Former Taiwan Premier Offers Lessons on How the U.S. Should Deal With COVID-19

The WorldPost’s deputy editor, Nils Gilman, interviewed Jiang Yi-huah, the premier of Taiwan from 2013-2014, on March 21.

People in Taipei, the capital of Taiwan, wait in line at a pharmacy to pick up masks they pre-ordered online. March 18. (Paula Bronstein/Getty Images )

Gilman: Tell us about the general situation in Taiwan right now in terms of managing the coronavirus outbreak. What’s the mood?

Jiang: For now, we are doing more or less OK. So far, we have 195 confirmed cases of coronavirus and two deaths, which is quite low, especially compared with surrounding countries and some in Europe. But people here are still scared.

We are not in a panic, but we do think the challenge could last a long time. People feel like they need to be better prepared for a long-term fight, so they go to the supermarket to buy as many things as possible — which is absolutely not necessary at this moment. But people are deeply worried about the future supply of their everyday needs.

Gilman: In the West, there is a perception that Taiwan has had exemplary success in handling the outbreak. Given that Taiwan is closely linked with China, both economically and in terms of transportation and geography, it is remarkable how successful Taiwan has been in containing the virus. What’s been the key to Taiwan success?

Jiang: There are several reasons. First, I think the experience of combatting SARS 17 years ago was important for Taiwan — not only for the government, but also for the general public. During the SARS epidemic, Taiwanese people were terrified: more than 300 people were infected by the disease, and the mortality rate was quite high, about 11 percent, so that within a few months 37 people died. Many people in that time, including me, were afraid they might lose their families and had to discuss how to survive. So when coronavirus disease came again, the general public and the government was not inexperienced. We knew how serious the problem could be. We were also ready to adopt tough measures to contain the disease.

The second factor is that, also because of the SARS experience, we have a great disease control and hospital service system in Taiwan. The doctors and nurses are well-trained in dealing with infected cases. Without getting into the details of the procedures, whenever we find a suspicious case, we have standard operating procedures for treating every case. We had two serious hospital infection accidents during the SARS outbreak, which caused the death of 10 medical workers. This time, the hospital system was more prepared.

The third reason for Taiwan’s relative success is its proactive measures — what the government calls an “early response” policy. The Central Epidemic Command Center decided soon after the outbreak that all mainland Chinese students (except degree students) and tourists were not allowed to enter Taiwan. It then ordered all public schools to postpone the start of classes until late February. Other measures — pervasive screening of potential patients, investigation of contact history, quarantine of people coming from infected areas and expropriation of all surgical face masks — were implemented faster than other countries.

Fourth, Taiwanese people are quite used to wearing face masks during an epidemic, which actually helps a lot in preventing the spread of coronavirus. I think it is a big difference from the United States and other Western countries. The use of face mask may be regarded as a sign of sickness in the West. But people here are wearing face masks to protect themselves from disease, and to make sure that the environment will be safe for everyone else as well.

Fifth, the Taiwanese government implemented tough measures to fight the pandemic: strict border control, encouragement not to travel abroad and surveillance of all suspected cases. Taiwan is close to mainland China, both geographically and economically. But at the beginning of the pandemic, the government ordered the cancellation of all transportation across the Taiwan Strait. Later on, we also closed the door to visitors and tourists from many other countries. The government restricts travel by many hospital workers and civil servants to places with high levels of infection during this period. It also asks all quarantined people to use a government-issued cell phone for the purpose of monitoring and tracing. These measures cause controversies, but work for disease control.

The last point is that Taiwan has a very good healthcare system, especially compared with the U.S. Taiwan’s health insurance system is affordable for the general public, which means everyone can get a medical examination or hospital treatment when necessary. It is also a scientific one: The health insurance system collects personal data and medical records, so hospitals and doctors can make good judgments about every patient’s condition. The quality of the national health system is quite important in the healing of patients and the containment of coronavirus.

Gilman: My understanding is that one of the lessons that came out of Taiwan’s SARS experience is that there were exercises and simulations that were done in the government in 2009 and 2010 to test new response mechanisms. Can you describe that?

Jiang: Starting in 2009, in the aftermath of SARS, Taiwan conducted comprehensive tests involving every health center and hospital in the country to see if they can handle the outbreak of contagious diseases and other serious challenges. We also have a robust accreditation and ranking system, conducted every year or two, to evaluate the performance of every hospital. I think these exercises and evaluations are helpful.

Gilman: The economic ramifications of the outbreak are clearly serious. What has been the role of the government in terms of managing the economic and distributional questions related to the epidemic? Is it monitoring and controlling the movement of goods?

Jiang: The Taiwanese government is controlling the distribution of some essential equipment related to health enhancement, of which surgical face masks are the most important. In Taiwan, most people want to put on face mask to protect themselves, but we cannot guarantee that everyone has a new face mask every day. So the government ordered factories that produce the face masks to supply their products to the government. The government then launched a rationing system for face masks. People must bring their health insurance cards to purchase face masks at pharmacies across Taiwan. For the time being, each citizen can only get three a week. The quota may be increased when the supply becomes more abundant.

In addition to face masks, the government also collects and distributes some critical equipment to hospitals, schools and immigration agency at airport, such as forehead thermometers, protective clothing and alcohol hand sanitizer. These goods are in high demand in Taiwan at the moment. But the supply of all the other commodities seems to be normal, so the government does not need to interfere in the market.

Gilman: Another major challenge for many countries in the West dealing with the COVID-19 outbreak has been establishing trust in the government’s decision-making process. The Taiwanese government seems to have done a good job in terms of maintaining transparency. Can you describe how?

Jiang: The government holds a press conference every day — sometimes twice. The commander of the Central Epidemic Command Center, the minister of health and welfare, outlines progress on disease control and explains to the general public the details of what kinds of cases we have today and how we are tracking every patient. So, we don’t need to panic. Generally speaking, the public is not worried about the transparency of information related to the disease control.

In addition, our doctors and hospitals are doing a great job. They cooperate with the government in investigating cases and make information as clear as possible to the public. For example, in some major newspapers, there is a doctor or expert talking about some important issue of the disease every day. Sometimes it is about how to promote your own health; sometimes it is a scientific explanation of the nature of the virus. This information helps the general public to have a better understanding of the coronavirus. In this way, the people will be less confused by rumors or fake news, which of course are popular in social media. Transparency and detailed information is vital.

Gilman: How is Taiwanese civil society reacting and contributing? What’s been the approach to information-sharing? Also, given that there will always be those who doubt and dissent from whatever decisions are being made by the authorities, how are dissenters being dealt with? How are rumors being dealt with?

Jiang: The Taiwanese legislature passed a new law, according to which the government can punish anyone who disseminates fake news about the pandemic, no matter where it appears. The police will track the source of the fake news and arrest the people who are distributing it. The penalty could be as high as $100,000 or three years in prison. After several indictments, most people realize it is not going to be fun for them to do that. Maybe in times of crisis or emergency it is necessary for an authority to secure social order with harsh measures like this.

As to some other decisions made by the government, there is indeed dispute or dissent. For instance, whether the authority should prohibit medical workers, teachers and students from travelling abroad; deny entry to Taiwanese citizens’ children who do not yet have citizenship; or collect and utilize the medical information and travel records of those who are quarantined. All these questions are highly controversial.

Many critics believe that when the government does this, there is always the risk that it may cross the line and violate individual freedom or civil rights. So there is discussion about the legality and legitimacy of some government decisions. But for the time being, dissenting voices are not yet challenging the government’s authority. Most people still entertain the idea that the government needs to do something during the emergency. So for now they are willing to accept these soft authoritarian measures in dealing with misinformation or individual freedom. Maybe after the end of the pandemic, people will come back to reflect upon what we should improve in dealing with this situation.

Gilman: Observing Taiwan at a distance, there seems to be an interesting balance between, on the one hand, a fairly open approach to gathering information from the public — allowing people to participate in giving their opinions about what should be done — and at the same time, experts are being relied on to make important decisions. In that context, how important do you think it is to the response that Vice President Chen Chien-jen is himself an epidemiologist?

Jiang: Maybe that importance is more symbolic than actual. But it still matters. Vice President Chen is a famous epidemiologist, but he will no longer be vice president after May 20. He will be replaced by a newly elected vice president, who also happens to be a doctor.

Of course, Vice President Chen has done his best to do public presentations and share information with the press. Therefore, people think that our leaders are quite aware of the situation and willing to communicate with the general public. It is always good that people have trust in the leadership.

But when I say the significance is mostly symbolic, I mean that the actual responsibility of combatting the disease lies in the hands of the minister of public health, Chen Shih-chung, who is doing a great job and commands widespread respect and trust among the Taiwanese people, and is more important than anyone else.

Gilman: Are there any specific lessons from what Taiwan is doing that you think the U.S. should learn? Are people required to put on face masks to go out on the street in Taiwan? Would you recommend that the U.S. do that?

Jiang: Face masks are required only when people enter hospital or some enclosed space, such as airplane or train. I don’t think some of Taiwan measures can be duplicated in the U.S. As you know, there is a cultural difference between the two countries.

Take the issue of face masks, for example. People in Taiwan are quite used to wearing them whenever they feel it may make them feel more comfortable, like when they feel threatened by flu. But they may also put on mask simply because they need some “face privacy” or some sense of security.

In the U.S., it is very different. Wearing a face mask is a sign that you are sick, and people are not encouraged to wear them as a preventative measure to avoid infectious disease. Even Taiwanese people (or Taiwanese students living in the United States nowadays) would not dare challenge the culture of American society. I don’t think the culture can be changed dramatically in a short period of time.

Take another example. The public health insurance systems, as well as the database that underpins it, is quite comprehensive in Taiwan. With Denmark, Taiwan is maybe one of the best countries in terms of this system. In the U.S., health insurance is extremely expensive, and the public healthcare system is fragmented. The healthcare system is critical to Taiwan’s success in combating this disease, but it cannot be duplicated in the U.S.

Another cultural difference is people’s attitude toward government. In Taiwan, a higher level of government surveillance of the general public is acceptable. But in the U.S., people cherish their individual freedom so much that I don’t think they will welcome such intervention in their private lives. For example, if a citizen with a fever is coming back to the U.S. from another country, the U.S. government cannot do what the Taiwanese government does, which is to give the citizen a cell phone so they can be located and tracked, and the police or a local officer will check if they stay home. Right now, every citizen coming back to Taiwan from abroad must self-isolate for 14 days. I guess many Americans just go visit friends or dine outside. I don’t think the U.S. government will be able to effectively force the American people to stay home as the Taiwanese government does.

That being said, I think there is still something that the U.S. can learn from Taiwan (and maybe from Singapore and South Korea as well, because they are also doing pretty well in dealing with the disease). For example, promoting the transparency of the government’s decision-making process, and encouraging people to take care of their health, such as washing hands several times a day.

Gilman: In addition to having a great health tracking service, as you mentioned, Denmark has also done something remarkable in terms of trying to support businesses that are being affected by the lockdown. In order to discourage businesses from laying off workers, the Danish government told businesses that it will pay 75% of workers’ wages, that the companies are expected to pay 25% and that workers are expected to give up five days of vacation.

This creates a kind of society-wide burden sharing: to keep people employed, keep money flowing in the system and also promote a sense of collective contribution to maintaining the stability of the economy. What is Taiwan doing in terms of trying to manage the economic implications of the coronavirus response?

Jiang: Good question. The Taiwanese government is doing something similar to Denmark, but maybe not as comprehensively. As you know, the industries that have been most seriously hit by the pandemic are the travel industry and airline companies. So the government passed a special budget of $2 billion to help the Taiwanese airline companies and travel agencies to survive. The government also announced that quarantined people will be subsidized for their loss, and small business loans will be extended.

Another major initiative is the announcement that the government will spend millions of dollars to encourage people to consume when the disease comes to an end. The government may want to distribute something like a coupon to every citizen, which they can use to purchase a wide range of commodities. The details of the initiative is still under discussion, but it is an attempt to boost the economy after the end of the coronavirus.