How Taiwan triumphed over Covid as UK faltered
Taipei’s success shows lives may have been saved had the UK government acted differently
Along central Taipei’s busy Yongkang Street crowds spill out of restaurants and bars every evening, mingling with people queueing outside popular eateries for a tiny table to cram around with groups of friends. Children out way past their bedtime run amok over the play equipment in a nearby park, shrieking and laughing as their parents chat nearby.
In London, it would be unthinkable. In the Taiwanese capital, it is just another spring evening.
Taiwan has ridden out the coronavirus pandemic mostly unscathed, while Britain has been crippled economically and in human terms. The death, disease and mental health crises sparked by lockdown have all exacted a heavy toll.
Both are islands ruled by democratic government, their large populations – more than 22 million people live in Taiwan – mostly crowded into cities, with public health systems that mean medical care is widely accessible.
At the end of 2019, both were heavily exposed to travellers carrying coronavirus: Britain because of its status as an international travel hub; Taiwan because closely woven cultural and economic ties meant hundreds of planes crossed the narrow strait to mainland China – where the virus was first detected – weekly.
A little over a year later, Britain has one of the world’s worst death rates, with more than 130,000 people lost to the virus and more than 4 million people infected. Taiwan has lost 10 people, and had just 1,000 documented cases, the vast majority of them among quarantined travellers.
The root of the difference lies in the approach their governments took.
Taiwan’s leaders, helped perhaps by having an epidemiologist as vice-president, perhaps by its experience of the outbreak of the Sars coronavirus in 2003, recognised the terrible threat posed by Covid-19, even as the earliest data trickled in. They decided the only way to protect their country, its people and economy, was to keep the virus out.
Britain, by contrast, made the catastrophic decision to treat the disease as akin to flu, aiming to limit its spread rather than stamp it out, said Jay Patel, a Covid-19 researcher at Edinburgh who studies comparative approaches to the pandemic worldwide. “Their playbook to begin with was different,” he said.
“The response plan for flu is broadly mitigation [of spread], so you try to prevent the number of cases exceeding what the healthcare capacity can handle. The Sars model [used by Taiwan] is about elimination, saying because of the casualty rate, we need to suppress this disease with a view to elimination.
“We didn’t have a Sars pandemic plan, because it didn’t seem as though that would be the next pandemic, though it seems so wrong to say that now. The western world thought the next big one would be flu and focused all their attention on that.
“The warning last February was that we will have to live with it, we can’t eliminate it. Yet even then, we could see international examples of how the virus was being eliminated.”
It is hard to compare Britain with other countries that are regarded as coronavirus success stories. China has an autocratic government able to implement sweeping and intrusive controls that would be unwanted and unfeasible in a democracy. New Zealand is a democracy, but its population is just 5 million and it is geographically remote, so the government had time to watch the pandemic unfold elsewhere before deciding how to act.
Taiwan offers a much more powerful – and bleak – comparison with the UK. Its success shows how Britain’s tragedy was never inevitable, and how lives and livelihoods might have been spared if the outbreak had been handled better by the UK government.
Taipei never needed to fall back on the UK’s most radical tool – lockdown – because it acted fast on a collection of effective policies including border controls, efficient track, trace and isolate systems, and widespread mask-wearing.
After a two-week extension of holidays last spring, Taiwanese schools have largely opened as normal (with a few localised, temporary closures after cases were identified). Restaurants, cafes, cinemas and theatres, beaches and hotels, have continued to trade.
The economy was initially damaged by the abrupt halt to a globalised way of life, but rebounded to grow 5% in the last quarter of 2020, and is forecast to expand at a similar rate this year.
The island’s success in combating the pandemic even spurred a quarter of a million Taiwanese citizens to move back to the island.
Dr Chen Chien-jen, now a professor at the Academia Sinica genomics research centre, was Taiwan’s health minister during the 2003 Sars outbreak. That was widely seen as a disaster, but may have set the island up for its extraordinary success in handling the current pandemic.
“At the beginning of this Covid-19 outbreak, I think a lot of governments had the same challenges we had during the Sars outbreak,” Chen said. “We didn’t realise that hospital infection control is so important.”
“The second thing is the border control … We closed our border as early as possible for Covid-19 … And the third thing is how to engage in communication to avoid disinformation. A lot of countries were not prepared for that, and this is really a pity. The fourth thing, I think, is the close contact tracing.”
It was perhaps the first government to appreciate the seriousness of the threat from the new disease. On 31 December 2019, when China reported cases of a mystery new illness to the World Health Organization, it immediately started screening travellers from Wuhan.
Taiwanese officials, although barred from the WHO, also tried to raise the alarm internationally over unofficial reports that the disease could be transmitted between humans, something not confirmed by Beijing for three more crucial weeks.
From 24 January, it closed its borders to travellers from China, then as Covid spread around the world it tightened controls to require two weeks’ strict hotel quarantine for all arrivals.
“Only a year later is the UK doing similar things, and still not with the same weight,” said Patel.
In mid-January, Taiwan activated the Central Epidemic Command Center that brought together government, academia, the medical system and the private sector in a unified fight.
Among its actions were rationing masks, so everyone in the country could access them, while stepping up production, and launching strong public communication campaigns about new controls and why they were necessary.
Even the intrusive data collection measures authorised temporarily for disease control, including using phone data for electronic “fencing” of people isolating after possible Covid-19 contact, have been widely accepted by the general public.
Late last year, Taiwan’s digital minister, Audrey Tang, said polling had found high privacy concerns among 9% of the population, leading to improved information campaigns, which reduced that figure to 6%.
It all comes down to government clarity and transparency, said Chen. “You have to let the people know what the government is trying to do.”
But while the lived experience of Sars gave an urgency to Taiwan’s planning, the conclusions drawn were researched and published extensively.
There was nothing stopping the British government, or others, from learning from them in the intervening years. But perhaps because of British exceptionalism, perhaps because other coronavirus epidemics – Sars, Mers – had been contained far from Europe, the UK chose to follow its own deadly path instead.