In Depth: China Launches New Plan to Tackle Tuberculosis

In the Nanshan district of Shenzhen, approximately 500 new tuberculosis (TB) cases are diagnosed annually. This figure highlights a broader issue across China, where TB, the world's leading infectious killer, affects both affluent and rural areas. The country ranks third worldwide for TB cases annually, following WHO reports. [para. 1][para. 2] China's traditional strategy has emphasized treatment over detection, leading to a majority of cases being identified when patients seek medical care. However, the Chinese government is tackling this by promoting more active epidemic management strategies as incidence rates decline. [para. 3]

TB, primarily a lung-affecting airborne disease, disproportionately affects the elderly in China, who have an incidence rate seven times higher than the general population. Despite a 30% reduction in national TB incidence and mortality rates since 2012, roughly 10% of China’s counties and districts are still considered high-prevalence areas, as noted in a new national TB plan. [para. 4][para. 5] The National Tuberculosis Prevention and Control Plan (2024-2030) calls for improved patient discovery and treatment management, noting that preventive measures and new technologies have been underutilized. [para. 6] According to WHO, 540,000 TB cases were recorded in China last year, with a potential 200,000 undiagnosed. [para. 7]

Experts emphasize the importance of early TB detection, though China's healthcare system relies heavily on passive detection, where patients are diagnosed only after developing symptoms. For instance, Zhao Hua's case illustrates the challenges of identifying TB promptly as he experienced significant delays in diagnosis despite severe symptoms. A Chinese CDC study revealed a typical 29-day delay between symptom onset and treatment, exacerbated by atypical symptoms and inexperienced general medical facilities. Many cases, such as asymptomatic TB, remain undetected, posing ongoing transmission risks. [para. 8][para. 9][para. 10][para. 11][para. 12]

Despite a substantial decline in TB incidence—falling from 107 per 100,000 in 2000 to 52 per 100,000 in 2023—10% of Chinese counties still have rates over 100 per 100,000 according to the national plan. Future goals include reducing incidence to under 43 per 100,000 by 2030. The plan emphasizes timely diagnosis in medical institutions and increased screening for high-risk groups such as close TB contacts, the elderly, and diabetics. [para. 13][para. 14][para. 15][para. 16] Methods used, however, often fail to detect asymptomatic individuals, as noted by CDC experts, underscoring the need for improved strategies. Yunnan province has pioneered incentive programs for healthcare workers, significantly enhancing proactive TB detection at primary healthcare levels. [para. 17][para. 18][para. 19]

Financial constraints remain a challenge in the fight against TB in China. In some regions like Shenzhen, substantial government investment supports free screenings, yet this is not widespread. The costs of diagnostics, medications, and care can be financially crippling, particularly in less affluent areas, as seen in Zhao Hua’s case where high medicine costs strained his family. [para. 20][para. 21][para. 22] Funding for TB prevention generally stems from central and provincial finances, supplemented by some local government funds, to offer free public health services. Despite advances like molecular biology testing offering rapid diagnosis, cost barriers hinder broad implementation. [para. 23][para. 24][para. 25]

Experts advocate for region-specific screening strategies that are more effective than large-scale screenings. WHO representatives express optimism about China's capacity to curb TB but emphasize the need for increased funding, evidence-based strategies, improved social security, and public engagement. [para. 26]