Cheryl Lin, co-director of the Policy and Organizational Management Program, shares the policy lessons she observed while reviewing Taiwan’s public health response.
-By Amanda Solliday
Despite its proximity to mainland China and a population of nearly 24 million, Taiwan has seen under 450 cases and seven deaths due to COVID-19, according to data maintained by the Coronavirus Resource Center at Johns Hopkins University.
Cheryl Lin and her colleagues took notice. Professor Lin is the co-director of the Policy and Organizational Management Program at Duke University. The program conducts interdisciplinary research and offers continued learning and professional opportunities in teaching, research, exchange and practice.
The team found a swift and accessible disease prevention system modernized by the severe acute respiratory syndrome (SARS) outbreak in 2003 helped Taiwan keep schools and businesses open throughout the coronavirus pandemic.
“We recognized how quickly and strategically Taiwan has responded with a series of effective policies,” Lin says. “We believed it would be valuable to help document and share some of the experiences with the global health community as the pandemic continued.”
In a policy review published by the Centers for Disease Control and Prevention’s Emerging Infectious Diseases journal, the team looked at Taiwan’s implementation measures during the first 50 days of the outbreak.
Here are some of the policies and other practices the study authors believe helped Taiwan in the early days of the pandemic.
Lasting Cultural Memory
An earlier epidemic of a flu-like illness, SARS, began in China in 2002 and quickly spread throughout 26 countries, also reaching Taiwan.
“The experience with SARS left Taiwan with painful memories and modernized its disease prevention system,” Lin says.
When COVID-19 began to spread in December 2019, Taiwan already had the machinery in place to respond.
“Immediately, the Taiwan Centers for Disease Control (CDC) formed a task force to establish the disease definition and reporting criteria for the medical community to look out for patients with respiratory systems and a travel history to Wuhan,” Lin says.
Because of the previous experience with SARS, citizens of Taiwan were also accustomed to wearing masks when sick or while in crowded areas, which Lin says helped slow the early spread of the coronavirus.
“The mentality in Taiwan is, ‘I’m wearing this mask not only to protect myself but also to protect others,’” Lin says.
Early Testing and Quarantine
On the same day of the first official announcement of an outbreak due to a new unknown virus in China on December 31, 2019, Taiwan activated a border quarantine and deployed health screenings on incoming flights from Wuhan, Lin says.
“These actions might have been the very first coronavirus prevention mechanism outside of China,” Lin says.
And by the second week of January, Taiwan’s CDC developed its own test kit for the virus. Once a patient tested positive for COVID-19, they were admitted to an isolation room at a hospital.
These patients were not discharged until they tested negative twice, and this rule was later increased to three negative tests for extra precaution. The patients’ close contacts were asked also to self-quarantine for 14 days.
“These measures really helped minimize the transmission,” Lin says. “A clear policy on quarantine built the barriers for community spread.”
Lin adds that for people who are suspected or confirmed cases, Taiwan’s government offers subsidized taxis to help with transportation to hospitals or for travelers coming from the airport to home quarantine, so not to contaminate public transportation.
In addition, designated hotels are available for people who might not be able to quarantine from family at home. People can stay for two weeks at these hotels.
Free Screening and Treatment
Taiwan offers a national health insurance, a single-payer system that covers nearly the entire population.
“People could easily go to hospitals and clinics to receive medical services and a COVID-19 test and not have to worry about the financial burden,” Lin says.
Also, Lin adds, because COVID-19 is classified as a “severe communicable disease,” testing and treatment are provided by the government to help prevent spread.
“This benefit also applies to foreigners,” Lin says. “If someone visiting the country is diagnosed with COVID-19, they are covered for testing and treatment.”
Swift Communication and Flexible Response
Throughout the early days of the pandemic, Taiwan’s public health officials held regular press conferences and public service announcements to communicate with the public about the outbreak. The officials outlined potential risks and detailed protective measures that people should take.
The government also formed an interdepartmental task force to coordinate issues such as the availability of supplies. For example, when there was a shortage of masks available for the general public, says Lin, domestic production of masks increased in Taiwan. The coordination also included scaling up health care and testing capacities with support from the private health care sector – laboratories, hospitals and pharmaceutical companies.
These types of decisions and disease prevention guidelines are outlined in a government’s emergency response plan, which Lin says should ideally be understood by all parties involved and frequently evaluated.
“Before the pandemic even begins, the plan needs to be regularly practiced, with drills and other coordinated measures, as well as reviewed and routinely updated,” Lin says. “And once the pandemic occurs, governments need to regularly and rapidly evaluate to what extent they adjust as things continue to evolve.”
Citation: Lin C, Braund WE, Auerbach J, Chou J-H, Teng J-H, Tu P, et al. Policy decisions and use of information technology to fight 2019 novel coronavirus disease, Taiwan. Emerg Infect Dis. 2020 Jul. https://doi.org/10.3201/eid2607.200574