Taiwan has until now contained the spread of Covid-19. At the time of writing, Taiwan has not only “flattened the curve” of infections but has kept its confirmed cases below 500, even though it has been more than two months since it saw its first case. Less than 1% of the more than 60,000 tests that it has conducted so far have been positive.

How did Taiwan keep the coronavirus at bay? Using the Risk Governance Framework developed by the International Risk Governance Council (IRGC) helps us understand the strategies Taiwan has adopted to fight Covid-19.

Early Pre-Assessment and Appraisal to Control Risk

Staff at Taiwan's Centers for Disease Control (CDC) noticed posts on Taiwan’s online forum PTT on December 31 about a disease similar to severe acute respiratory syndrome (SARS) spreading in Wuhan, China. The CDC staff member quickly informed his colleagues at CDC which then sent an email to the World Health Organization (WHO) asking for more information. Taiwan’s government immediately held an inter-ministerial meeting to appraise the risks, and implemented new processes to control these risks. Beginning December 31, passengers on flights from Wuhan had to undergo health screenings before they were allowed to disembark the plane. Taiwan’s Vice Premier Chen Chi-mai said that Taiwan was, “the earliest country to activate epidemic prevention measures against this disease.”

Characterization and Involvement of Other Stakeholders to Manage the Risk

In order to more effectively manage this risk, the government on January 8 listed the new respiratory disease as a category 5 communicable disease, granting legal power to enact new measures. This would include the power to put people on forced quarantines. Taiwan’s CDC visited local hospitals and negative pressure wards in Wuhan to learn more about the disease, so as to be able to characterize the virus itself. On January 15, it identified the hazard as a “severe pneumonia with novel pathogens.” As the threat became clearer over the course of January, with more cases of the new disease cropping up in other parts of Asia, Taiwan’s authorities activated the Central Epidemic Command Center (CECC) to involve other stakeholders and government agencies in managing the risks. All these steps happened before Taiwan saw its first Covid-19 case.

Photo Credit: CNA Taipei's Grand Hotel marks a day with no new Covid-19 cases. April 14, 2020.

Development of Risk Scenarios and Corresponding Risk Governance Options

Taiwan saw its first confirmed case on January 21. As part of its risk assessment, Taiwan developed five scenarios on how the coronavirus outbreak could develop, and the adjustments to the risk governance options it would have to make. The Ministry of Health and Welfare Department of Medical Affairs director Shih Chung-liang said that if suspected cases continued to increase, the CECC would move into one of the next scenarios, centralizing its Covid-19 treatment in 21 hospitals. If the pandemic continued to get worse, the next scenario called for 100 hospitals to be designated as isolation hospitals.

Stringent Testing Protocol to Cut off Source of Risk and Strengthening Healthcare Organizational Capacity to Cope

The government decided on January 5, 2020, that they would conduct retrospective testing of individuals who had traveled to Wuhan 14 days prior and who had fever or respiratory infections. On February 12, the CECC also decided to trace severe respiratory cases from January 31 and who had tested negative for influenza to be tested for Covid-19. Of the 113 tissue specimens tested, one was found positive.

Testing was later expanded to high-risk groups such as medical and healthcare workers who develop fever or respiratory symptoms, in order to prevent cluster infections from forming within the healthcare institutions and disrupting Taiwan’s healthcare organizational capacity. Of the 1,852 healthcare workers who had been tested as of April 15, all have turned out negative.

As part of its risk assessment of its organizational capacity, Taiwan also decentralized Covid-19 testing to 167 small hospitals. The “infrastructure upgrades and data management experience” Taiwan has also integrated its patient records and travel history for more efficient tracking of travelers who developed Covid-19 symptoms, as well as develop an efficient mask rationing system.

Photo Credit: CNA Chen Shih-chung, April 17, 2020.

Conducting “Concern Assessment” to Address Socio-Emotional Aspects of Risk

Taiwan understood the pertinence of provisioning surgical masks to avoid panic buying and price gouging. The government invested more than US$10 million to increase face mask production in Taiwan from 1.88 million masks a day in January to 15 million by April. A mask rationing system was also implemented allowing each adult resident to purchase two masks a week initially, which has now been increased to nine masks every two weeks. Prices were also fixed at US$0.16 per mask. Heavy penalties were enforced for price gouging.

In addition, the delaying of the opening of schools by two weeks acted as a precautionary measure to prevent the virus from spreading. Providing parents with 14 days of “disease prevention childcare leave” was also part of the concern assessment, knowing that current societal values and norms at workplaces in Taiwan might make it difficult for parents to take leave to take care of their children.

Effective Risk Communication to Build Trust and Confidence, and Reduce Panic

The CECC organizes daily briefings on the new cases confirmed as well as new measures to be implemented. Taiwan’s Health and Welfare Minister Chen Shih-chung who heads the CECC has also become a key facilitator in this risk communication process.

Taiwan’s Premier Su Tseng-chang is also another key facilitator of the risk communication – on the day the first Covid-19 case was confirmed in Taiwan, he immediately addressed Taiwanese on his social media platforms. When a bout of panic buying occurred when cases spiked in mid-March from repatriating Taiwanese, Su also put up a Facebook poster reminding Taiwanese to buy more food and eat healthy, reminding his audience that Taiwan is a food-producing country. Such clear risk communication has helped to allay the concerns of Taiwanese, reduce uncertainty, as well as build confidence and trustworthiness in the government’s ability to handle the virus.

Photo Credit: CNA Premier Su Tseng-chang, April 14, 2020.

Expanded Risk Governance: Ethical, Legal and Human Rights Concerns

There are still gaps in Taiwan’s responses. Former director Chou Kuei-Tien at the Risk Society and Policy Research Center (RSPRC) at the National Taiwan University believes that there is a need for more grassroots, stakeholder engagement in the risk governance process. Nonetheless, RSPRC postdoctoral research head Chao Chia-wei highlighted how the decentralized g0v (pronounced “gov zero”) civic tech community was active in using the online community infrastructure to develop open-source maps to track the stocks of masks at pharmacies, as an example of stakeholders and citizen scientists working together with the government on a social initiative – Taiwan’s Minister without Portfolio Audrey Tang had provided the National Health Insurance (NHI) data on pharmacy locations and mask stocks for the maps.

Chou also pointed out that the public had privacy concerns about the use of GPS data to track individuals on quarantine, the integration of health records with travel data, and one particular case when the travel history of an undocumented worker was released. Chou also highlighted other ethical, legal, and human rights issues, such as when the CECC announced a travel ban on medical workers in Taiwan at the start of the pandemic – a decision it later reversed due to pushback. Chou pointed out that the lack of a legal advisor on the CECC is a concern.

Heightened Awareness of Risks due to Taiwan’s Geopolitical Situation

Taiwan has historically had to monitor diseases coming out of China. Much attention has been paid to how Taiwan learned from SARS in 2003, which hit Taiwan hard – it had the third most number of cases and deaths, with 346 confirmed cases and 73 deaths. It lesser known that Taiwan has also been fending off the African swine fever (ASF). The latest ASF outbreak started in China in August 2018 and has since spread to more than 10 countries surrounding, but not including Taiwan, which is enforced strict customs controls on meat products.

Effective Risk Governance to Ensure Resilience and Basic Functionality of the System

While many countries undergo lockdowns, people in Taiwan go about their daily lives, but with their masks on. This has been possible because the risk management strategies described above. To fight future diseases that are to come, and to enhance its preparedness, Taiwan is also setting aside US$133 million over the next seven years to setup a disease prevention center, which will also look into the research, development and testing of vaccines and biopharmaceuticals, as well as distributing rations.

This article is based on a podcast recorded by National Taiwan University's Risk Society and Policy Research Center (RSPRC). You can find the recording here.

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TNL Editor: Nicholas Haggerty (@thenewslensintl)

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