Taiwan’s demographic and public health infrastructure has been central to shaping its TB control efforts. The island has experienced rapid demographic transitions, with fertility rates dropping from 7 births per woman in 1951 to 1.09 in 2023, one of the lowest globally. By 2023, only 135,571 newborns were registered, marking the lowest in history, while 18% of the population was aged 65 years or older—a figure projected to reach 20% by 2025, classifying Taiwan as a super-aged society. Despite these demographic pressures, Taiwan has achieved substantial progress in TB control, reducing incidence from 73 per 100,000 in 2005 to 28 in 2023, with mortality dropping from 4.3 to 1.9 per 100,000 over the same period.
These achievements reflect long-standing investments and political commitment. The Taiwan CDC, established in 1999, integrated TB control under a centralized framework, with funding fully covered by the central government. The National TB Program (NTP) introduced milestone initiatives, including the “Ten-Year Halving Tuberculosis Plan” (2006–2015), followed by the “End TB by 2035 Project” (Phase I: 2016–2020; Phase II: 2021–2025), with preparations for Phase III underway. Mandatory case reporting under the Communicable Disease Control Act is strictly enforced, with penalties for physicians and institutions failing to report, while surveillance systems such as the Notifiable Infectious Disease Reporting System (NIDRS), Laboratory Automated Reporting System (LARS), and the National TB Management System ensure comprehensive monitoring and timely data integration.
Taiwan’s National Health Insurance (NHI) plays a crucial role by ensuring universal coverage for 99% of residents. Since 1997, the “No Reporting, No Reimbursement” policy has tied reimbursement of TB services to mandatory notification, incentivizing complete case reporting. Patients can access TB diagnosis and treatment through all hospitals and nearly 90% of private clinics contracted with NHI. To encourage timely diagnosis and treatment, copayments for TB and latent TB infection (LTBI) patients are fully reimbursed by Taiwan CDC, and care for uninsured individuals is also covered. This financial safety net has minimized both patient delays and health system delays in seeking TB care.
A comprehensive patient support structure strengthens these systems. Around 700 TB case managers under a Pay-for-Performance (P4P) scheme coordinate care between clinics and public health services, while 2,500 public health nurses at 374 centers provide education, monitor adherence, and conduct contact tracing. Since 2006, Taiwan has adopted a people-centered Directly Observed Therapy (DOT) program, with government-employed DOT workers assigned to each patient. This model has significantly reduced treatment interruption, loss to follow-up, and TB-specific mortality, maintaining recurrence rates below 1% since 2008. In 2015, Taiwan introduced electronic DOT (eDOT) to enhance accessibility and privacy, which gained renewed traction after the launch of eDOT 2.0 in late 2023.
Special attention has also been given to foreign-born populations, particularly migrant workers, who exceeded 700,000 in 2023 and now account for over 9% of TB cases. Health examinations are mandated shortly after arrival and at regular intervals. Previously, workers diagnosed with TB were repatriated, but regulatory changes since 2014 have allowed them to stay for treatment under DOT. Further amendments in 2015 and 2022 shifted the decision-making power to workers themselves, dramatically increasing the proportion remaining for treatment from 10.6% in 2014 to nearly 89% in 2022. These reforms have improved TB notification among foreign patients, raising timely reporting rates to over 96%.
To alleviate the economic burden of TB, Taiwan provides targeted financial support. The Taiwan Anti-Tuberculosis Association offers an annual grant of USD 31,000 to support low-income patients lacking social welfare resources. A 2018 National TB Patient Catastrophic Cost Survey revealed that 22% of non-MDR-TB and 45% of MDR-TB households experienced catastrophic costs, primarily due to income loss and non-medical expenses rather than direct medical fees. Low household income, stigma, and inpatient care were identified as key risk factors for financial hardship. Taiwan’s system of subsidies, reimbursement of copayments, and dedicated grants reflects its commitment to reducing financial barriers and ensuring equitable access to TB treatment.
Source: Chan, P.C., Chiang, C.Y., Lee, P.H., Lo, H.Y., Chu, P.W., Chen, J.J., Kato, S. and Raviglione, M.C.B., 2025. Assessing the impact of the TB response in Taiwan–the journey towards ending TB. IJTLD open, 2(5), pp.251-259.
