Tuberculosis is a serious public health problem in China. China has the world's third largest cases of tuberculosis (after India and Indonesia), but progress in tuberculosis control was slow during the 1990s. Detection of tuberculosis had stagnated at around 30% of the estimated total of new cases, and multidrug-resistant tuberculosis was a major problem. These signs of inadequate tuberculosis control can be linked to a malfunctioning health system. The spread of severe acute respiratory syndrome (SARS) in 2003, brought to light substantial weaknesses in the country's public health system. After the government realized the impact that the SARS outbreak had on the country, they increased leadership in their health department. After the SARS epidemic was brought under control, the government increased its commitment and leadership to tackle public health problems and, among other efforts, increased public health funding, revised laws that concerned the control of infectious diseases, implemented the world's largest internet-based disease reporting system to improve transparency, reach and speed, and started a program to rebuild local public health facilities and national infrastructure.
These measures contributed to acceleration in efforts to control tuberculosis. By 2005, the detection of cases of tuberculosis had increased to 80% of the estimated total new cases, permitting China to achieve the 2005 global tuberculosis control targets. At the same time, specific efforts to improve tuberculosis control also contributed to strengthening of the public health system. In this case, the strengthening of the disease control program and the public health system had worked together to achieve a desired health outcome.
On February 23, 2007, the Chinese government undertook a review of the tuberculosis situation in China, which looked at the progress in tuberculosis control before the SARS epidemic, outlined the measures taken to improve the public health system after that epidemic, described how those measures contributed to the acceleration of tuberculosis control efforts, and discuss the challenges that China must address to halve the number of tuberculosis cases and deaths as part of the Millennium Development Goals (MDGs).
Epidemiology
In China, tuberculosis has been the number 1 cause of death from infectious disease in adults. In 1990, 360,000 people in China died from tuberculosis.
Tuberculosis is one of China's major public health problems. According to the 2015 WHO estimates, China has the world's third largest number of tuberculosis cases, behind only India and Indonesia, comprising around 10% of the world total. Of the 37 notifiable communicable diseases in China, tuberculosis ranks first in terms of notified cases and deaths. Despite the serious nature of this disease, the country's progress in tuberculosis control was slow during the 1990s and early part of the new millennium. The estimated proportion of new cases of sputum smear-positive tuberculosis that were diagnosed and treated by the public health program—a key indicator of efforts to control tuberculosis—had stagnated at around 30%, far below the 70% target set by the WHO.
In 2003, an epidemic of severe acute respiratory syndrome (SARS) broke out in China. (See Progress of the SARS outbreak.) The spread of SARS brought to light substantial weaknesses in the country's public health system. After the SARS epidemic was brought under control, the Chinese government implemented a series of measures to strengthen its public health system. This effort coincided with acceleration in efforts to control tuberculosis. Within three years, implementation of the WHO-recommended DOTS (Directly Observed Therapy, Shortcourse) strategy to control tuberculosis increased from 68% to 100% of counties and the detection of cases of smear-positive tuberculosis by the public health system more than doubled, from 30% of new cases to 80%. Together with a tuberculosis treatment success rate of more than 90%, China achieved the 2005 global targets for tuberculosis control.