Tuberculosis remains a leading infectious cause of morbidity and mortality worldwide despite the availability of the bacille Calmette Guérin (BCG) vaccine and chemotherapy. Progress has been made in understanding immuopathogenesis and vaccine development in recent years. Mycobacterium tuberculosis (Mtb) may activate innate immunity of macrophage by Toll-like receptors (TLRs) and other pattern recognition receptors (PRRs) , which can eliminate the bacteria and regulate the acquired immune responses. Besides major histocompatibility complex (MHC) restricted CD4 ⁺ and CD8 ⁺ T cells, CD1- restricted T cells and γ δ T cells also take part in immune responses to Mtb infection. Memory T cells and regulatory T cells play a special role in regulating immune responses to mycobacterial infection. In view of poor BCG protective efficacy in adults, improved control of tuberculosis requires development of new and more effective vaccines. Various vaccine candidates including recombinant BCG, live-attenuated Mtb, and booster vaccines , such as recombinant modified vaccinia virus Ankara expressing Mtb antigen, nucleic acid vaccines, and subunit protein vaccines with novel adjuvants , are at different stages of development. One promising vaccine strategy is priming with BCG or BCG replacement vaccine followed by boosting with subunit vaccines. However, the vaccine strategy, optimal dose, route, frequency, and timing of the boost remain to be determined. The challenges facing tuberculosis vaccine development include a lack of immune markers for protection in humans, difficulty in prioritizing which candidates to move to clinical trials, shortage of clinical trial sites, lengthy time required for vaccine evaluation, and high cost.