Abstract: China still bears high Tuberculosis (TB) disease burden despite many achievements have been made in the past decades. For a long time, insufficient understanding on the transmission dynamics of TB has lead to a lack of targeted control strategies. Traditionally, the incident TB was believed to occur mainly due to reactivation of remote infection. However, with the development of molecular epidemiology, many studies from different areas and countries have shown evidence that recent transmission could be the main contributor to the TB epidemics. The authors’ previous studies also showed that recent transmission of TB is the key driver of the incident TB in China, and is recognized as the main reason for the high prevalence of MDR-TB. Here, based on these studies, the author propose that delineating the transmission model of TB by using the molecular epidemiology is crucial for the allocation of control resources and implementation of corresponding strategies. On this basis, the TB burden would not rapidly reduce in China in near future unless the recent transmission of TB is stemmed through multiple ways like to enforce the improvement of active case detection, to strengthen the laboratory testing capabilities, and to improve the rate of bacterially confirmed TB cases.