The Taiwan Model
BY OSCAR CHUNG
Minister of Health and Welfare Chen Shih-chung takes a question at a daily press conference held to provide the latest news regarding the coronavirus outbreak March 10 in Taipei City. (Photo by Michelle Lin)
A proactive approach and world-class health system are the cornerstones of the country’s effective handling of coronavirus.
When mysterious cases of pneumonia caused by a new type of coronavirus emerged in the Chinese city of Wuhan late last year, few imagined it would lead to a pandemic declared March 11 by the World Health Organization (WHO). But Taiwan knew from experience to be cautious, implementing strict screening of all direct flights from the capital of Hubei province before January. “It was a crucial first step in containing the virus,” Minister of Health and Welfare Chen Shih-chung (陳時中) said. “And that owes much to the lessons learned during the severe acute respiratory syndrome [SARS] outbreak.”
In 2003, a total of 346 people were diagnosed with SARS in Taiwan. This was the third highest number of infections worldwide behind only China and Hong Kong. But Taiwan’s total number of cases of COVID-19, the disease caused by the new coronavirus, has so far remained lower than many other nations despite the country’s close geographical proximity to China.
“Because Taiwan was badly affected by SARS after China hid the true extent of the outbreak, we were highly suspicious of their data this time around and decided to take action ahead of time,” said Chan Chang-chuan (詹長權), dean of the College of Public Health at National Taiwan University (NTU).
Passengers are monitored for signs of fever at a Taipei Metro station. (Photo by Chin Hung-hao)
The government’s reaction to coronavirus is built upon changes made after SARS struck to strengthen Taiwan’s preparedness. These included the promulgation in 2004 of regulations allowing the establishment of a Central Epidemic Command Center during major public health emergencies. Such centralization of operations means the country’s agencies and ministries work cohesively and are on the same policy page.
Further improvements have been made to case monitoring, border control, disease screening and quarantine enforcement. The latter makes use of well-coordinated efforts by units governing health and civil affairs, as well as the police. Location data provided by telecom companies is employed to ensure high-risk individuals remain at home. Together, these measures form a strong community-focused disease control system that lessens the burden on public health.
Given the threat posed by coronavirus, Taiwan’s government quickly recognized additional legislation would be necessary to supplement existing statutes. On Feb. 25, the Special Act for Prevention, Relief and Revitalization Measures for Severe Pneumonia with Novel Pathogens was passed, shortly followed by second and third acts March 25 and April 2, respectively.
The legislation sets out a range of measures designed to strengthen disease prevention and control efforts, as well as support local businesses affected by the pandemic’s impact at home and abroad. These include punishments of prison time or a fine of up to NT$5 million (US$166,666) for anyone breaking quarantine, hoarding essential materials or spreading disinformation about COVID-19. Conversely, compensation of NT$1,000 (US$33) per day is available for those who comply with quarantine requirements.
Health For All
A pillar in Taiwan’s coronavirus response is its National Health Insurance (NHI) system established in 1995. The NHI delivers coverage to more than 99 percent of the country’s residents encompassing Western and traditional Chinese medicine, as well as dental, childbirth and rehab care. Such is the quality of service provided that 89.7 percent of respondents to a Ministry of Health and Welfare survey last year expressed satisfaction with the NHI, the highest approval rate to date. This is backed by the findings of online business magazine CEOWORLD, which ranked Taiwan’s health care system first among 89 countries and territories.
According to Chen, the NHI’s efficacy in tackling COVID-19 has benefited from a number of technological innovations. Chief among them is the MediCloud System, through which patients’ medical records are shared between different hospitals and clinics to give physicians up-to-date information on recent ailments, prescriptions and test results.
Big data analytics is also being utilized by combining information held by the NHI, National Immigration Agency and Taiwan Centers for Disease Control. This enables medical staffers to see when a patient has visited high-risk countries or had close contact with someone who has tested positive for coronavirus.
Pedestrians cross the road while wearing surgical masks in Taipei. Taiwan’s success managing the COVID-19 pandemic has been attributed in part to the high awareness of disease prevention best practices among the public. (Photo by Chin Hung-hao)
The NHI is also key to Taiwan’s much-praised allocation method for surgical masks. To prevent panic buying and ensure access for all residents, a name-based system tied to an individual’s NHI card—or ID number for people such as temporary visitors not enrolled in the insurance—limits purchases per person each week. Rolled out Feb. 6, the system has proven successful thanks to its controlled prices and clear implementation. “The decision to ration masks was extremely prudent given global shortages of personal protective equipment,” Chen said.
Short-term measures are being complemented by R&D for potential long-term solutions to COVID-19 leveraging Taiwan’s scientific strength. The National Health Research Institutes (NHRI) has launched a variety of projects designed to combat coronavirus. One of these involves blood taken from horses injected with the virus—the animals produce antibodies but do not suffer from the disease. This equine serum is being prepared for testing on seriously ill patients at NHRI’s National Institute of Infectious Diseases and Vaccinology.
Vaccine development is progressing apace, with clinical trials expected to start in the next few months. NHRI is also developing a rapid test using SARS antibodies to detect coronavirus, and its Institute of Biotechnology and Pharmaceutical Research has conducted trials with remdesivir, an experimental drug with potential to treat COVID-19.
Pandemics show no respect for borders, which is why Taiwan has ramped up international cooperation during the crisis through science diplomacy and by sharing its expertise. Recent examples include signing of the Taiwan-U.S. Joint Statement on a Partnership against Coronavirus in Taipei in March, which states that both sides will share best practices and cooperate in areas including scientific research and exchanges of medical equipment.
“Taiwan learned from SARS that global cooperation is needed to fight a contagious disease,” Chen said. In keeping with this, and as a responsible stakeholder in the global community, Taiwan has strictly adhered to the International Health Regulations throughout the COVID-19 outbreak by reporting confirmed cases to the WHO of its own accord. This includes keeping neighbors China, Japan, Singapore and South Korea up to date on Taiwan’s situation, as well as uploading the genetic sequence of local virus strains to the database operated under the Global Initiative on Sharing All Influenza Data.
Without meaningful WHO participation and full access to the body’s activities, mechanisms and meetings, these actions are less effective than they should be. “Taiwan’s position between East and Southeast Asia means it could be a major gap in the world’s disease-fighting network if it cannot participate in global health affairs, with potentially disastrous consequences,” Chen said.
The minister’s words were echoed by NTU’s Chan, who urged the international community to continue backing Taiwan’s bid for WHO participation. “It’s important for all countries and territories to have a seat at the WHO table,” he said. “Taiwan sharing its experiences combating coronavirus would certainly benefit global efforts to manage COVID-19 and make the world safer.”
Retrieve from Taiwan Peview