CSR Blog: Quiet Storm: Taiwan’s COVID-19 Outbreak, Mapping the Pandemic in a Democracy

By Nicholas A. Henderson

In late 2019, when news broke of a novel coronavirus spreading in Wuhan, China, Taiwan’s government deployed their rapid response plan. Taiwan, an island of 24 million people, had learned from the SARS epidemic of 2003 and wasted no time in becoming the first to employ mobile phones for tracking infected individuals using geofencing technology. The island required all visitors to quarantine upon entry and ultimately was successful in limiting their exposure to COVID-19; from April to December, Taiwan held a 255-day record without a single locally transmitted case. In January, Taiwan reported 893 cases in total, a full year removed from the outbreak in Wuhan. 

Figure 1: Epidemic Alert Level Criteria

Despite avoiding COVID-19 for most of 2020, on April 20th, 2021, Taiwan’s Central Epidemic Command Center (CECC) “confirmed the infections of 10 pilots working for the Taiwan based international carrier China Airlines.” One month later, on May 10th, 55 cases linked to the China Airlines outbreak were reported in Taiwan. 

The steady increase in case counts led to the central government ratcheting up the coronavirus alert level. As depicted in Figure 1, the spread of COVID-19 directly correlates to the level of alert. Each level denotes increased restrictions on the citizenry, at which time the government of Taiwan reassesses its COVID-19 pandemic response. 

Beginning in early May, the alert level increased first in New Taipei City, then in the capital city of Taipei. Eventually, Taiwan raised the level in New Taipei City and Taipei to level three for the first time in the history of the pandemic on May 15th, subsequently declared nationwide by May 19th. 

Figure 2: Taiwan’s Four COVID-19 Alert Levels and How They Affect Citizens

The Response

Taiwan’s four alert levels prepared by the CECC, shown above in mandarin, enact the following protections:

Level 1: Imported cases resulting in isolated community transmission.

• Masks must be worn at all times on public transportation and in crowded public venues.
• The CECC recommends the cancellation or postponement of non-essential gatherings that will bring people into close contact with others.
• Places of business and public venues must implement an identification-based registration system, social distancing, temperature checks, and routine disinfection.

Level 2: Domestically transmitted cases from unknown sources.

• Fines imposed for failure to follow mask guidelines.
• Cancellation of outdoor gatherings of 500+ people and indoor gatherings of 100+ people.
• Public gatherings must implement social distancing, mask-wearing/partitions, an identification-based registration system, temperature checks, crowd controls, and routine disinfection or be canceled.
• Places of business must impose crowd controls; those unable to implement necessary epidemic prevention measures should temporarily suspend operations.
• When necessary, the CECC may order the closure of entertainment or leisure-related businesses or public venues.

Level 3: Three community clusters within a week (or) ten domestically transmitted cases from unknown sources in one day.

• Masks must be worn at all times outdoors.
• Cancellation of outdoor gatherings of 10+ people and indoor gatherings of 5+ people.
• Apart from essential services, law enforcement, medical treatment, and government, all places of business and public venues must close.
• At places of business or public venues that remain open, mask-wearing and social distancing is required.
• In neighborhoods where community transmission has occurred, residents must stay within defined a perimeter and comply with COVID-19 testing. All public gatherings and school classes within the neighborhoods are suspended.

Level 4: Sharp increase in domestic cases (a daily average of 100+ cases over the last 14 days) with at least half transmitted from unknown sources.

• Leave home only for essential activities (to purchase food, receive medical treatment, or for essential work); observe social distancing and wear a mask at all times outdoors.
• When at home, wear a mask (or) maintain social distancing.
• All public events canceled: Apart from essential services, law enforcement, medical and government services, all in-person work and school are suspended.
• Lockdown imposed in townships, counties, or cities where the outbreak is severe. Only designated personnel may enter/exit the lockdown area; residents must remain in their homes.

*Level of alert may be adjusted at the discretion of the CECC

The Question

From my own observations as an American currently living in Taipei, Taiwan’s response to the latest outbreak of COVID-19 moved far more quickly and in a more organized fashion than the pandemic response I had experienced in the United States. On May 12th, Taiwan reported 16 more cases and remained at a level 2 alert. However, by Friday afternoon, businesses around Taipei were closing, followed by the announcement on Saturday the 15th that Taipei would enter into the level 3 alert. The Taiwanese government’s response was clearly communicated and remarkably efficient.  

It is worth noting that, in addition to the government’s quick response, the people of Taiwan are already accustomed to wearing masks when an illness can be passed from one person to another. The citizens of Taiwan also tend to adhere to government mandates on mask-wearing and are willing to quarantine in order to protect the public. Further still, Taiwan’s culture is also very similar to that of China, in so far as 面子 (mianzi), also known as “ (saving) face,” or the importance of maintaining social standing, which leads people to actively avoid the public shame that comes from spreading COVID-19 throughout the community. I would argue based on my own experience living in Shanghai and Taipei that this social phenomenon is even stronger here on this island Taiwan, therefore, has a distinct advantage in the public’s willingness to adhere to pandemic restrictions in comparison to other democracies such as the US. To put it bluntly, people in the United States receive stares from strangers for wearing masks, while in Taipei it is the other way around: to avoid stares; “mask up.” 

Yet, the question remains: is Taiwan’s COVID-19 outbreak response working? Unlike China, Taiwan is a democracy, and its government faces a different kind of scrutiny from the electorate. Furthermore, the threshold for how much of these restrictions the Taiwanese people can handle is as of yet, undetermined. National unity has been and will be tested. 

Furthermore, if Taiwan’s pandemic response is working, how much longer should the citizens of Taiwan expect to be held on high alert? Should the government consider policy changes to prevent further adverse effects on the population because of the lockdown? To answer these questions, we must first assess the seven-day average spread, and whether the data suggests the virus is being contained. 

Data

Despite local concern over the number of cases per day, Taiwan’s containment strategy is showing fruitful results in the 7-day-rolling average of infection. This is the reason why, at present, Taiwan’s government has not heightened to a level 4 alert, which would strictly limit freedom of movement, and be largely unpopular.  

Figure 3 shows Taiwan’s daily case count from May 10th to May 31st, followed by the 7-day average, and the rate of the 7-day average. 

Figure 3: Taiwan’s Case Count Data Set

Let it be known there are still backlogs of tests that could add to the total case counts – these are the latest numbers as of the writing of this piece. All numbers are sourced from the Taiwanese CDC and are updated as new numbers emerge. The reason for selecting a rolling average is it identifies the long-term trends; a 7-day average was chosen because it smooths out any variation in the data. The R-squared for this data set is 82 percent, which is statistically significant. 

Taiwan’s government is constantly re-evaluating the situation. Figure 4 is a seven-day rolling average of the infection rate by date since the beginning of the level 1 alert. These numbers show a spike in cases of COVID-19, initially growing at a rate of double-digit percentages (see Figure 3). However, after level 3 soft-lockdown procedures were implemented, the rate of transmission began to slow. The first day of a clear negative rate of transmission was May 24th, 14 days after the introduction of initial COVID-19 pandemic protections.

Figure 4: 7-day Average Rate of Infection Compared to the Date

As Figure 4 shows, May 30th marked three consecutive days of record negative case counts, reversing the exponential increase seen in the initial seven days from May 16th to May 23rd. The negative trend then continued from the 30th to the first of June, marking 5 consecutive days of decline. From this data, it’s safe to say that due to targeted testing, tracing, and the participation of the Taiwanese people, the spread of the virus is indeed slowing. 

Figure 5: Rate of the 7-Day Average of Infection vs. the Date

A clearer depiction of the data shows the rolling seven-day average of the spread slowing even further (Figure 5). As stated earlier, on May 23rd, the spread of COVID-19 took a precipitous drop, 14 days after the first reported cases that raised the COVID-19 alert in Taiwan to level 1. After the proper containment procedures went into effect, the community spread of the virus was crippled. Showing the most promising numbers yet, May 30th marked only 328 new cases, down from the perceived peak of 533 on May 17th, and most recently June 1st showed 262 new cases, the lowest infection number since the peak. 

So, what does this mean? The data indicates that Taiwan’s pandemic response is working, and despite the panic buying in the grocery stores sparked by cities gaming out what a level 4 lockdown might look like (making it more difficult for me to purchase passionfruit), Taiwan will most likely not enter a level 4 lockdown. It also means that the Taiwanese government’s investment in its own people, its active fight against disinformation, and its effort to contextualize policy to engage the public have all, for the most part, paid off.  

Boasting a track record of success controlling COVID-19, and a history of an active effort to unite its citizenry, Taiwan has entered this latest outbreak with a high degree of public confidence. Taiwan’s policies, renewed faith in the government, and a cultural belief in protecting the greater society as a whole knocked the infection rate down from a spread rate of +46.2 percent to its current rate of -8.26 percent.

The data is further bolstered by the Mayor of Taipei, Ko Wen-je (柯文哲), who stated at a press conference on May 30th that there was “no need for a full lockdown at this stage, as the number of confirmed domestic COVID-19 cases in Taiwan has started to fall because people have been voluntarily staying at home and adhering to the government’s epidemic prevention regulations under a soft lockdown over the past two weeks.”

Policy Suggestions

First, Taiwan Should Consider Further Expansionary Monetary Policy.

Taiwan should consider continued support for local businesses with expansionary monetary policy to offset the impact of the mandatory shuttering of businesses. If there is a lesson to be learned from the US COVID-19 response, it is that the economy benefits positively from tax breaks and stimulus during a severe economic downturn induced by a pandemic.

Taiwan is actively applying those lessons and passed a relief package on May 28th. However, the current aid package will not be sufficient if quarantine is extended past June 14th. Despite favorable terms on the current loans to small businesses, my own conversation with business owners has shown that they are not confident in a full economic recovery in 6 months, leading to concern over whether the loans could be paid back at the end of the lending period. Further expansionary policy could lead business owners to believe that the economy would rebound, and strengthen consumer confidence in taking government loans. 

Despite furvent efforts from the CECC and the  efficiency of the central government, vaccine rollout has been slower than expected. Health and Welfare Minister Chen Shih-Chung (陳時中) stated on Saturday May 29th, “by late October, 60 percent of Taiwan’s more than 23 million inhabitants could have received their first jab against COVID-19.” He added that the number of vaccination centers will double by August. If the pandemic alert continues at level 3, or consumer behavior is stunted due to the risk of infection from COVID-19, the government must act to assist business owners, either by encouraging consumers to spend and partake in the economy, or through stimulus packages in the event of a longer soft-lockdown period. 

Second, Taiwan and the US Must Combat the Narrative from China.

Taiwan must continue to fight China’s disinformation and sharp power campaigns, as it relates to this latest outbreak. Sharp power, being Beijing’s gateway to “woo or coerce Taiwan into accepting its terms of capitulation without the use of force.” President Tsai Ing-wen (蔡英文) on May 26th stated,“Taiwan and Germany’s BioNTech were on the verge of signing a contract to purchase the vaccines, but due to interference from China, negotiations have been delayed to the present.” Despite short-sighted articles calling for Taiwan to accept vaccine aid from China and choose between the “virus or politics”  in the form of the  Sinovac vaccine, or by purchasing AstraZeneca or Moderna from a third party with the manufacturer’s guarantee. Taiwan’s President is clear-eyed, stating that:“ The purchase of vaccines must first, be coordinated by the central government, in conjunction with its overall epidemic prevention strategy, to ensure the smooth and fair distribution of the shots.” Tsai insisted on negotiating directly with the original manufacturer, in order to  “obtain the original manufacturer’s direct guarantee and responsibility for quality and safety so as to avoid legal and political risks.”

For the US and the Democratic Progressive Party (DPP), it is a question of timing. As stated earlier, vaccine rollout has been slow. In order to receive enough vaccinations to immunize the population quickly, Taiwan will need external support. While the process of vaccine distribution is delayed further by the mainland, this lends Chinese state media like the Global Times the opportunity to twist the narrative, shifting the blame for Taiwan’s vaccine shortage away from Beijing to DC.

Third, Garner More International Support.

On May 28th, Taiwan’s representative to the US Hsiao Bi-khim (蕭美琴) raised the issue of vaccine availability in a “meeting with US State Department Global COVID-19 Coordinator Gayle Smith and Jonathan Fritz, the Deputy Assistant Secretary for China, Mongolia, and Taiwan.”

According to her office, Representative Hsiao “expressed the urgent need for the US to support Taiwan’s access to safe and effective vaccines.”

The next day, May 29th, Taiwanese-American, Democratic Congressman Ted Lieu respectfully requested “that the US provide Taiwan with the AstraZeneca COVID-19 vaccine as soon as possible, describing Taiwan as an ‘important ally’ of the US.” Congressman Lieu is correct; more can be done on the part of the US to support its strategic ally. Furthermore, the US must do more to secure the vaccine supply chain for Taiwan to combat this latest outbreak and oppose the narrative by China that Taiwan needs assistance from the mainland in order to contain this latest outbreak. 

On the same day as Ted Lieu’s speech, Japan entered into talks with AstraZeneca, arranging to send Taiwan more vaccines. Japan is attempting to make changes to the “no transfer” clause in its contract with the vaccine company in order to move vaccines to Taiwan, even as it is currently attempting to control its own outbreak of COVID-19.

Although the US has voiced its support for Taiwan to receive the necessary vaccines, as of the writing of this piece, there has been no concrete action to counter China’s obstruction of Taiwan’s access to vaccinations. This cannot continue. There must be a change in DC as to how this issue is viewed. Congress should be united in standing with Taiwan against China’s influence. Further delay only adds to China’s warped narrative. This adds one more bullet in China’s bandolier, bolstering what Chip Gregson, Stephen Young, and Global Taiwan Institute Director Russell Hsiao call China’s “sharp power capacity,” which is capable of undermining Taiwan’s Central Government. 

Conclusion

The COVID-19 pandemic is under control in Taiwan – for now. So to answer the first question, yes, it looks as if Taiwan’s response is working. However, that does not excuse the US from its security obligation to Taiwan in providing the necessary vaccines it needs to become safe again. Taiwan is a democracy, aligned with US ideology and morals; however, the US democratic system is reactive in nature, whereas Taiwan’s democratic system is far more proactive in pandemic preparedness. Washington will have miscalculated if it expects the Taiwanese people to be patient while China launches misinformation attacks at Taiwan. The US must act, and soon. 

As a solution, the US, and especially US AID should either actively consider lending Taiwan higher importance in vaccine distribution, or counter China’s pressure on Germany’s BioNTech to allow Taiwan to purchase vaccines, given the active sharp power risk Taipei faces from Beijing. Washington cannot afford to allow China to turn their vaccine into a suitable “carrot” for the Taiwanese public, in the absence of US support. In essence, there is currently a vaccine power vacuum in Taiwan that must be filled by friendly forces to maintain the alliance. Although a failure to deliver vaccines will not destroy the US-Taiwan partnership, the Taiwanese people will not forget it if the US fails to come to their aid. Nightly news shows in Taipei are already calling out the US for their unwillingness to expedite vaccine shipments; it is imperative for the US to dismantle this narrative. So far, the Biden administration has “surprised” the people of Taiwan by not being soft on China; Mr. Biden should put his words to practice. To answer the second question, the people of Taiwan should expect to be on high alert until at least June 14th, the stated day that the CECC and central government will re-evaluate the alert level. However, if the level 3 alert lasts longer than two weeks, the Central Government must approve further economic stimulus, similar to US Paycheck Protection Program loans (PPP Loans), or low-interest private loans 2.5 times the applicants average payroll cost. These loans helped offset economic loss, prevent businesses from failing, and provided owners direct incentives to keep employees on their payroll. The spread is slowing, and the government’s plan is working, but the strength of the people of Taiwan is currently on display. Frankly, after a year in the US, it’s impressive for an American in Taipei to witness. I will continue doing my part to slow the spread. 

共同努力，共同進步，臺灣加油!

(Gòngtóng nǔlì, gòngtóng jìnbù, Táiwān jiāyóu) 

Work together to make progress together, let’s go Taiwan!

Nicholas A. Henderson is a Master’s candidate and Boren Fellow at the Johns Hopkins School of Advanced International Studies (SAIS) in Washington, D.C., where he studies International Economics in Mandarin Chinese. Nick currently lives in Taipei, Taiwan where he is finishing his thesis on supply chains and the Taiwanese semiconductor market. Nick can be reached at nahenderson@protonmail.com.