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Lessons from Taiwan’s coronavirus response

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Tourists wear protective face masks to protect themselves from COVID-19 while passing by a flag rising ceremony at Chiang Kai Shek Memorial Hall in Taipei, Taiwan, 11 March 2020 (Photo: Reuters/Ann Wang).

In Brief

When COVID-19 first spread from mainland China to other countries in late January, Taiwan began to gain international attention. The spotlight has shifted from Taiwan’s isolated international status to how it can efficiently manage the spread of COVID-19. An early study conducted by Johns Hopkins University in January indicated that Taiwan could have had the second highest confirmed cases after China.

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This was due to Taiwan’s close connections with mainland China — there are 400,000 Taiwanese people living there and there have been thousands of cross-strait flights every week.

Attention has since shifted to Taiwan’s model for controlling the spread of COVID-19 and how it was able to do so more efficiently than other East Asian countries. Perhaps Taiwan can boost its international reputation after Israeli Prime Minister Benjamin Netanyahu and New Zealand Prime Minister Jacinda Ardern stated that they plan to follow Taiwan’s COVID-19 response guidelines.

Taiwan has one of the best national health care systems in the world. It is accessible to 99.9 per cent of citizens and allows them to obtain high-quality medical services for low costs. A visit to the doctor for a cold only costs less than US$10. The comprehensive coverage of Taiwan’s healthcare system has contributed to the country’s fight against COVID-19. The government has also added travel history information to national health ID cards so doctors can track their patients’ travel history.

The Taiwanese government used this digital governance approach to successfully identify the majority of its confirmed cases. Based on the findings, Taiwan banned people from Hubei province from entering Taiwan starting from 26 January. On 5 February, Taiwan closed its borders and prohibited mainland Chinese tourists from entering. Taiwan was one of the earliest countries to implement these policies.

The Taiwanese government applied big data techniques for epidemiological predictions and also cooperated with civil society to create applications, such as the popular face masks application that provides information regarding availability of face masks in the users’ vicinity.

A lack of trust in China is another reason that the Taiwanese government has done better than others at preventing the spread of COVID-19. In 2003, Taiwan had negative experiences with the Chinese Communist Party (CCP) during the SARS epidemic. During the outbreak, the CCP blocked Taiwan from participating in the World Health Assembly and refused to allow Taiwan access to timely epidemic information from Chinese medical statistics or the World Health Organization.

This political oppression and informational isolation left the Taiwanese government in the dark and it had a significant impact. Seventy-three people died in Taiwan due to information insufficiency, accounting for nearly 10 per cent of global deaths in the SARS epidemic.

Taiwan’s distrust of China meant that the information provided by the CCP about the current coronavirus outbreak was not taken as fact. So, the Taiwanese government had more autonomy to make decisions and find the most appropriate strategy.

Face masks and strict quarantine policies are two vital elements of Taiwan’s coronavirus response model. The 2003 SARS outbreak led Taiwanese people to believe that wearing a face mask was an easy and practical way to protect themselves in case of a pandemic and in daily life. Meanwhile western cultures tend to associate face masks with being sick, unhealthy or dirty, rather than a tool of self-protection. This cultural difference explains contrasts in the mask wearing habits of Taiwanese and Western people.

Taiwan was the first country to announce a face mask export ban policy on 24 January. But face masks manufactured in Taiwan only cover 10 per cent of national usage. To prevent a shortage, the Taiwanese government collaborated with over 30 Taiwanese private face mask production companies and machine tool companies to create 60 new production lines. Until mid-March, Taiwan could produce 10 million face mask per day, meaning that each of its 23 million residents could get a face mask every two days.

The Taiwanese government also announced three different types of quarantine policies including home-based isolation, home-based surveillance and self-health management. People with health conditions or people returning to Taiwan from abroad must comply with different quarantine policies. And anyone found violating these policies may be fined US$5000–US$10,000. This mandatory quarantine policy has reduced the possibility of patients spreading the virus.

Participation at the local level is key to the success of quarantine policies. Local village chiefs call every day to ensure that those who are in quarantine are really staying at home. The chiefs also deliver food to quarantined people.

Another two critical elements of Taiwan’s model are scientific evidence-based decision-making and winning over public confidence and support. Taiwanese President Tsai Ing-wen assigned the Minister of Health and Welfare Chen Shih-chung the role of Chief Commander and asked him to organise a professional committee, which included doctors and experts in epidemiology, to manage disease prevention. The Chief Commander and the committee now hold a media press conference every afternoon to announce pandemic updates.

But most politicians — including Tsai — have taken a backseat and do not have overall responsibility for these processes. The Taiwanese government respects the information provided by medical professionals and their decisions, allowing it to gain public confidence in its COVID-19 response policies.

In an attempt to control the spread of COVID-19 via public transportation, on 1 April the Taiwanese government banned passengers with body temperatures exceeding 37.5 degrees Celsius from taking public transportation. All Taiwanese flight attendants must also wear full protective gear and passengers are prohibited from changing their seats without permission.

From its high-coverage healthcare system to the use of face masks and strict quarantine policies, to respecting advice from medical professionals, there is a lot that other countries can learn from Taiwan’s model for managing COVID-19.

Hsien-Ming Lin is a PhD candidate in Social and Cultural Anthropology at KU Leuven, Belgium, and at the Institute of Political Science, National Sun Yat-sen University, Taiwan.

This article is part of an EAF special feature series on the novel coronavirus crisis and its impact.

4 responses to “Lessons from Taiwan’s coronavirus response”

  1. Thanks for an informative analysis. Taiwan is a relatively small country geographically. Its population is also not large. Do these two factors facilitate these interventions? It is interesting that Israel and New Zealand are also relatively small on both of those measure.

    I hope the author will provide a follow up in a month or so regarding how Taiwan is doing. It would be informative to compare the 3 countries.

    • Richard, Good questions. Yes, Taiwan is geographically quite small (Maryland and Delaware combined)but it has a population of 23.8 mln, which makes it one of the most densely populated places in Asia. Greater Taipei is a metropolis of 7+ mln. Also, it is very close to China, so therefore early expectations were that it would be seriously affected.

      However, the Tsai government was very alert, had an excellent health system in place, and acted very early, as the article describes.

      The results so far are incredibly good for NZ and Taiwan, particularly if you look at the number per million inhabitants: I just took the numbers of infected and deaths from the JHU website for today, and compared the US, Israel, New Zealand and Taiwan (rounded numbers):
      Cases Deaths Cases/1 mln pop. Deaths/1 mln pop
      USA 366,614 10,783 1110 32.7
      Israel 8,904 57 989 6.3
      New Zealand 1,106 1 221 0.2
      Taiwan 373 5 16.2 0.21

      So, both Taiwan and New Zealand are doing quite well, Israel is half-way-inbetween and the USA is doing pretty badly.

      • Apologies, the system “collapsed” my Table, so let me try to simplify it by only showing the last two columns, and putting spacers inbetween the number:

        ——Cases/1 mln pop.—Deaths/1 mln pop
        USA———1110————32.7
        Israel——-989————-6.3
        New Zealand–221————-0.2
        Taiwan——–16.2———–0.21

        As shown, Taiwan and New Zealand are doing very well, Israel somewhere in between, and the US not very good. Very much the result of putting in the appropriate policies and measures EARLY.

  2. Taiwan is up to a 12 million masks per day average as of 3/24/2020. Taiwan mask production was always adequate for heath care workers – especially in light of Taiwan having 313 cases as of 4-3-2020. Taiwan’s estimate that 10% of needed coverage was provided by their 1.8 million daily pre-coronavirus mask prpduction was due to Taiwan aiming to provide for every man, woman and child.

    As of 2/10/20 Taiwan allocated 1.4 Million/day to health care workers – meaning the US would need 19.6 Million/day just for healthcare workers, adjusted for population.

    A fruitful case study here is in evaluating Taiwan’s impressive PR skills for getting such amazing press results despite having such enormous mask production while letting so little slip out of the country – while China is still pilloried while letting out far more production. China has a much worse coronavirus problem and lets out far more exports despite having only 116 million daily production – a per capita production rate less than 1 /6th of Taiwan (ie adjusting for population).

    The US has also been pilloried internationally for talking about banning exports for 3M – while Taiwanese production of 4.6 Billion per year rivals 2017 US production of 4.7 Billion per year (I have been unable to find current production figures for the U), despite Taiwan having 1/14th the population. Taiwan lets 10 million or 2/3rd of one days production go to donations and they received international accolades.

    Here is the kicker – if the US kept all its production for itself – something it has not totally done yet but is talking about – Taiwan would still have approximately 1,000 times the mask production per coronavirus case as the US because the US has equivalent production and 1,000 times the cases. How is the Taiwanese PR miracle accomplished that stops the world from noticing this 1,000x disparity? https://www.taiwannews.com.tw/en/news/3903194

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