Abstract
Master Plan for the Prevention and Control of Infectious Diseases is established every five years by the Commissioner of the Korea Disease Control and Prevention Agency in consultation with the Minister of Health and Welfare in accordance with Article 7 of the Infectious Diseases Control and Prevention Act. The 3rd Master Plan for the Prevention and Control of Infectious Diseases consists of 16 key tasks and 55 detailed tasks to be carried out over five years from 2023 to 2027 under four strategies: ‘Advance national preparedness for and response to infectious disease emergency’, ‘Respond with preemptive and comprehensive measures for infectious disease control and prevention’, ‘Reform infectious disease R&D’, ‘Solidify foundation for infectious disease response.’
Keywords: Infectious diseases; Communicable diseases, prevention & control; Communicable disease control; Communicable diseases; Master plan
Introduction
According to the Infectious Disease Control and Prevention Act, the Commissioner of the Korea Disease Control and Prevention Agency (KDCA) must establish a Master Plan for Infectious Diseases (the following is referred to as a Master Plan) in collaboration with the Ministry of Health and Welfare [1]. With the conclusion of the Second Master Plan in 2022, the KDCA has created the Third Master Plan, outlining the strategy and specific goals for managing infectious diseases in the Republic of Korea over the next five years. Before developing this plan, an assessment of the achievements of the Second Master Plan, along with an analysis of the conditions and policy environment that are necessary for the Third Master Plan, were conducted.
Despite challenges encountered in some tasks, including the vaccination and epidemiological survey rates1), during the implementation of the Second Master Plan owing to the coronavirus disease 2019 (COVID-19) pandemic, 71 out of 79 performance indicators were successfully met (89.9%) (Table 1). Notably, progress was made in areas, such as strengthening the response and preparedness for infectious diseases, establishing a One Health cooperation system, and standardizing the infectious disease prevention and management system. However, some shortcomings have been identified both in the selection of major infectious diseases for management and in safeguarding vulnerable populations. Additionally, limitations were observed in performance management due to changes in performance indicators. Furthermore, there is a need to improve coordination among comprehensive plans for each infectious disease and management system and the tasks and indicators based on the Third Master Plan.
Table 1. Achievement status of performance indicators by key tasks of the 2nd Master Plan.
| Core task (number of basic task) |
Number of indicator | Number of objective achievement indicator | Achievement rate (%) | |
|---|---|---|---|---|
| Originally (2018) | Final (2022) | |||
| Total (24) | 63 | 79 | 71 | 89.9 |
| □ Strengthening the response and preparation system for infectious diseases (5) | 17 | 14 | 12 | 85.7 |
| □ Establishment of a One Health cooperation system (5) | 9 | 18 | 15 | 83.3 |
| □ Strengthening measures to prevent and manage infectious diseases (4) | 13 | 12 | 11 | 91.7 |
| □ Establishing a technological innovation platform for responding to infectious diseases (5) | 13 | 23 | 21 | 91.3 |
| □ Strengthening infrastructure for responding to infectious diseases (5) | 11 | 12 | 12 | 100.0 |
An analysis of the conditions required to establish the Third Master Plan revealed the need for advanced public health capabilities as well as collaboration with the global community in preparation for the emergence of unforeseen novel infectious diseases (referred to as Disease X). Further, the analysis also highlighted the elevated risk for waterborne diseases, zoonoses, and vector-borne diseases owing to the effects of environmental changes, such as water, soil, and vectors driven by climate change, as well as the expansion of networks through increased travel (First Climate Change Health Risk Assessment, March 2022). Additionally, the incidence of healthcare-associated infections, including antibiotic-resistant bacterial infections, is continuing to rise because of the increasing older adult population and the expanded use of invasive medical technologies2). Moreover policies framed from a One Health perspective are becoming a part of global collaborative efforts to reduce abnormal disease and pathogen circulation at the human-animal-environment interface. Furthermore, the diversification of infectious disease response measures is evident across all domains of infectious disease management, including surveillance, prediction of epidemics, and cause analysis, owing to the utilization of big data and artificial intelligence technologies. As traditional mass media and print media give way to Internet broadcasting and social media as primary communication channels, there is a pressing need to formulate strategies for minimizing the adverse impact of fake news and infodemics3) on public health.
Method
To evaluate the Second Master Plan, the structure of the plan (including its vision, core tasks, sub tasks, and performance indicators), achievement of performance indicators, revisions, and linkage with specific projects were assessed. Based on the evaluation of the Second Master Plan, a foundational framework was established through the participation of relevant experts; open forums involving the KDCA, related ministries, and local governments; symposiums organized by the Korean Society for Preventive Medicine; public hearings; and discussions among relevant departments. After deliberation by the Infectious Disease Management Committee, the “Third Master Plan for the Prevention and Management of Infectious Diseases (2023–2027)” was formulated (Table 2).
Table 2. Progress and discussion topics in the 3rd Master Plan for the prevention and control of infectious disease forum.
| Progress | Date | Theme and discussion topic |
|---|---|---|
| 1st Forum | 2022.04.28. | Evaluation of the 2nd Master Plan for infectious disease, future directions, and schedule |
| 2nd Forum | 2022.06.02. |
Policy objectives related to the Master Plan for infectious disease Review of the alignment with Master Plans for specific infectious diseases and management systems Presentation of the framework (draft) for the 3rd Master Plan for infectious disease |
| 3rd Forum | 2022.06.29. | Review of the vision, principles, and key objectives (draft) for the 3rd infectious disease basic plan |
| 4th Forum | 2022.08.04. |
Finalization of the vision, principles, and key objectives for the 3rd Master Plan for infectious disease Presentation of core tasks and performance indicators |
| 5th Forum | 2022.09.06. |
Deriving performance indicators using a top-down approach Discussion on principles and methods for developing performance indicators |
| Symposium | 2022.10.16. | Input gathering from the academic community during the symposium of the Korean Society of Preventive Medicine
|
| Public hearing | 2022.12.09. | Public hearing and opinion collection for the draft of the 3rd Master Plan for infectious disease
|
Results
Under the vision of fostering ‘A Society Safe and Secure from infectious diseases,’ the Third Master Plan sets the universal values of ‘Evidence-based,’ ‘Equity,’ ‘Innovation,’ ‘Domestic and international Cooperation,’ and ‘Communication and Engagement’ as the fundamental principles to achieve the goals of ‘Prepare for Disease X beyond COVID-19’ and ‘Strengthen infectious disease prevention and control capabilities through public-private and international collaboration.’ Based on these five principles, the Master Plan outlines the following four strategies: ‘Advance national preparedness for and response to infectious disease emergency,’ ‘Respond with preemptive and comprehensive measures for infectious disease control and prevention,’ ‘Reform infectious R&D,’ and ‘Solidify foundation for infectious disease response.’ To ensure smooth implementation of these strategies, 16 core and 55 sub tasks were identified (Table 3) [2].
Table 3. Strategies and core tasks for implementing the 3rd Master Plan for the prevention and control of infectious disease.
| Strategy | Core task |
|---|---|
| I. Advance national preparedness for and response to infectious disease emergency | ❶ Establishment of infectious disease crisis preparedness |
| ❷ Strengthen ability to respond to infectious disease crisis | |
| ❸ Biosecurity and management of high risk pathogens | |
| II. Respond with preemptive and comprehensive measures for infectious disease control and prevention | ❶ Establishment of infectious disease management system based on One Health |
| ❷ Prevention and management of general infectious diseases | |
| ❸ Promotion of chronic infectious diseases eradication | |
| ❹ Strengthening the protection and management of high-risk groups | |
| III. Reform infectious disease R&D | ❶ Strengthening the evidence-based infectious diseases prevention and management system |
| ❷ Diversification of monitoring and investigation systems | |
| ❸ Advanced infectious disease diagnosis technology | |
| ❹ Lead research on vaccine and treatment development | |
| IV. Solidify foundation for infectious disease response | ❶ Expanding public-private partnerships with multidepartments, local governments |
| ❷ Strengthen community engagement, competence and communication | |
| ❸ Establishment of infrastructure for preparing and responding to infectious disease crisis | |
| ❹ Establishing a global cooperative system to respond to infectious diseases | |
| ❺ Strengthening the R&D base for infectious disease management |
1. Strategy 1: Advance national preparedness for and response to infectious disease emergency
Building upon the experience gained from COVID-19 responses, the plan aims to enhance the system and capacity for preparing and responding to infectious disease public health crises and bolster biological security measures, such as the management of highly hazardous pathogens.
To achieve these objectives, the strategy outlines promoting the exchange of infectious disease surveillance information among nations through global organization networks and expanding the use of the Quarantine Information Pre-entry System (Quarantine COVID-19 Defence, Q-CODE) to prepare for the introduction of infectious diseases from other countries. Additionally, mandatory education for frontline infectious disease response personnel and a certification system for testing facilities providing immediate diagnostic testing in times of crisis will be implemented. Regular scenario-based training exercises will be introduced for government departments to enhance the capacity for infectious disease response. The strategy also aims to achieve the domestic production and stockpiling of anthrax vaccines within the designated timeframe. It aims to strengthen biological security and the management of highly hazardous pathogens, including the implementation of a differentiated management system for such pathogens.
2. Strategy 2: Respond with preemptive and comprehensive measures for infectious disease control and prevention
This strategy includes proactive approaches for ongoing infectious disease prevention and management, such as Comprehensive Tuberculosis Control Plans, National Measures for the Prevention and Control of Zoonotic and Vector-borne Infectious Diseases, and the National Strategic Plan for Viral Hepatitis B&C Control. It also emphasizes the promotion of a One Health policy, which involves a multidisciplinary and multisectoral approach spanning human, animal, and environmental health. Simultaneously, the plan aims to enhance health equity for high-risk groups that could potentially be affected by infectious diseases.
To implement this strategy, the Prime Minister’s orders for inter-ministerial collaboration will be implemented for the establishment of a One Health cooperation system across government ministries. A One Health-based infectious disease management system will be created, including joint assessments of the infection status between humans and animals, collective risk assessments for zoonotic infectious diseases, expanded programs for antibiotic stewardship programs in healthcare institutions, and the maintenance of a real-time response system between central, regional, and local levels to prevent outbreaks and spread of waterborne and foodborne infectious diseases. Various policies will be implemented to strengthen ongoing infectious disease prevention and management, such as the development of surveillance indicators for infection-vulnerable institutions, enhancement of the respiratory infectious disease surveillance system, development of guidelines for preventing mass outbreaks of Legionella and strengthening of management in malaria-prone areas. Chronic infectious diseases targeted for eradication will be minimized by providing free screening and diagnostic testing for people at risk for developing and transmitting tuberculosis, providing early detection and early treatment support through acquired immunodeficiency syndrome prevention support centers, introducing hepatitis C testing as part of national health examinations, and offering post-screening management and treatment coordination for hepatitis. Furthermore, measures will be taken to enhance protection and management for populations at high risk for infectious diseases, including the development of infectious disease prevention and management manuals for facilities housing vulnerable populations (including individuals with disabilities and older adults), the establishment of an education system for administrators and staff, formation of infectious disease management support teams in correctional facilities and training of staff, development of an infectious disease surveillance support system for military units, expansion of Biosafety Level 3 research facilities at the Armed Forces Medical Research Institute, improvement of infectious disease prevention and crisis response manuals in schools, and strengthening communication between schools and homes for infectious disease prevention and management.
3. Strategy 3: Reform infectious disease R&D
This strategy outlines solidifying and integrating infectious disease-related data that had previously been fragmented, utilizing various surveillance and investigation results as the basis for policymaking, and facilitating a multifaceted approach to research on infectious disease diagnostic technology, vaccines, and treatments by the KDCA.
Efforts will be made to consolidate and integrate data from all stages of infectious disease response, from quarantine to reporting and epidemiological investigations. It will also establish an evidence-based infection control system, including enhancing the epidemiological investigation system for systematic tracking and management of large-scale contacts and developing predictive models for varying degrees of infectious disease outbreaks and epidemic trends. The strategy also includes expanding pathogen surveillance, including implementing a comprehensive respiratory disease surveillance system, such as COVID-19; and monitoring antibiotic-resistant bacteria, foodborne and waterborne pathogens, and healthcare-associated infections. Surveillance and survey systems will be diversified, including the implementation of a sewage surveillance system, expansion of laboratories conducting sewage testing, and establishment of a regular serum testing system for analyzing the efficacy of vaccinations against infectious diseases highly likely to progress to a pandemic. To enhance diagnostic accuracy and speed, measures will be taken to develop diagnostic methods and multiplex diagnostic tests for future infectious diseases and infectious diseases of unknown cause. Additionally, the strategy outlines facilitating vaccine and therapeutic research and development, including securing core technologies for mRNA vaccines, supporting the development of technology for domestic production and self-sufficiency of essential vaccines with high foreign dependency (e.g., hepatitis A and Japanese encephalitis vaccines), and supporting the development of antiviral treatments that inhibit common infection mechanisms of RNA viruses with a high likelihood of developing novel mutations.
4. Strategy 4: Solidify the foundation for infectious disease response
This strategy outlines measures to amend laws and regulations in line with the opinions of professionals in the field of infectious disease prevention and management and to establish robust infrastructure required for crisis response, including medical facilities and infection control resources. Additionally, efforts will be made to enhance the global, inter-agency, and public-private cooperation system, as well as strengthen the foundation for research and development.
The roles of key agencies responsible for infectious disease response (Ministry of Health and Welfare and KDCA), relevant organizations, and local governments will be defined by the level of crisis, and governance will be established through improvements in crisis management organizations. The Infectious Disease Prevention Act will be revamped in reflection of the demands in the field and human rights protection. Collaboration with relevant advisory committees, such as the National Infectious Disease Crisis Response Advisory Committee and experts in the field will be reinforced. The regional disease response centers will play a central role in strengthening regional cooperation, and public communication and community involvement will be facilitated by developing an integrated infodemic information center to minimize damage from false and manipulated information. The 「2023 Mid- to long-term plan for preparation and response to emerging infectious disease pandemics」, including a rapid response system and measures for prolonged outbreaks, will be established, and a foundation for infectious disease crisis preparation and response will be bolstered through the expansion of central and regional infectious disease hospitals and the establishment of a resource procurement management system for crisis preparedness and response.
Measures will be taken to establish a global infectious disease response cooperation system through the installation of the Global Health Security Coordination Office, the establishment of a network to collect overseas infectious disease information, infectious disease surveillance and risk assessment for key countries in each continent, expansion of global technology support (including laboratory diagnostics and epidemiological investigations), resource exchange through cooperation with foreign pathogen resource banks, and participation in the global network for Biological Safety Level 4 facilities. Finally, the foundation for research and development for infectious disease management will be solidified through the designation of pathogens requiring urgent national response, overall research and development planning for diagnosis-treatment-vaccine research performance, including securing innovative core technologies, promotion of research on the development of products for surveillance, prediction, prevention, diagnosis, and infection control based on on-site demands, diversification of resources through mandatory submission of domestically held pathogen resources, and promotion of private distribution through pathogen resource banks.
Conclusion
The Third Master Plan has been designed to align with the measures established for major infectious diseases and management systems, allowing for effective coordination with management goals and performance indicators. Performance indicators for each field have been consistently set with the objectives of each comprehensive plan for infectious disease management systems (Table 4) [3]. Additionally, communication and health equity have emerged as new major policy targets through monthly public forums involving multiple agencies during the planning process. The Master Plan established by the central government is shared with local governments and serves as the basis for the development and implementation of the Master Plans at the metropolitan and municipal levels.
Table 4. Status of the plan for each infectious disease and management system.
| A plan for each infectious disease and management system |
|---|
| I. Infectious disease management |
| National measures for the prevent and control of zoonotic and vector-borne infectious diseases |
| National action plan for malaria re-elimination |
| Comprehensive tuberculosis control plans |
| National strategy on HIV/AIDS |
| National strategy on STI |
| National action plan for prevention and control of healthcare-associated infections |
| National action plan on antimicrobial resistance |
| National strategic plan for viral hepatitis B&C control |
| II. Management system |
| Plan on emergency preparedness and response for infectious disease |
| Master Plans for quarantine |
| Comprehensive pathogen resource management plans and annual implementation plan |
| Plan for diagnostic tests for infectious diseases |
| Medium-term national stockpile strategy for Disease X |
| III. R&D field |
| Disease management R&D project mid- to long-term development plan |
| National research strategy for crisis response to infectious diseases |
HIV/AIDS=Human immunodeficiency virus/Acquired immune deficiency syndrome, STI=Sexually transmitted infections.
The Third Master Plan outlines the policy goals and directions for the next five years. This will enable seamless coordination with the central and local governments and management strategies for the effective and integrated implementation of infectious disease prevention and management policies.
Acknowledgments
None.
1) 수인성·식품매개질환 역학조사실시율, 신종감염병 대응 전담인력 배치, 의료기관 정보제공횟수, 어린이 인플루엔자 예방접종률 및 어르신 인플루엔자 예방접종률, B형 간염 주산기감염 예방조치 실패율, 국가 감염병 관련 연구 논문발표, 특허등록 및 기술료 등
2) 카바페넴내성장내세균속균종(CRE) 감염증 발생/사망이 5년 동안 약 2.6/3.7배 증가(2018년) 11,954/141명→(2022년) 30,522/527명
3) 우리나라 코로나19 예방접종 관련 약 6,500건의 허위·조작정보 대응(2022.12월 기준)
1) Rate of epidemiological investigations for waterborne and foodborne diseases, allocation of dedicated personnel for responding to emerging infectious diseases, frequency of providing information by healthcare institutions, influenza vaccination rates for children and older adults, rate of failure in the prevention of perinatal HBV infection, publication of research papers related to national infectious diseases, patent registrations, and technology royalties.
2) Incidence and mortality of Carbapenem-resistant Enterobacteriaceae (CRE) infections have increased by approximately 2.6 and 3.7 times over five years, respectively. From 11,954/141 cases in 2018 to 30,522/527 cases in 2022.
3) Approximately 6,500 cases of false or manipulated information related to COVID-19 vaccination in Republic of Korea have been addressed (as of December 2022).
Declarations
Ethics Statement: Not applicable.
Funding Source: None.
Conflict of Interest: The authors have no conflicts of interest to declare.
Author Contributions: Conceptualization: JH. Data curation: JYY. Formal analysis: MSC, JYY. Resources: MSC, JYY. Supervision: JH. Visualization: JYY. Writing – original draft: JH. Writing – review & editing: JH, MSC.
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