are tied in multiple ways through physiological interactions both pre- and postnatally. In the Pacific, these interactions have occurred in the context of colonial and postcolonial changes. We argue that these biocultural interactions help to explain the historical experience of TB for people in the Pacific nations of Tuvalu and the Cook Islands. Successive campaigns against specific helminths and later efforts at TB control have led to variable outcomes. In this article, we analyze the implications of controlling syndemic conditions for health practice.