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How Taiwan tamed Covid without lockdowns

Lessons for New Zealand from another small island nation.

By Gary Judd QC

Published by NBR Tue, 12 May 2020

An RNZ news item, on May 7, ‘Mass masking’ should be part of level 2, epidemiologist says’, included: “Otago University epidemiologist Professor Michael Baker told Morning Report [during a May 6 interview] that New Zealand and Taiwan had taken very similar paths in suppressing the virus. The only significant difference was over wearing masks.”

What I had heard about Taiwan made me suspect that Baker was incorrect, so I decided to do some research.

New Zealand and Taiwan are both island nations and so are better able to shut out diseases than most. After all, that is what New Zealand does, mostly with success, with foot and mouth and many other animal and plant diseases.

Taiwan cherishes democracy, like New Zealand. It does not employ the authoritarian and coercive measures of the Chinese Communist Party (CCP) that controls China, Taiwan’s neighbour across the Taiwan Strait.

These similarities make it useful to compare New Zealand’s approach to Covid-19 with Taiwan’s.

Significant advantages

In doing so, we should remember that New Zealand has some significant advantages. New Zealand has a land area of 268,021sq km, more than seven times Taiwan’s 36,193sq km, but our population of 4.886 million (2018) is only about one-fifth of Taiwan’s 23.78 million. Taiwan’s greater population density makes a higher transmission rate more likely there.

Despite these population factors, by May 7, Taiwan had only 440 confirmed cases and six deaths, a minute proportion of its population, compared with New Zealand’s 1142 and 21 deaths (also a small proportion, but large by comparison). So, if New Zealand and Taiwan have been following similar paths, Taiwan’s path took a better direction than New Zealand’s without the costs imposed by New Zealand’s actions.

In fact, New Zealand and Taiwan have not followed similar paths. The significant differences are, in summary: first, Taiwan was well prepared at the start; second, unlike New Zealand, Taiwan did ‘go early’; and third, Taiwan was able to employ science and technology unavailable to New Zealand.

Taiwan was well prepared at the start because it had been severely affected by the SARS epidemic. Further detail is given in my discussion of Taiwan’s response and its science and technology advantages, below.

By contrast, New Zealand’s preparation for a pandemic has proved inadequate despite Parliament passing the Epidemic Preparedness Act 2006. It was enacted by the Helen Clark government and its stated principal purpose is to ensure there is adequate statutory power for government agencies to try to prevent the outbreak of epidemics in New Zealand, to respond to epidemics in New Zealand, and to respond to certain possible consequences of epidemics.

New Zealand has the unfortunate habit of thinking that legislation is the cure for most everything. The response to any real or imagined problem is to pass a law. Since the 2006 Act was passed, the world has had the 2009 H1N1 or swine flu pandemic and others, yet that does not appear to have sparked any effective disaster planning for a worse pandemic.

Second, Taiwan acted straight away. Having taken initial precautions by vetting people coming in from China, once further evidence confirming the initial suspicions trickled out despite the obfuscations from China and the World Health Organisation (WHO), Taiwan reacted immediately with coordinated and sophisticated measures.

Taiwan started investigating inbound flights

As recounted in an article in the Washington Post of April 17: “As Taiwan shows, the antidote to the virus is freedom” and, elsewhere, Taiwan’s suspicions were aroused in December 2019. On December 31, 2019, while China was still denying the virus was capable of human transmission, Taiwan officials began boarding planes arriving from Wuhan to identify and isolate passengers with fever or pneumonia before they could deplane. Further restrictions on entry were imposed during January and increased in February.

Christine Chiou is a paediatrician specialising in infectious diseases working at the National Institutes of Health in the US. She trained and practised in Taiwan and participated in Taiwan’s efforts to fight the SARS epidemic in 2003. In an article in The Diplomat (an online international news magazine based in Tokyo), ‘How Taiwan Battles the Coronavirus’, she says Taiwan became “hypervigilant” once the first case of mysterious pneumonia was reported in Wuhan.

Chiou explains that on January 20, Taiwan established a central epidemic command centre (CECC) spearheaded by the vice-president, himself a well-respected epidemiologist. “Surveillance, contact tracing, and isolation/quarantine were implemented straight away. Taiwan has managed to maintain a low case count through vigourous public health measures. There has not been any shutdown of theaters, department stores and, most importantly, schools, although large gatherings are discouraged.”

Testing, as well as surveillance, contact tracing and isolation/quarantine, started in January.

By contrast, New Zealand’s first response was the February 3 restrictions on foreign nationals travelling here from, or transiting through, mainland China. Even though New Zealand’s first case was reported on February 28, it was not until March 14, after the WHO declared the outbreak to be a pandemic on March 11/12 (by which time New Zealand had five confirmed cases), that the government decreed anyone entering the country must self-isolate for 14 days.

Thus, the first two significant differences are that Taiwan was well-prepared and leapt into action as soon as the reports from Wuhan started leaking out. New Zealand was ill-prepared and acted much more slowly.

Science and technology

The third significant difference is Taiwan’s employment of science and technology. It has a mastery of these far greater than New Zealand’s. An understanding of Taiwan’s abilities can be gathered from an article in JAMA, an international peer-reviewed general medical journal published continuously since 1883: ‘Response to Covid-19 in Taiwan Big Data Analytics, New Technology, and Proactive Testing’.

Introducing the descriptions of Taiwan’s actions, the article (published March 3, with data as of February 24) commences:

Taiwan is 81 miles off the coast of mainland China and was expected to have the second highest number of cases of coronavirus disease 2019 (Covid-19) due to its proximity to and number of flights between China. The country has 23 million citizens of which 850 000 reside in and 404 000 work in China. In 2019, 2.71 million visitors from the mainland traveled to Taiwan. As such, Taiwan has been on constant alert and ready to act on epidemics arising from China ever since the severe acute respiratory syndrome (SARS) epidemic in 2003. Given the continual spread of Covid-19 around the world, understanding the action items that were implemented quickly in Taiwan and assessing the effectiveness of these actions in preventing a large-scale epidemic may be instructive for other countries.

Before commencing the detail, the authors note:

For the past five weeks (January 20 to February 24), the CECC has rapidly produced and implemented a list of at least 124 action items … including border control from the air and sea, case identification (using new data and technology), quarantine of suspicious cases, proactive case finding, resource allocation (assessing and managing capacity), reassurance and education of the public while fighting misinformation, negotiation with other countries and regions, formulation of policies toward schools and childcare, and relief to businesses.

What was done is summarised in the conclusion:

Taiwan’s government learned from its 2003 SARS experience and established a public health response mechanism for enabling rapid actions for the next crisis. Well-trained and experienced teams of officials were quick to recognise the crisis and activated emergency management structures to address the emerging outbreak. …

Testing identified those with virus

Science and technology enabled Taiwan to identify and isolate infected or possibly infected persons mostly at the border, but also by sophisticated contacts with people who came through. This enabled the authorities to limit the possibility of an infected person encountering people inside the border. Testing identified those who had the virus and they were treated.

Being prepared, acting immediately, and utilising science and technology produced the fourth significant difference. Taiwan achieved its outstanding results without shutting down its economy. It has not imposed a lockdown on its citizens. Shopping and other business is normal. Restaurants have not closed. There was a two-weeks extension of schools’ normal winter break, but that is all.

The restrictions have been largely confined to travel to and from Taiwan and prohibiting large gatherings.

While the wearing of face masks is considered by many in Asia, including Taiwan, to be a useful way to avoid contracting and spreading infectious respiratory diseases, and is a commonly adopted practice, there was no compulsion for masks to be worn until it was directed they be used on public transportation from April 6. Probably many Taiwanese would have been wearing masks anyway, both before and after news of the Wuhan outbreak started circulating. Perhaps the practice then intensified, despite lack of compulsion.

A mask-wearing habit may have contributed to Taiwan’s good result. It is impossible to say.

This uncertainty does not mean that the wearing of masks should not be encouraged in certain circumstances. Where people are close together in confined spaces, it may reduce the possibility of infected persons passing the virus on to others.

Compulsion a different matter

Compulsion is a different matter: there needs to be compelling evidence of danger before it should be considered. Comparison of the paths adopted by Taiwan and New Zealand does not provide the evidence, and the scientific community has yet to reach a consensus on the benefits of mask-wearing by the general public as against the downsides, as reflected in the New Zealand Health Ministry’s refusal, so far, to make a recommendation.

What one can say is that Taiwan’s April decision suggests it may be a good idea when public transportation in New Zealand becomes significant again. Taiwan has demonstrated its competence in combating the virus. It has credibility. That following its example may be worthy of consideration.

What I have found is that Taiwan’s is a great story that should be told. Unfortunately, as the WHO kowtows to the Chinese Communist Party’s pretense that Taiwan is still part of China, the WHO does not provide separate information about Taiwan. That is one reason the Taiwan story is not well known.

This leads to the first of at least two deeper messages to be taken from Taiwan’s story.

First, the combination of the Chinese Communist Party’s ludicrous ideological refusal to acknowledge Taiwan’s existence as a separate country and the WHO’s deference to the party’s position meant that the organisation did not learn about and report on the precautionary techniques and practices adopted by Taiwan after the SARS epidemic.

It also meant that the WHO presumably did not know or, if it did, did not report that Taiwan had started acting when suggestions arose of a problem in Wuhan. Had it recognised and treated Taiwan as a member, as it should have if it were acting apolitically, it would have been given that information and what Taiwan was doing about it, and it could have reported that to its other members with the authority that is vested in the WHO.

New rules

New rules, adopted by the WHO in 2005 and binding on all member states, were aimed at boosting collective defences against global health challenges and improving pandemic preparedness and response. They entered force in June 2007 and require states to notify the WHO of potential global health emergencies.

In line with the WHO’s first function, to act as the directing and coordinating authority on international health work, and a later one to provide information, counsel and assistance in the field of health, countries rely on information coming from the WHO. Perhaps if the Taiwan story had been told by the WHO, other countries’ story might also have been different.

New Zealand, with the rest of the world, was deprived of learnings from Taiwan that might have prevented or mitigated the spread of the virus. If New Zealand is principled, it should call out the “One China” policy for what it is. It should recognise Taiwan as a separate country and demand reform of the WHO.

Second, Taiwan’s actions, when compared with New Zealand’s, show that the ‘go early, go hard’ mantra that the prime minister and other ministers repeat at every available opportunity is no more than truth-distorting spin.

It is true the government has gone hard but it did not do so until after March 12. It did not go early.

Taiwan’s story shows that had New Zealand been better prepared and reacted earlier, the draconian measures, which have denied New Zealanders their basic freedoms and been so destructive to the economy, may have been unnecessary.

New Zealand’s lack of preparedness (the fault of the Clark and Key/English governments as well as this one) and lesser scientific and technological abilities may have meant we were simply unable to go early. Nor did we know what Taiwan was doing. Most other countries were in that position too. Almost all have had to scramble.

The government, meaning elected politicians and the bureaucracy, may have had legitimate reasons for not taking decisive action earlier but if that is so, surely we were and are entitled to an honest acknowledgement and explanation, rather than a mindless slogan designed to obscure the truth.

This is supplied content and not commissioned or paid for by NBR.

Gary Judd QC was a member of the Apec Business Advisory Council (ABAC) 2009-2012. One of the ABAC meeting he attended took place in Taiwan. He also presented around the Asia-Pacific at many seminars, dialogues and training programmes including several in China.

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