Taiwan Shows the World that the Coronavirus Can Be Contained
The island nation's comprehensive approach to the pandemic, drawing on medical, technological and manufacturing expertise, offers valuable lessons for the rest of the world as the virus continues to rapidly spread
By Matthew Fulco and David Stinson (Project Research Fellow of TABF)
Taiwan has been one of the few countries in the world able to contain the spread of the novel coronavirus, a virulent new respiratory illness that emerged in Wuhan in late 2019. Known officially as COVID-19, the virus has spread exponentially across the world to every continent but Antarctica since the first cases were diagnosed in China late last year.
As of March 31, more than 784,000 cases and 37,000 deaths have been caused by the virus globally, with the U.S., Italy, China and Spain hit especially hard. China, which is widely believed to be the source of the virus, has 82,240 cases and 3,309 deaths.
In contrast, Taiwan has just 306 cases and five deaths. It has tested nearly 32,000 people, of whom more than 28,000 have tested negative. Taiwan's world-class single-payer healthcare system ensures that any resident who does become infected receives proper treatment and needs not worry about paying. In East Asia, only Macau, a city with a population of about 600,000, has fewer cases and fatalities.
Taiwan has a robust homegrown medical supply chain, ensuring that it does not suffer shortages of vital protective and life-support equipment. Taiwan is preparing to ramp up production of masks to 13 million a day by early April.
Taiwan's ability to contain the coronavirus is especially impressive given that it is right next door to the original epicenter of the disease: China. When the coronavirus first broke out in China, some analysts forecast Taiwan to be hit hard given its geographic proximity to China and the extensive commercial and person-to-person ties between the two sides of the Taiwan Strait.
Taiwan has also managed to corral the coronavirus despite being excluded from the World Health Organization (WHO) due to China's objections. The WHO failed to provide Taiwan with timely updates about the coronavirus outbreak during the crucial early period when decisive action could have prevented a pandemic, leaving the island nation to fend for itself.
To be sure, Taiwan learned hard lessons during the 2002-03 SARS outbreak – which also originated in China – and that has been reflected in Taiwan's approach to disease control with the coronavirus. Taiwan had 346 SARS cases and 37 deaths directly attributed to the disease. Western countries, on the other hand, were relatively unscathed by SARS and did not view COVID-19 with the same alarm as their counterparts in East Asia.
However, learning lessons from SARS and being able to implement them effectively in real time are not one and the same. Taiwan has been able to do both.
Staying one step ahead of the virus
Integral to Taiwan's success in containing the coronavirus has been its embrace of expertise in epidemic control. Taiwan's vice president Chen Chien-jen is an epidemiologist by training. He rose to prominence when he served as Taiwan's Department of Health Director General (now the Ministry of Health and Welfare) during the SARS outbreak.
Chen's emphasis on developing effective quarantine and screening procedures during SARS helped Taiwan get the epidemic under control. In subsequent years, Taiwan beefed up its anti-epidemic capabilities, steeling itself for another SARS-like outbreak – a perennial risk given poor hygiene conditions in China's wet markets and demand for the meat of wild animals – and was ready when the coronavirus hit.
The Taiwanese government swiftly sprang into action after hearing reports from Taiwanese working in Wuhan that a mysterious new respiratory illness – described as a “severe pneumonia” – had emerged there. There are thousands of Taiwanese businesspeople working in the central Chinese city. This connection to Wuhan ended up helping Taiwan see through the efforts of local officials to cover up the disease's severity.
Taiwan understands how China's ruling Communist Party operates, especially its obsession with secrecy. Chinese officials will go to great lengths to prevent their career paths from being compromised. It happened with SARS and again with COVID-19. This time, the damage to public health is far worse.
"Although at that time [in early January] China and the WHO denied there had been human-to-human transmission, when we heard that medical care workers had been infected, it did not seem likely to us that they had gotten sick through exposure to the wet market where the virus is believed to have originated," Vice President Chen told Japan Forward in a March 2 interview.
Fortunately, Taiwan acted to contain the coronavirus very early. On Dec. 31, it began screening airline passengers from Wuhan for signs of infection, marking one of the first international responses to the outbreak. It banned Wuhan residents from entering Taiwan on January 23 as Beijing locked the city down. That same day, the WHO declined to declare the outbreak a public health emergency of international concern (PHEIC), despite its own finding that multi-generational human-to-human transmission was occurring in Wuhan.
Taiwan knew better. On January 24, it halted exports of surgical face masks to ensure adequate local supply and asked local firms to accelerate production. It suspended all tours to China on January 25 and banned all Chinese visitors on February 6.
To prevent community transmission from taking root in Taiwan, the government has adopted selective social distancing measures. The key to their success has been early and effective implementation – pre-empting local outbreaks, not reacting to them. First, Taiwan announced schools would remain closed for two weeks after the end of the Lunar New Year holiday. They reopened February 25, as there was no sign of significant local transmission. Mass events have been postponed, notably the nation's largest religious pilgrimage (Matsu) that ordinarily takes place in mid-March.
Meanwhile, Taiwan has used home quarantine effectively for people who have been potentially exposed to the virus, pioneering an “electronic fence” method of mobile phone tracking. Anyone who breaks an isolation order can be fined up to NT$1 million (roughly US$33,000). Official data show that more than 220 people have been fined NT$18 million (about US$595,000) for breaking quarantine rules.
With an uptick in cases in March, mostly people returning from overseas, Taiwan tightened travel restrictions even further. On March 19, it banned foreign nationals from entering unless holding alien residency cards (ARCs), or in a few other special cases. All arrivals to Taiwan must undergo a 14-day quarantine. Airline passengers are banned from transiting through Taiwan from March 24 to April 7.
Sharing public health and medical technology expertise with the world
While the battle against the novel coronavirus is far from over, Taiwan has shown that it is possible to control the contagion without resorting to draconian lockdown measures, and with minimal support from the WHO. All the more impressive is that Taiwan has done so in an open and transparent environment. It holds daily press briefings to keep the public informed and also updates the bilingual (Chinese-English) Centers for Disease Control (CDC) official website on a daily basis, showing the number of new cases per day, whether they are imported or local, the total number of cases, and how the virus is affecting the rest of the world.
Further, Taiwan has put its high-tech prowess to good use in the fight against the epidemic. In early February, it integrated the databases for public health, border control and national registries. Taiwan has also harnessed its strong telecoms infrastructure for messaging, tracking and location-sharing purposes. As a result, the government can directly broadcast updates all mobile network subscribers, as well keep track of large crowds, and warn its citizens if there is a substantial risk of disease transmission.
To optimize mask rationing (set at 3 per person weekly), Taiwan has implemented a pilot program for pre-ordering masks online available to anyone in the national health insurance (NHI) program. People pick the masks up at pharmacies or convenience stores. The online civic and tech community gOv has created maps with real-time mask availability information to reduce queues.
To be sure, Taiwan must remain vigilant in its anti-epidemic measures. It should also share its public health expertise with the world. While politics obstruct Taiwan's participation in the WHO, there are many other opportunities, especially at the bilateral level.
For instance, in March, Taiwan and the U.S. vowed to fight the coronavirus pandemic together. This partnership will include medicine development, contact-tracing technology and the exchange of medical supplies, according to a joint statement from the American Institute in Taiwan (AIT) and Taiwan's Ministry of Foreign Affairs. When mask supplies are stable, Taiwan plans to send 100,000 masks per week to the U.S., while the U.S. has prepared raw materials Taiwan will use to manufacture 300,000 protective outfits.
Taiwan should continue to explore such partnerships with other key democratic partners. Additionally, it should consider how to apply the attributes that have helped it control the coronavirus to broader industrial transformation efforts. The Tsai Ing-wen administration's 5+2 innovative industries plan rolled out three years ago includes biomedicine and the Internet of Things (IoT).
Now is the time to update that policy, with a focus on the development of health technology solutions that optimize Taiwan's diverse strengths in epidemic control. Demand for such solutions will increase as the world looks to contain the coronavirus outbreak, not only as a matter of public health, but also to ensure basic economic stability. Taiwan should position itself at the forefront of this coming health-tech wave.