Korea's decade-long fight against tuberculosis (TB) to shed the stigma of having the highest disease incidence among OECD countries is at risk of regression.

The rapid decline in the incidence rate from 100 per 100,000 people in 2020 to 39.8 in 2022 was due to active TB control and screening for latent TB to detect and actively treat hidden patients. Still, next year's 24.3 percent budget cut is causing concerns in the field.

Min Jin-soo, a professor of respiratory medicine at Catholic University of Korea Seoul St. Mary's Hospital, expressed worries at a press conference held by Qiagen Korea on Tuesday, the 10th anniversary of the launch of its latent tuberculosis diagnostic test product in Korea, under the theme of “The Present and Future of Fighting Tuberculosis in Korea.”

Professor Min, an advisor to the Public-Private Mix (PPM) National B Control Project and a member of the PPM project's Central Steering Committee, explained the achievements of the Second TB Control Plan, which reduced the TB incidence rate (per 100,000 people) to 39.8 in 2012.

He pointed out that the Third TB Control Plan has been in place since 2013 to bring it down to 20 or less by 2017, but a budget cut of 24 percent has made it difficult to achieve the goal.

According to the Korea Disease Control and Prevention Agency (KDCA), the TB control and prevention budget next year is 37 billion won ($27.6 million). This is a 24.3 percent decrease from this year's 48.9 billion won.

The budget for the screening project for new latent TB infections has been completely cut, and the labor costs for TB nurses and dedicated personnel who manage TB in medical institutions and health centers have also been drastically reduced. The reduction in the number of TB nurses who have contributed to increasing the success rate of treatment by managing TB patients' testing, hospitalization, and medication is inevitable.

In addition, the budget for 15 out of 16 TB projects to prevent, diagnose, and treat TB under the Third TB Control Plan has been reduced or eliminated. Only one project, the epidemiologic survey of congregate facilities, received an increase of 0.1 percent from this year.

According to the WHO, the standard for TB elimination is a TB incidence rate of 10 or less per 100,000 people. To achieve this, Professor Min said, Korea must improve the treatment success rate of active TB patients, expand screening for latent TB infection to detect those in hiding, and develop a vaccine to prevent TB.

Latent TB is when a person is infected with Mycobacterium tuberculosis but is inactive. It is crucial for the elderly, immunocompromised people, people with human immunodeficiency virus (HIV), healthcare workers, and people who work in congregate facilities to be screened because TB bacteria can remain dormant in the body and develop into TB when the immune system is compromised.

Therefore, the first, second, and third comprehensive TB control measures also focus on screening for latent TB and mandate screening for workers in medical and educational facilities, postpartum care centers, and childcare facilities such as daycare centers.

However, Professor Min pointed out that even if a person tests positive through the screening program, only 50 percent of them go to the hospital, and even if they go to the hospital, only 33 percent start treatment after receiving explanations.

"Therefore, it is essential to have dedicated TB nurses and staff who can identify TB patients and continue to manage them so that patients who start treatment do not drop out," he said.

In the worst-case scenario, reducing screening programs due to budget cuts could lead to a resurgence in TB incidence, Min added, noting that the global post-Covid-19 epidemic has seen a temporary increase in cases due to poor TB control.

"Therefore, to reduce the incidence of TB to below 20 per 100,000 people by 27 years, it is necessary to strengthen support for the entire TB control cycle to minimize the disease burden and early detection of patients through screening blood tests, as included in the Third Comprehensive Plan," Dr. Min said. "It is questionable whether it can be finished well despite a good start. I hope that the government's policy will continue unabated."