At the crest of interest in Taiwans response to Covid-19 last April, The News Lens published an op-ed by Patrick Ng on the international spotlight placed on Taiwan’s healthcare system. Nearly a year later, quality control tests of the first vaccines are set to be complete in the coming days. In the first part of a two-part interview, Ng answers questions on what may be the final stages of Taiwans pandemic and how the healthcare system will be irrevocably changed.

You co-authored an article, viewed over a million times, that established the narrative of how Taiwan successfully suppressed Covid-19 in its early stages. Taiwan now appears to be on the verge of emerging from Covid-19. When do you think Taiwan can return to something like a pre-pandemic normal life, ending its quarantine on arrival policy? Will a critical mass of vaccinated people domestically suffice?

You ask an important question not just for Taiwan but for every country that has mandatory quarantine or lockdown policies in place. It is ultimately a question of how much risk policy makers are willing to assume. Opening borders is a risk. Plans to reduce measures such as quarantine on arrival when Covid-19 is not eradicated is a risk.

Countries can seek to pursue a variety of pandemic strategies. I see Taiwan trying to do these two: 1) elimination strategy where the aim is zero cases of Covid and no detectable community transmission; and 2) suppression strategy where the aim is to minimize Covid cases with a low level of community transmission. Taiwan is currently under elimination strategy. If we move towards ending quarantine on arrival or opening borders, we begin to implement a suppression strategy.

Taiwan’s residents have benefited economically and socially from living in a country where the virus was contained. I would say that Taiwan is one of the few countries where people have been living what other countries consider to be pre-pandemic normal lives. Because of this advantage, Taiwan’s economy was able to grow by 3.11% in 2020, while most economies around the world retracted. But borders will not be closed indefinitely. Other countries are rolling out vaccination campaigns to help drive their economies again. Taiwan will also need to open their borders to remain competitive.

If the risk cannot be removed, then Taiwan must manage the risks of significant community transmission.

Reaching herd immunity is one way to accomplish this goal. This is the idea that with enough immunized people, the virus will be unable to infect others at a fast enough rate by itself. But there are caveats. Since Taiwan has had great success in containing the virus, very few people here have antibody responses from a previous Covid-19 infection. So protection will come almost exclusively from vaccinations.


Photo Credit: CNA

An Oxford/AstraZeneca Covid-19 vaccine delivery on the tarmac at Taoyuan International Airport, Taoyuan, Taiwan.

When vaccines are available to the public, the critical questions will be 1) how many people will choose to get vaccinated; 2) how long the vaccines can provide protection against serious disease and death; 3) are dangerous variants emerging where current vaccines are not effective.

A recent poll from Global Views magazine indicated that 60.3% of those surveyed would be willing to get a free vaccine from the government while 7% were undecided. This is worrisome because it may be difficult to reach herd immunity levels with this level of support. Furthermore, we are seeing reports of more infectious variants of the virus. If these variants are more infectious, a higher level of immunity is needed to prevent significant community spread. The more infectious a disease, the more vaccinated people are needed to reduce the chance of widespread community transmission. Incomplete vaccine coverage will also prevent eradication of the virus and require that countries manage its impact on the population.

It is unknown how long vaccinations can protect against Covid-19. Getting booster shots may help remind our immune system to produce antibodies against the disease. However, we have to be cautious around the threat of variants. The possibility where vaccinations do not protect against a new variant is alarming. The more time Covid is able to spread and mutate around the world, the more vigilant and responsive we must be to contain it.

Taiwan has been incredibly successful in containing the virus and showing the world what a democratic nation can achieve. When borders are open again and quarantines are reduced, Taiwan’s next challenge will be to maintain its competitive edge as vaccinations allow other countries to reopen and manage the risks of significant community transmission as we co-exist with the virus.

There have been a number of conspiracy theories circulating in Taiwan, including in English-language media, on the origins of the pandemic. Are you worried about the spread of conspiracy theories on the pandemic here?

I haven’t lost sleep at night from pandemic origin conspiracy theories primarily because, unlike other countries, Taiwan is amenable to wearing masks and properly protecting themselves as advised by the public health authorities. As long as the conspiracy theories do not spread misinformation about how to properly protect people from Covid-19, they will just be a talking point.

What I am worried about is how people might choose not to get vaccinated. Annual flu vaccinations have not surpassed 30% of Taiwan’s population. If Covid were to mutate often enough where we need to receive regular vaccine booster shots, I am unsure whether Taiwan’s residents would be willing to get vaccinated on a regular basis.


Photo Credit: CNA

A Taipei resident receiving a flu vaccination, January 30, 2021.

Another concern is whether people will opt to wait for certain Covid-19 vaccines before they decide to get vaccinated. The Global Views poll indicated almost 55% of respondents preferred a vaccine that was made in Taiwan. Waiting for Taiwan to release a safe and effective vaccine will take time. This delay will affect Taiwan’s ability to reopen borders and obtain herd immunity.

What are some of the lessons that practitioners and administrators have learned that will influence healthcare in Taiwan going forward?

I believe the pandemic will accelerate investments in hospital infrastructure and design so that space can be used flexibly to handle surge events. Improvements to infectious disease capabilities for the next pandemic will likely occur such as reducing cross contamination by using separate air filtration systems in different areas of the hospital. I imagine that hospitals will start to include pandemic preparedness as part of their certification process.

Around the world, various digital innovations and technologies are widely used to empower the healthcare workforce as they adapt to new ways of meeting safely with patients. While Taiwan has not experienced major changes in how it provides care due to efforts to contain the virus, we can learn from other countries’ examples. Telehealth is beginning to be a preferred option for interactions between patients and providers both for safety and convenience. The movement towards healthcare at home will likely accelerate in other countries. I anticipate that hospitals will increasingly be used only for complex care and usual care will likely be concentrated in outpatient clinics outside the hospital to save costs.

Clinicians and the public health community have learned that you have to move fast in a pandemic. We were fortunate that the lessons from SARS in 2003 prepared the country for the fast response we saw here in Taiwan. The country’s healthcare workforce will need to have an agile mindset and adjust practices as information about a novel disease comes in. Innovation, creativity, and ingenuity is needed to care for patients when a disease is unpredictable and unknown.

Medical supply chains will increasingly be optimized for risk mitigation. Having proper medical products is necessary to provide the right care at the right time. The availability of medical supplies will ultimately affect clinical practice and patient outcomes. In the past, supply chains were optimized for efficiency and cost reductions. We are entering an era where managing supply chain risk and disruption is needed as borders closed and factories shut down at the beginning of the pandemic. Diversification of manufacturers to improve overall resiliency and reduce over-reliance, advance market commitments for supplies to reduce panic buying, and alignment and coordination with hospitals and the government to coordinate ordering and fulfillment of essential equipment will likely be in place as a result of Covid.

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TNL Editor: Nicholas Haggerty (@thenewslensintl)

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