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Taiwan’s COVID-19 and Pandemic Experience: What are the Lessons for Canada?

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Image credit: Reuters/Ann Wang

POLICY PERSPECTIVE

by Heidi Tworek
CGAI Fellow
April 2021

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Taiwan’s COVID-19 and Pandemic Experience: What are the Lessons for Canada?

British Columbia recorded over 1,000 cases of COVID-19 on March 31, 2021. Taiwan has recorded that many cases in total. Only 10 people have passed away from the disease in Taiwan. These numbers seem impossible, an exception that only islands like New Zealand or Taiwan could possibly achieve. Nothing could be further from the truth. Taiwan shows how to learn lessons from previous failures and ensure that when the next pandemic comes, Canada is ready.

Taiwan officially contacted the World Health Organization (WHO) on December 31, 2019 to note concerns around human-to-human transmission of the novel coronavirus. Unlike most other governments around the world, Taiwanese officials acted swiftly in early January. By mid-January, COVID-19 was listed as a category 5 communicable disease under the Communicable Disease Control Act: it was deemed an emerging contagious disease that required mandatory quarantines and reporting. After this legal categorization, Taiwan created the Central Epidemic Command Centre (CECC) on January 20 to run the country’s all-of-society response and to co-ordinate between ministries. Further actions followed swiftly, including banning all visits from China, rationing masks, ramping up production of personal protective equipment (PPE) and lengthening schools’ winter break. By February 26, however, schools had reopened and never had to close again due to COVID-19. In late February, the Taiwanese Public Opinion Foundation reported that 85.6 per cent of respondents felt “fairly” or “very” confident that President Tsai Ing-wen’s government could control the virus. Their confidence was well placed. Despite small outbreaks over the next few months, most restrictions on gatherings were lifted in May and June 2020. From April to December 2020, Taiwan went 255 days without a locally transmitted COVID-19 case.

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Taiwan’s effective response to COVID-19 was not inevitable. Actually, it stands in stark contrast to the jurisdiction’s poor handling of the first SARS crisis in 2002-2003. Taiwan’s success was not simple, but built upon deep-seated reforms enacted after many missteps during the SARS crisis, when 73 people died. At that time, multiple government ministries had overlapping competencies which exacerbated confusion and inaction. After the crisis ended, Taiwan dramatically revised its epidemic response mechanisms to streamline processes and ensure a more rapid mobilization during the next pandemic.

One central insight was the crucial importance of communications as a non-pharmaceutical intervention. This may sound simple, but too many jurisdictions have communicated so poorly around public health guidelines that confusion has abounded alongside fear, anger, anxiety and resentment. By contrast, Taiwan has exemplified the importance of clear, consistent and compassionate communications to meet people where they are. Taiwan’s communications prowess stems from multiple interlocking approaches to communication, all of which Canada could emulate at the municipal, provincial and federal levels. Here are six lessons for Canada from Taiwan’s approach.

First, transparency ensured trust and eased anxiety during the initial stages of the COVID-19 response. This included details of cases and giving a clear sense of contact tracing. It also meant using digital maps to prevent rushes on supplies. During the first months of the crisis, Taiwan experienced mask shortages, like everywhere else. While domestic companies were ramping up production, the available masks were distributed through pharmacies. Taiwan’s digital minister, Audrey Tang, created an interactive digital map that displayed the number of masks available at each pharmacy in real time. This helped people to know where they might queue to purchase masks and which pharmacy had already sold out for the day. Such transparency created high levels of trust in government efforts. Possibly even more important, officials maintained that trust by admitting and learning from their mistakes. Tang found many issues with the maps because of how pharmacies reported their mask numbers, and adapted the maps accordingly. Tang visited pharmacies and swiftly implemented feedback from Taiwanese residents to make the maps as useful as possible. Mistakes were not denied, but seen as a chance to be responsive and improve transparency.

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Second, Taiwan adopted a communications strategy of humour over rumour to underpin all its messaging. Some posters and ads used the Taiwanese spokesdog, the shiba inu, to inform people of how far to keep apart. (It’s three shiba inus, for anyone who is curious). When there were fears of a toilet paper shortage, Taiwanese premier Su Tseng-chang quickly uploaded a caricature of him shaking his butt alongside an infographic. This debunked the rumour of a shortage, while engaging in wordplay around the Mandarin words for “butt” and “stockpile”.

Third, Taiwan used what we might call a positive “flood the zone” approach. The strategy did not seek to delete low-quality material as a way to address what the WHO has called the “infodemic” of incorrect information. Instead, Taiwanese officials worked hard to ensure that high-quality information was easily available and plentiful. CECC worked with the National Communications Commission to produce materials to reach people on as many platforms as possible, including Line (a popular messaging app), YouTube, Instagram, Facebook, TV, radio and texting. Materials included memes and even downloadable stickers of the health minister.

Fourth, Taiwan did not implement a one-way communication strategy, but included multiple avenues for people to ask questions. Taiwan’s Centers for Disease Control (CDC) has answered individual concerns on Facebook, Line and a telephone hotline (the 1922 hotline). The CDC’s official Line account also offered a Q&A service. By May 2020, over 2.2 million people had subscribed to the account. Taiwan also used a mass texting system known as the Public Warning Cell Broadcast Service to share important information around issues like quarantine. Taiwan’s institutions leveraged their capacity to create messages on as many channels as residents were using as well as to find creative ways to alleviate individual anxieties.

Fifth, officials paid close attention to preventing stigmatization. After the mask shortage had eased, the government mailed masks to every household. As masks were still rationed, there was no choice of colours. When some male pupils complained in April that they had been bullied for wearing pink masks to school, Taiwanese public health officials and the health minister, Chen Shih-chung, all showed up at their daily press conference the next day wearing pink masks. The Taiwanese Ministry of Foreign Affairs tweeted afterwards: “The big takeaway: No color is exclusive for girls or boys. #GenderEquality lies at the heart of #Taiwan values.”

Sixth, all these communications efforts require institutional capacity and support. With a team, I examined nine jurisdictions’ COVID-19 communications during the first six months of the pandemic. We found that countries like South Korea and Taiwan had not only prioritized communications, but also invested money and institutional support to back up that priority. The Taiwanese government also spent over US$7 million to boost cellular and internet infrastructure for rural areas, particularly around remote quarantine stations. This enabled more citizens to access vital services and information.

These efforts have paid off for the government and have become part of their diplomacy abroad to highlight a democratic approach to the virus. Implicitly, at least, Taiwan has contrasted its approach with the Chinese strategy of strict lockdowns. In June 2020, Tsai said that Taiwan could “control the spread of the virus without sacrificing our most important democratic principles.” The #TaiwanCanHelp campaign has highlighted Taiwan’s ability to address COVID-19. The campaign included a crowd-financed full-page advert in the New York Times on April 14, stating: “WHO can help? Taiwan. In a time of isolation, we choose solidarity. You are not alone. Taiwan is with you.” Tsai has used the hashtag herself while tweeting about Taiwan’s response to COVID-19. Taiwan engaged in mask diplomacy by donating masks around the world. The government has also worked with the National Taiwan University to translate guidelines and policies into English. Taiwan’s success in responding to COVID-19 even inspired a visit in August 2020 from then-U.S. health secretary Alex Azar, which led to the first memorandum of understanding on health co-operation between the U.S. and Taiwan. Azar’s visit was the highest level visit by an American cabinet official since 1979. The effective response to COVID has raised Taiwan’s profile, even though the jurisdiction is currently excluded from the WHO.

A defeatist attitude around COVID-19 cases and casualties is problematic for many reasons. First, geography is not destiny. Other islands like Great Britain have not fared as well. Second, Taiwan’s successes can be credited to effective policy which other jurisdictions can adapt to their own circumstances. Clear communications do not happen by magic, but require institutional structures and the capacity to execute well. Third, Taiwan offers a democratic approach to containing a pandemic, showing how rapid, multi-pronged policies can prevent lockdowns as well as the economic and social harms arising from many restrictions that have become necessary elsewhere. Finally, Taiwan’s approach to communications offers a useful example of how to counter poor quality information through a strategy of effective outreach.

Overall, Taiwan demonstrates the importance of rapidity, whether in communications, PPE manufacture or testing. Canada launched some programs like the Canada Emergency Response Benefit (CERB) in March with impressive speed. But how many such programs would have been necessary, if the machinery of government had moved faster in January and February? Given the U.S.-Canadian border and devastating circulation of COVID in the U.S., it would be unrealistic to expect that Canada could have completely emulated Taiwan. But a far better outcome was possible.

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About the Author

Dr. Heidi Tworek is associate professor of international history and public policy at the University of British Columbia, Vancouver, Canada. Her work examines the history and policy around media, hate speech, health communications, international organizations, and platform governance. She is a member of the Science and Technology Studies program, the Language Science Initiative, and the Institute for European Studies at UBC. She is a senior fellow at the Centre for International Governance Innovation as well as a non-resident fellow at the German Marshall Fund of the United States and the Canadian Global Affairs Institute. 

Heidi's prize-winning book, News from Germany: The Competition to Control World Communications, 1900-1945, was published in 2019 by Harvard University Press. Alongside two co-edited volumes, Heidi has published or has forthcoming over 35 book chapters and journal articles on media and communications, German and transatlantic politics, the digital economy, the history of technology, legal history, digital history, and the history of health. She is currently working on several projects, including a history of health communications and an edited volume on the interwar world.

Heidi is committed to bringing a historical sensibility to policy discussions. She regularly writes policy briefs on topics including Covid-19 communications, online harassment of politicians, and platform governance. She has briefed or advised officials and policymakers from governments around the world on media, democracy, and the digital economy. She has also served on the steering committee for multiple transatlantic and international working groups on transatlantic relations, freedom of expression, and global platform governance. 

Her writing has been published in English and German in major magazines and newspapers, including Foreign Affairs, Washington Post, The Atlantic, Politico, Globe & Mail, Columbia Journalism Review, War on the Rocks, Wired, Nieman Journalism Lab, Frankfurter Allgemeine Zeitung, Süddeutsche Zeitung, Der Tagesspiegel, ZEIT, Internationale Politik, and The Conversation. Her work has been featured in publications such as the New York Times, Financial Times, CNN, STAT News, Globe & Mail, and many others. Heidi also appears regularly on national radio and television in the United States, Canada, the United Kingdom, and Germany. 

She received her BA (Hons) in Modern and Medieval Languages with a double first from Cambridge University and earned her MA and PhD in History from Harvard University. Her PhD received the Herman E. Krooss Prize for best dissertation in business history. Heidi has held visiting fellowships at the Transatlantic Academy in Washington DC, Birkbeck, University of London and the Centre for Contemporary History, Potsdam, Germany. She has also taught as a guest lecturer at Freie Universität, Berlin and Göttingen University. She is a term member of the Council on Foreign Relations. 

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