The History of Tuberculosis Prevention Day and National Strategic Plan for Tuberculosis Control in Republic of Korea

Abstract

Objectives

This study aims to raise awareness of tuberculosis and emphasize prevention by reviewing the history of World Tuberculosis Day and Tuberculosis Prevention Day, as well as analyzing tuberculosis control policies and achievements.

Methods

This study was prepared using a literature review and policy reports on Tuberculosis Prevention Day.

Results

Since the 2010 revision of the Tuberculosis Prevention Act, Tuberculosis Prevention Day has been observed annually on March 24, replacing the previously designated Tuberculosis Prevention Week. Since 2013, a five-year Tuberculosis Control Plan has been implemented to systematically manage tuberculosis. The third plan is currently in progress, incorporating past achievements and addressing previous limitations.

Conclusions

Tuberculosis Prevention Day underscores the severity of tuberculosis, its public health importance, and the efforts of frontline workers. The National Tuberculosis Control Plan has been developed based on domestic and international conditions, with a focus on training professionals, initiating preventive activities, and strengthening government-private collaboration systems.

Key messages

① What is known previously?

Tuberculosis Prevention Day (March 24) was designated through the Tuberculosis Prevention Act in 2010. The Tuberculosis (TB) Control Plan has been established every five years since 2013.

② What new information is presented?

Following the designation of Tuberculosis Prevention Day, awareness campaigns expanded to run year-round. The Strategic Plan for Tuberculosis Control in the Republic of Korea (2023–2027) was developed with four major implementation strategies and 14 specific tasks, aiming to reduce the tuberculosis incidence rate to 20 per 100,000 by 2027.

③ What are implications?

The TB Control Plan has been continuously adapted and developed in response to domestic and international conditions. It has also provided opportunities for training and engagement of TB professionals. Additionally, collaboration between the government and the private sector has played a key role in efforts to eliminate tuberculosis.

Introduction

Tuberculosis (TB) is a disease caused by the invasion of Mycobacterium tuberculosis into the body. Since this bacterium primarily enters the lungs through respiratory transmission between humans, pulmonary TB is the most common form. However, the bacteria can also invade other organs, such as the pleura and lymph nodes, leading to extrapulmonary infections. In its early stages, TB is often asymptomatic, with the symptoms developing over time. The most common symptom is cough, accompanied by weight loss, night sweats, fever, general fatigue, and loss of appetite. Without proper treatment, the disease can be fatal [1].

The history of TB in humankind dates back to prehistoric times, as evidenced by archaeological remains. Even Hippocrates recorded that young individuals were particularly susceptible to TB. During the Industrial Revolution, TB caused significant mortality in the densely populated urban areas of Europe, especially among the impoverished and working-class populations, making it a major social issue. The discovery of M. tuberculosis in 1882 and X-rays in 1895 enabled the diagnosis of TB, and the development of the Bacillus Calmette–Guérin (BCG) vaccine in the early 20th century marked a turning point in the control of TB. However, over 90% of TB infections remain in a latent state, and the emergence of multidrug-resistant TB (MDR-TB) is preventing the disease from being completely eradicated. As a result, TB is a historical disease that has coexisted alongside humans, exerting a profound impact on human history [2].

In the Republic of Korea (ROK), rapid industrialization, economic growth, and improved living conditions have significantly reduced TB incidence, leading to a decline in public awareness over time. However, in 2023, the total number of TB cases in ROK was 19,540 (38.2 cases per 100,000 people), with 1,331 TB-related deaths (2.6 deaths per 100,000 people) [3]. Among legally designated infectious diseases, TB ranked fourth in terms of the number of cases, following coronavirus disease (COVID-19), carbapenem-resistant Enterobacterales infections, and varicella, while it ranked second in mortality, following COVID-19 [4].

For these reasons, the World Health Organization (WHO) and governments worldwide, including ROK, have been raising awareness about the dangers of TB and the necessity of its prevention through World Tuberculosis Day. Various policies have been implemented to combat the disease. Accordingly, this report aims to examine the history of World Tuberculosis Day and ROK’s national TB management policies.

Results

1. History of World Tuberculosis Day

The WHO has designated March 24 as World Tuberculosis Day to be observed annually. Through this commemoration, the WHO raises awareness of the global prevalence and dangers of TB while providing information on its treatment and prevention to emphasize the need for vigilance. At the same time, it urges governments worldwide to recognize the importance of TB eradication efforts.

On March 24, 1882, German bacteriologist Robert Koch (R. Koch) identified M. tuberculosis as the causative agent of TB. Before this discovery, people believed that TB resulted from hereditary factors or exposure to foul air. In the early 1800s, a phenomenon known as “vampire panic” emerged in New England, USA, causing widespread social unrest. The pale appearance and subsequent deaths of patients with TB led to the misconception that deceased family members were returning as vampires to infect the living. These misunderstandings and superstitions rendered preventive and therapeutic measures ineffective while amplifying fear and prejudice against TB. In this context, the discovery of M. tuberculosis marked a pivotal breakthrough in understanding and treating this disease [5].

To commemorate this achievement, the International Union Against Tuberculosis and Lung Disease proposed in 1982—on the 100th anniversary of Koch’s discovery—that March 24 be recognized annually as World Tuberculosis Day [6]. Subsequently, in 1996, the WHO officially designated World Tuberculosis Day as an international observance. Since 1997, the WHO has conducted annual World Tuberculosis Day campaigns, focusing on the key aspects of TB management each year to promote global solidarity (Table 1) [7].

Table 1. The theme of World TB Day.

	The theme of World TB Day
2025	Yes! We can end TB: commit, invest, deliver
2023–2024	Yes! We can end TB!
2022	Invest to end TB. Save lives
2021	The clock is ticking
2020	It’s time to end TB!
2019	It’s time for action
2018	Wanted: leaders for a TB-free world
2017	Unite to end TB: leave no one behind
2016	Unite to end TB
2015	Gear up to end TB
2014	The “missed” 3 million
2013	Stop TB in my lifetime
2012	Call for a world free of TB
2011	Transforming the fight towards elimination
2010	Innovate to accelerate action
2008–2009	I am stopping TB
2007	TB anywhere is TB everywhere
2006	Actions for life – towards a world free of TB
2005	Frontline TB care providers: heroes in the fight against TB
2004	Every breath counts – stop TB now!
2003	DOTS cured me – it will cure you too!
2002	Stop TB, fight poverty
2001	DOTS: TB cure for all
2000	Forging new partnerships to stop TB
1999	Stop TB, use DOTS
1998	DOTS success stories
1997	Use DOTS more widely!

TB=tuberculosis; DOTS=directly observed treatment, short-course. Data from the World Health Organization [7].

2. History of Tuberculosis Prevention Day in Republic of Korea

Following Korea’s liberation, the Ministry of Health established the first Tuberculosis Prevention Week from December 1 to 7, 1953, as part of the efforts to prevent and eradicate TB [6]. During this week, intensive TB awareness campaigns were carried out in collaboration with the Korean National Tuberculosis Association (KNTA), involving lectures, film screenings, free medical consultations, and counseling sessions at schools, workplaces, and community organizations. Information about TB was also disseminated through newspapers and radio broadcasts. At the time, TB was widely perceived as an incurable disease, so the primary focus of the campaign was to promote awareness that TB could be treated and prevented through BCG vaccination. Tuberculosis Prevention Week served as an important opportunity to educate the public and raise awareness about the disease [6].

Subsequently, on March 24, 1989, ROK held its first World Tuberculosis Day commemorative ceremony, during which awards were presented to individuals who had made significant contributions to TB eradication, and the achievements of TB control efforts were assessed. Following this, TB-related events continued to be held annually on March 24, providing an opportunity to expand TB awareness campaigns beyond the traditionally winter-focused Tuberculosis Prevention Week and the Christmas Seal Campaign, ensuring year-round public engagement in TB prevention efforts [6]. Later, in 2010, an amendment to the Tuberculosis Prevention Act officially designated March 24 as a legally recognized observance, Tuberculosis Prevention Day. This designation further elevated the significance of national and local government-led events, promotional campaigns, and educational initiatives aimed at raising the awareness of TB prevention and management [8]. As a result, starting with the first Tuberculosis Prevention Day event in 2011, a total of 14 such events have been held to date. These events serve as a platform not only to recognize those who have contributed to TB eradication efforts, but also to announce national TB policies and promote awareness, fostering a heightened sense of vigilance toward TB prevention.

3. Major Developments and Achievements in Republic of Korea’s Tuberculosis Control Policy

ROK’s national TB control policy began with the establishment of the Five-Year Tuberculosis Control Plan by the Ministry of Health in 1955. During this period, the key initiatives included BCG vaccinations, X-ray screenings for early case detection, and nationwide TB prevalence surveys. In 1962, public health centers were designated as the primary institutions for implementing national TB control programs, laying the groundwork for systematic execution. In 1968, the Tuberculosis Prevention Act and its accompanying enforcement decree and regulations were enacted to establish a legal framework for national TB control. The law aimed to prevent TB-related personal and social harm by ensuring proper prevention measures and appropriate medical care for patients with TB, ultimately contributing to public welfare and national health improvement. In 2000, the Korea Tuberculosis Surveillance System was developed to facilitate the electronic reporting and monitoring of TB cases in medical institutions, which has since been expanded and refined.

Entering the 2000s, the TB control policies of ROK evolved through the establishment and implementation of long-term strategic plans, including the Tuberculosis Eradication 2030 Plan (2006), the First Strategy Plan for Control of Tuberculosis in the Republic of Korea (2013–2017), the Second Strategy Plan for Control of Tuberculosis in the Republic of Korea (2018–2022), and the Third Strategy Plan for Control of Tuberculosis in the Republic of Korea (2023–2027). The Tuberculosis Eradication 2030 Plan, introduced in 2006, set forth the vision of a “healthy society free from TB,” with the goal of reducing the TB incidence rate to one case per million people by 2030. This plan outlined three core strategies under the “Target 3-100” initiative: 100% case detection, 100% contact management, and 100% treatment success [9]. A representative initiative that emerged during this period was the Private-Public Mix (PPM) Tuberculosis Control Program, which began as a pilot project in 2007. As the number of patients with TB receiving treatment at private medical institutions increased, public health centers faced limitations in managing patients effectively. To address this, TB specialist nurses were assigned to 11 private medical institutions to provide continuous education, counseling, and support for patients with TB throughout their treatment. Recognizing the growing importance of the PPM Tuberculosis Control Program, the initiative was expanded nationwide in 2011, covering 97 medical institutions. Under this program, TB specialist nurses in private medical facilities were responsible for diagnosing patients (including those with drug-resistant TB), conducting case investigations, providing expert counseling on medication adherence, screening family contacts, and supporting LTBI testing and treatment. The government has continuously secured funding and improved the working conditions for these personnel to enhance program effectiveness. Since its inception as a pilot project with 11 participating institutions, the PPM Tuberculosis Control Program has grown significantly. As of 2024, it operates across 174 medical institutions nationwide, with 294 TB specialist nurses. In 2023, the program managed 15,858 out of 19,540 patients with TB (81.2%), achieving a treatment success rate of 94.1%. This initiative has become a cornerstone of TB patient management in ROK (Figure 1) [10,11].

Figure 1. Tuberculosis outbreak situation in Republic of Korea and Major policies related to TB.

TB=tuberculosis; PPM=Private-Public Mix; KTBS=Korea Tuberculosis Surveillance System; KDCA=Korea Disease Control and Prevention Agency; MOHW=Ministry of Health and Welfare; KNTA=Korean National Tuberculosis Association. Data from the article of Cho [10] and the Korea Disease Control and Prevention Agency [11].

1) 「First Strategy Plan for Control of Tuberculosis in the Republic of Korea (2013–2017)」

In 2013, in accordance with Article 5 of the Tuberculosis Prevention Act (regarding the establishment and implementation of comprehensive TB control plans), the Korea Disease Control and Prevention Agency (KDCA) formulated the First Strategy Plan for Control of Tuberculosis in the Republic of Korea (2013–2017). The plan was based on the vision of a “TB-free society and a healthy nation” and aimed to reduce the TB incidence rate by half compared to 2011 levels, targeting 50 cases per 100,000 people by 2020. To achieve this goal, three key strategies were implemented: early detection of TB, meticulous patient management and support, and strengthening the TB control infrastructure [12]. One of the representative initiatives launched during this period was the establishment of the Central Tuberculosis Epidemiological Investigation Team in 2013. This team, composed of 28 TB epidemiologists deployed across four regional centers in addition to the main headquarters, was responsible for conducting nationwide epidemiological investigations of TB outbreaks. In its first year, the team conducted 1,142 epidemiological investigations in group facilities. With the expansion of investigation criteria and scope, the number of epidemiological investigations steadily increased, reaching 3,620 cases in 2023, with 86,302 individuals screened for TB exposure [13]. In July 2016, the Special Health Insurance Benefit for TB Treatment was introduced, eliminating all out-of-pocket costs for patients with TB, thereby significantly enhancing the financial accessibility to medical care. Furthermore, to bring the national TB incidence rate to the level of advanced countries by 2025, the Tuberculosis-Free Nation Action Plan was introduced, reinforcing prevention-focused management strategies. Under this plan, from 2017 to 2018, screening and treatment programs for latent TB infection (LTBI) were implemented. The target population for LTBI screening included approximately 1.7 million individuals in group facility occupations (medical institutions, daycare centers, social welfare facilities, kindergartens, schools, postpartum care centers), adolescents (first-year high school students, out-of-school youth), and other groups (military conscripts, correctional facility inmates and staff).

As a result of these comprehensive management efforts, a systematic TB control infrastructure was established across all sectors of TB prevention and treatment. This led to a sustained annual decrease in the TB incidence rate by 5.8% from 2011 onwards, after a prolonged period of stagnation since 2000. By 2017, for the first time, the number of newly diagnosed patients with TB fell below 20,000 cases per year. However, despite these achievements, several challenges remained, including the increasing incidence of TB among the elderly due to the aging population and the rising number of patients with TB entering the country from abroad, highlighting the need for additional countermeasures.

2) 「Second Strategy Plan for Control of Tuberculosis in the Republic of Korea (2018–2022)」

The Second Strategy Plan for Control of Tuberculosis in the Republic of Korea (2018–2022) was established with the goal of reducing the TB incidence rate to half of that in 2016 level by 2022. To achieve this, four key strategies were set: blocking transmission through early detection, patient-centered management and support, research and development in diagnosis and treatment, and establishing domestic and international cooperation networks. One of the newly introduced initiatives during this period was On-site Tuberculosis Screening which provided TB screenings to elderly individuals and homeless populations who faced physical and economic barriers to accessing medical services. After piloting the program in 2018 and 2019 to establish an operational framework, it was expanded nationwide in 2020. Through this program, approximately 210,000 individuals were screened annually, leading to the detection of 119 patients with TB in 2020, 155 in 2021, and 171 in 2022, totaling 455 cases. In addition, the Private-Public (PPM) Program was expanded, increasing the number of participating medical institutions from 127 to 184, while local government cooperation committees were established to strengthen regional TB control efforts. The number of TB-dedicated personnel also significantly increased from 416 to 1,009, reinforcing patient-centered management and support infrastructure. Furthermore, the number of institutions providing LTBI treatment was expanded from 385 to 655, and 62 new specialized medical centers for MDR-TB were established along with the formation of a treatment consortium. Financial support measures were also reinforced, including the introduction of special health insurance benefits for LTBI treatment, medical assistance for recipients of public healthcare benefits, expansion of health insurance coverage for new MDR-TB medications, and adjustments to caregiving cost support for patients under hospitalization orders, all aimed at improving TB treatment success rates. These various efforts led to the expansion of comprehensive support measures and the strengthening of the treatment infrastructure [14].

As a result of these efforts, by 2022, the TB incidence rate was reduced to 39.8 cases per 100,000 people, successfully meeting the target set in the First Strategy Plan for Control of Tuberculosis in the Republic of Korea (2013–2017). Despite a global surge in TB cases during the COVID-19 pandemic (2020–2022), ROK continued to maintain a steady decline in TB incidence, making this achievement even more significant. However, according to the 2022 WHO Global Tuberculosis Report, ROK still recorded the highest TB incidence rate among Organisation for Economic Co-operation and Development (OECD) countries as of 2021, and its TB mortality rate ranked third. Additionally, the gaps in TB management for high-risk and vulnerable populations remained, and the treatment success rate for patients with TB stagnated, presenting ongoing challenges for future national TB control policies.

3) 「Third Strategy Plan for Control of Tuberculosis in the Republic of Korea (2023–2027)」

The Third Strategy Plan for Control of Tuberculosis in the Republic of Korea (2023–2027) aims to reduce the TB incidence rate to 20 cases or fewer per 100,000 people by 2027. The plan is built upon four key strategies: first, strengthening TB prevention and early detection; second, enhancing patient treatment and management; third, advancing innovative technologies for prevention, diagnosis, and treatment; and fourth, reinforcing a stable policy implementation and support framework. To enhance the effectiveness of implementation, this plan establishes 14 core initiatives, each with specific targets and annual action plans. Regular monitoring and evaluations are conducted for each initiative, with continuous efforts to supplement or support those that do not meet their objectives. The Third Strategy Plan for Control of Tuberculosis in the Republic of Korea (2023–2027) includes measures, such as expanding LTBI screening support for workers in care facilities, refining epidemiological investigation criteria for contact tracing, and developing TB screening manuals and quality control measures for designated medical institutions at overseas diplomatic missions. Additionally, this plan outlines long-term operational strategies for the PPM Program, the implementation of one-on-one intensive management for patients with MDR-TB, and research and development initiatives for next-generation TB vaccines, treatments, and diagnostic tools [15]. In conjunction with these efforts, the BCG vaccine, which has been entirely imported since 2006 for the prevention of severe pediatric TB, has been undergoing a localization initiative since 2008 to ensure a stable domestic supply. Furthermore, for TB treatments that are either discontinued or unavailable in ROK, the government has been supporting contract manufacturing or emergency imports to maintain stable supplies. In 2024, ROK established the Task Force on Infectious Disease-Related Pharmaceuticals in collaboration with the Korea Orphan & Essential Drug Center to ensure the stable and efficient supply of essential pharmaceuticals and to improve the operational efficiency (Figure 2) [15].

Figure 2. 「The strategy plan for control of tuberculosis in the Republic of Korea (2023–2027)」 vision and goal.

TB=tuberculosis; BCG=Bacillus Calmette–Guérin. Data from the Korea Disease Control and Prevention Agency [15].

Conclusion

In 2025, the KDCA will once again host the 15th Tuberculosis Prevention Day ceremony on March 24, recognizing individuals who have contributed to national TB control efforts and emphasizing cooperation among government agencies, private organizations, and the medical sector to eradicate TB. The event will also serve as an opportunity to reflect on the legacy of past contributors, acknowledging that their dedication and efforts have shaped the present, while reaffirming the commitment to further advancing these achievements for future generations.

The key accomplishments of ROK’s national TB control plans are as follows. First, as of 2024, the total number of TB cases in ROK has decreased to 17,944, marking a 8.2% decline from the previous year. This also signifies 13 consecutive years of decline since the peak of 50,491 cases in 2011. Second, ROK has adapted its TB control policies flexibly in response to changing domestic and international conditions, transitioning from a treatment-focused approach to a broader strategy that includes prevention and early detection. Additionally, targeted policies have been developed to focus on high-risk groups, such as the elderly and foreign nationals. The step-by-step expansion of financial support for medical expenses and assistance for vulnerable populations has been a particularly significant achievement. Third, the operation of the Tuberculosis Epidemiological Investigation Team, along with the deployment of TB-dedicated personnel at public health centers and medical institutions, has established a system where specialized professionals are continuously trained and actively engaged in TB control. Lastly, through the PPM Program, ROK has maintained a strong cooperative framework between the government and private medical institutions, accumulating extensive experience that serves as a critical foundation for TB eradication efforts in the country.

Moving forward, the KDCA will continue monitoring changes in the domestic and international public health environments, periodically reviewing and evaluating comprehensive TB control plans to enhance their alignment and effectiveness. These efforts will be pursued to ensure that the goals set for each phase are successfully achieved.