The Next Turn For Taiwan’s Race Towards Vaccination

Facing anxiety and apprehension, Taiwan attempts to regain footing as it steers towards strengthening its vaccination campaign.

Brian Chee-Shing Hioe October 4 2021

Before an outbreak that began in May, Taiwan was hailed as having one of the world’s most successful COVID-19 responses. For over a year, Taiwan did not see a single lockdown. The suppression of the coronavirus was due to a number of factors, including the quick closure of borders, near-universal mask-wearing, and the use of alcohol sanitizer and temperature checks at restaurants, businesses, and public transportation.

The government intervened and worked with private industries to boost the production of medical masks, hand sanitizers, PPE, and other medical supplies used to prevent the spread. The Central Epidemic Command Center (CECC), which coordinates Taiwan’s COVID-19 response, held daily press conferences to keep the public updated on breaking developments, offering a centralized source of accurate, up-to-date information. Text messages were sent out nationally to individuals thought to have crossed paths with positive cases.

A fourteen-day quarantine was instituted for inbound travelers, though most non-Taiwanese citizens were prevented from returning to Taiwan. Taiwan was able to maintain close to zero cases due to the coronavirus primarily being stopped at the border, despite Taiwan’s close proximity to China, the origin of the outbreak, and frequent travel between the two places.

This led Taiwan to be termed the “gold standard” in COVID-19 prevention by international outlets such as The Telegraph. Likewise, global rankings generally placed Taiwan only behind New Zealand in evaluating comparative normalcy. Bars, nightclubs, music venues, and other establishments carried on, as did sporting events. During the pandemic’s first year, Taiwan was the only place in the world where baseball games were still taking place. All this occurred during a period where many worldwide were forced to stay indoors for months at a time.

Due to its lack of global recognition, Taiwanese society often perceives itself as marginal and internationally isolated. But Taiwan’s success in 2020 led to a reversal of this verdict, coming out on top in its ability to fend off the virus. Taiwan seemed to be #1, for once.

The Tsai administration, which leans in the direction of advocacy for independence, took advantage of Taiwan’s moment in the sun to advance its international profile, and donated surplus medical masks and PPE to countries that were facing shortages, with an eye on shoring up diplomatic goodwill. The Tsai administration touted Taiwan’s success as potentially offering guidelines for other countries that had still yet to contain the outbreak.

But pride comes before a fall, perhaps. Or rather, this rare moment of national pride quickly reversed course once coronavirus cases began to rapidly swell, as daily cases jumped from single digits to the hundreds on May 15th, 2021, seemingly overnight.

All too quickly, opposition politicians and media pundits began lambasting Taiwan as having had one of the world’s weakest pandemic campaigns. Criticism pointed to the high death rate and Taiwan’s slow vaccination rollout, with frequent standards of reference comparing Taiwan to the United States in terms of crisis management. At a time in which Taiwan was struggling to get its outbreak under control, due to its plodding domestic vaccination push, the U.S. seemed to be on the verge of reopening. As a comparative, then, it seemed that despite COVID-19 running rampant in the U.S. early on, they had been more effective and done better than Taiwan in the long run.

The situation again reversed course, with Taiwan eventually achieving single-digit cases by 100 days in. Taiwan reported zero daily cases for the first time on the 101st day of the outbreak, August 25th. By then, the U.S. was being ravaged by the Delta variant.

Taiwan succumbed to an outbreak due to the spread of newer, more infectious variants, such as the Alpha variant, but in this sense Taiwan was lucky. When the outbreak took place in Taiwan in May, the Delta variant had not yet begun to spread globally. And although there have been several erroneous international reports about Taiwan overcoming the Delta variant, this was not truly the case until in September, when the variant entered a large urban area for the first time. A week later, after a cluster infection that started in a kindergarten in Banqiao, New Taipei, cases were back down to zero digits, with the cluster peaking at just over thirty cases.

There have only been two other significant domestic Delta clusters in Taiwan to date. The first occurred in the Pingtung county, due to individuals who were in home quarantine, nonetheless managing to spread COVID-19 to their neighbors. The Pingtung cluster only ever grew to a dozen individuals. Another case of Delta transmission in Taoyuan, between a pilot, his son, and several co-workers did not spread to others.

As quarantine measures for inbound travelers were never fully removed, they were strengthened again to prevent the Delta variant from entering Taiwan after these cluster infections. Inbound travelers are no longer allowed to quarantine at home, but only in government-run facilities, and with authorized taxis to these facilities. Though the Delta variant finally entered Taiwan in early September, the situation is currently stabilized.

Parallels have been drawn between Taiwan and Singapore, given the status of both as mid-size populated Asian countries. After clusters broke out among migrant workers in electronics factories in Miaoli, comparisons were made with Singapore’s response among low-paid migrant workers living in crowded dormitories. Similar to Vietnam and Singapore, Taiwan initially experienced success battling the coronavirus, but encountered greater difficulties with more infectious variants. Within domestic political discourse, there was little comparative discussion between Taiwan and other Asia-Pacific countries, but the media’s comparative focus between Taiwan and Western countries such as the U.S. or U.K. remained quite visible.

Yet Singapore’s vaccination rate is much higher than that of Taiwan, with 82% of its population fully vaccinated. Israel is also noted as another example of a smaller country that has achieved a high vaccination rate, with 61.5% of its population fully vaccinated.

Vaccination has sluggishly lagged for Taiwan, with only 13.14% of the population fully vaccinated and 57.5% of the population with at least one dose of vaccine as of press time.

Comparing Taiwan’s population of 23 million and Australia’s population of 25 million, Australia has managed to vaccinate 66% of its population, of which 46% are fully vaccinated. Australia is, in part, aided by the fact that it has secured the rights to domestically manufacture AstraZeneca vaccines, even if this has seen slower production than hoped for. Taiwan does not have the right to manufacture any internationally developed vaccines domestically though there have been efforts to secure this. The first vaccine available in Taiwan was the AstraZeneca vaccine, but the Taiwanese public was initially hesitant due to reports of sudden deaths after vaccination.

Even then, Taiwan originally had just over 300,000 doses of AstraZeneca vaccines, from shipments in March and April. Even if the public had been willing to be vaccinated, this would not be enough to cover Taiwan’s population of 23 million. Although the Tsai administration was accused of having neglected to see the need to buy vaccines, they placed vaccine orders in October of last year, and these orders were riddled with significant delays. The COVAX platform has also, across the board, failed to live up to promises to deliver vaccines internationally.

Over half of the doses that Taiwan has used to vaccinate its population are donations by the U.S., Japan, and European Union countries that were likely hoping to build stronger ties with Taiwan. The U.S. seized the opportunity to signal its support of Taiwan through donating 2.5 million doses, as announced in a high-profile diplomatic visit, with credit given to Taiwan’s preceding “mask diplomacy” as having led to this “vaccine diplomacy”.

The opposition KMT has criticized the Tsai administration as a “vaccine beggar” in this. Again, Taiwan is not the only country to experience delays with shipments, but there were few comparisons between Taiwan and other countries that have, similarly, experienced significant delays — it was more common to compare Taiwan to the U.S., as though the situation in the U.S. conveyed normalcy across the world and Taiwan was the exception, rather than vice-versa. Countries that are not large and without the capacity to mass-produce domestic vaccines have generally experienced delays with shipments, even when orders were placed far in advance. Likewise, large and powerful countries, such as the U.S. and those within the European Union, have generally built up stores of vaccines domestically rather than export to other countries. While the exception to this is China, Taiwan’s geopolitical contention with China prompts much public distrust and a refusal to accept Chinese vaccines.

Indeed, Taiwan never faced any question of its capacity to vaccinate — at the high point of vaccination, Taiwan could vaccinate over 290,000 individuals in a single day. In theory, at this pace, Taiwan could vaccinate its entire population with one dose in less than one hundred days, if only it had enough vaccines.

Given these issues, Taiwan was pressured into an early rollout of domestically developed vaccine Medigen, as part of a push toward self-reliance. This was not without controversy, as Medigen skipped Phase 3 trials as part of a process known as immuno-bridging — the first time in the world that this was done. Still, more than one million individuals have indicated willingness to be vaccinated with Medigen. Likewise, Taiwan took the unusual step of authorizing FoxConn chair Terry Gou’s Yonglin Foundation, semiconductor manufacturing giant TSMC, and humanistic Buddhist organization Tzu Chi to negotiate purchases of BioNTech on its behalf. This was likely done by the government in order to respond to calls on the Tsai administration to allow non-state groups to purchase vaccines, with the view that they could perhaps be more effective than the Tsai administration.

What has proven remarkable is that the initial outbreak was quashed primarily without vaccines and without resorting to forced lockdowns. Although there were calls from pan-Blue politicians to escalate to a full Level Four alert, with a full lockdown, the Tsai administration refrained in order to minimize economic fallout. Case numbers went down through simple voluntary compliance, with restrictions of indoor gatherings of over five and outdoor gatherings of over ten. Similarly, contact tracing was rolled out using a QR code location registration system, requiring individuals to text a government hotline when they entered any establishment.

At one point, Taiwan had the lowest Rt value in Asia, referring to the effective reproduction number for COVID-19. Interestingly enough, the CECC did not explicitly aim for zero cases, with the expectation that cases might remain in the single-digits and be managed with sufficient contact tracing.

Currently, the CECC is currently aiming to vaccinate as much of the population as possible before relaxing measures, with plans to open up more establishments once Taiwan reaches 60% vaccination. To this extent, local governments supported by the KMT have sought to upstage the CECC regarding its measures by declining to relax them despite new announcements by the CECC. This was particularly the case with Taiwan’s two major metropoles, Taipei and New Taipei, whose regional mayors may harbor ambitions for future national presidential runs.

This differs from other political contexts, in which local governments sought to ease measures as quickly as possible, resulting in an explosion of cases. It is unknown when Taiwan will have enough supply to vaccinate the population. Endemicity seems the likely scenario for COVID-19 internationally and the higher infectiousness of the Delta variant means it is unlikely that Taiwan or any other country will reach the sufficient rates of vaccination to achieve herd immunity. Recently, there has been talk of the need to “get used to co-existing with COVID” from Taipei mayor Ko Wen-je, but such proposals are likely to be politically unpopular. In the interim, until vaccination is at levels that can allow for the relaxation of measures, an elimination approach is likely to be favored, with the public hoping to return to their pre-COVID lifestyle as quickly as possible.

Brian Chee-Shing Hioe (@brianhioe) is one of the founding editors of New Bloom Magazine and a freelance journalist and translator based in Taipei.