Taiwan’s Model for Combating COVID-19: A Small Island with Big Data

This article is part of the series on “COVID-19 in the Middle East and Asia: Impacts and Responses”. Read more ...

As the global number of confirmed COVID-19 cases surpasses 30 million, Taiwan has been one of the few success stories of containing the novel coronavirus. The island democracy with a population of 23 million has fewer than 600 confirmed cases and just 7 deaths since the beginning of the pandemic.[1] Many of the confirmed cases were imported from abroad, suggesting limited levels of community transmission.[2] For people in Taiwan, life is largely back to normal in scenes reminiscent of the pre-COVID-19 era.[3] This feat is all the more impressive given that the island lies just 81 miles from the coast of China, where the virus was first detected, and has been denied access to pertinent information due to its politicized exclusion from the World Health Organization (WHO).

Taiwan’s success was made possible due to its previous experience with the Severe Acute Respiratory Syndrome (SARS). In what has become known as the “Taiwan Model” for managing the coronavirus outbreak, Taipei took early measures to control the spread of the coronavirus, including closing its borders to China and harnessing the power of digital technology to conduct efficient contact tracing and enforce mass quarantines.[4] Taiwan notably was able to control the spread of the virus without resorting to a nation-wide lock-down, a path taken by China in the early months of 2020.[5]

Lessons from the SARS Epidemic

In retrospect, the SARS outbreak in 2003 was a dress rehearsal for Taiwan’s response to COVID-19. The SARS virus originated in China’s southeastern Guangdong province in late 2002 and spread rapidly to Taiwan in early 2003. The island’s health authorities put potential SARS patients into its hospitals and mandated more than 131,000 people, who had contacts with suspected SARS patients or had traveled to affected countries, to quarantine at home.[6] There were frequent quarantine violations during the SARS epidemic, but such a loophole would later be remedied.[7] Only 45 probable SARS cases emerged from the mass quarantine, suggesting the effectiveness of physical and social isolation to curtail the spread of infectious diseases.[8]

From its SARS experience, Taiwan’s government realized it needed a more comprehensive and integrated approach to tackle future public health crises. The central government thus established the National Health Command Center (NHCC), a cross-agency integration mechanism with an epidemic prevention system.[9] The government also strengthened its collaboration with the private sector.[10] As Vincent Chao, Director of the Political Division at the Taipei Economic and Cultural Representative Office (TECRO) in Washington, stated: “After SARS, we established new regulations that gave our health officials greater authority in a health crisis like this. We learned the lesson of preparing early and preparing constantly. We learned the lesson to be hypersensitive to reports of mysterious illnesses and always err on the side of caution.”[11] For nearly 17 years, Taiwan’s government was preparing for another SARS-like virus, laying the groundwork and marshaling human and capital resources to effectively respond to future public health crises. Taiwan’s rapid response to COVID-19 was the result of its previous battles with SARS and later the H1N1 flu pandemic in 2009. Compared to other countries around the world that did not experience such health crises, Taiwan was ahead of the curve when the novel coronavirus emerged in late 2019.

Early Actions: Border Control

In late December 2019, Taiwan authorities were on high alert after learning about a mysterious pneumonia-like flu in Wuhan city in central China’s Hubei province.[12] At the time, neither China nor the WHO had made public statements concerning the virus or issued any public health warnings. Taipei, owing to its natural distrust of China and previous SARS experience, took the information very seriously. Taiwan’s government made a number of early, decisive steps that would, in hindsight, help to contain the spread of the virus within its territory.

Taiwanese authorities began performing onboard inspections of passengers on direct flights from Wuhan on December 31, 2019.[13] Airport personnel also started conducting fever screenings and health assessments among arriving passengers.[14] After a team of experts returned from an investigative mission to China in early January, Taiwan began required hospitals to test for and report cases related to the new virus.[15] All these measures were taken before Taiwan confirmed its first coronavirus case on January 21.[16]

In addition, Taipei took the decisive action of closing its borders to China ahead of the Lunar New Year holiday in late January. Every week, thousands of people travel between Taiwan and China. More travel was to be expected during this major holiday celebrated by many Asian countries. Five days after confirming its first coronavirus case, Taiwan banned the entry of Chinese nationals from Hubei Province on January 26, and extended the ban to Chinese nationals from Guangdong Province and Wenzhou city in Zhejiang Province.[17] Taiwan later prohibited the entry of all Chinese nationals from mainland China, Hong Kong, and Macao on February 11.[18] Except for flights between Taiwan and four Chinese cities — Beijing, Shanghai, Xiamen, and Chengdu - the air links between the two sides were closed.[19] On February 6, all foreign cruises were prohibited from docking in Taiwan.[20] Had it not been for the timely border control measures, Taiwan could have potentially imported more cases from the increased flow of tourists from China and elsewhere.

As the epicenter of the coronavirus shifted to Europe and the United States and turned into a global pandemic, Taiwan banned all foreign nationals, except those with special permission, from entering its territory starting on March 19.[21] Five days later, foreign travelers could not transit through the island.[22] As Taiwan was able to successfully contain the spread of the virus, in June it lifted the ban on foreign air travelers transiting through Taiwan’s Taoyuan International Airport, though some other restrictions on foreign entry remain in place.[23] Taiwan’s Ministry of Education also announced in August that international students enrolled in Taiwanese universities - excluding students from China — could return to the island to resume their studies.[24] Taipei, however, has not lifted its restrictions on the entry of foreign nationals including Americans who seek to travel to the island for tourism.[25]

Central Epidemic Command Center

On January 20, Taiwan quickly activated its Central Epidemic Command Center (CECC) under the National Health Command Center.[26] The CECC has policy-making authority on a range of issues including surveillance, border control, quarantine, and resource allocation.[27] During public health crises, relevant departments of the executive branch are stationed in the center.[28] The CECC is led by experts who provide guidance on disease prevention measures.[29] The center also has public hot lines, where residents can call in and ask questions related to the virus.[30]

The CECC also has provided accurate and timely information on the national coronavirus situation to keep the general public informed. It also alerts the public to false rumors on the coronavirus that may be circulating on social media. [31] Since January 22, the CECC has live-streamed a daily press conference and issued daily press releases that announce details of new infection cases and prevention measures.[32] Minister of Health and Welfare Chen Shih-chung, who leads the CECC press conferences, has become the public face of the government’s coronavirus campaign. Minister Chen is comparable to US chief epidemiologist Anthony Fauci, but the two health officials differ in significant respects. Although both men have tried to coax their respective citizens to abide by coronavirus prevention guidelines, Chen is widely popular in Taiwan and enjoys more political clout.[33] Unlike Fauci, whose exhortations have been undermined and sidelined by President Donald J. Trump, who has downplayed the risk of coronavirus to Americans, Minister Chen has the unwavering backing of Taiwan President Tsai Ing-wen, whose administration has taken the virus very seriously.[34] It also helps that Taiwanese citizens are more socially accustomed to wearing face masks when sick and to prevent the spread of infectious diseases even before the coronavirus outbreak, and that the issue does not take on a divisive political tone, which has played out in the United States.[35]

Minister Chen also plays the very visible role of the island’s top quarantine enforcer by emphasizing and reiterating fines and other penalties for failing to provide accurate information about one’s travel history to immigration authorities and violating rules regarding quarantines.[36] Chen has warned that he would publicly disclose the names of violators on national television, in what can be considered a form of societal public shaming.[37] He also said that people who ignore such directives and are later confirmed to carry COVID-19 will pay out-of-pocket for their doctors’ visits related to the coronavirus.[38] During the spring and summer, Chen also exhorted Taiwanese nationals not to travel to high-risk countries including Europe, the United States, the Middle East, and Africa as those places experienced explosions in coronavirus cases.[39]

Contact Tracing Utilizing Smart Technology

A major factor behind Taiwan’s relatively low infection and death counts was its highly effective contact-tracing investigations. Taiwan conducted contact tracing as soon as it received reports of coronavirus cases, with public health officials immediately launching investigations and performing COVID-19 tests.[40] Taiwan’s government utilized its community surveillance system, big data from its immigration and national immigration digital databases, and mobile phone data for effective contact tracing, containment, and surveillance of people in quarantine and isolation. Front-line health care workers could detect cases by accessing an integrated patient cloud medical chart system — the NHI MediCloud System — to check patients’ contacts and travel histories, and based on the patients’ symptoms, they assessed patients’ health conditions.[41]

In early February, the CECC launched investigations of the passengers of the virus-afflicted Princess Diamond cruise ship that briefly entered Taiwan.[42] The island’s health authorities conducted contact tracing of more than 3,000 cruise passengers who disembarked at Keelung port in northern Taiwan for a one-day local tour on January 31 by tracking and analyzing the passengers’ physical movements throughout the city from mobile phone data.[43] Health authorities later sent text messages notifying Taiwanese residents in the area who potentially came into contact with the Diamond cruise passengers to self-isolate at home.[44]

Furthermore, the “Quarantine System for Entry” for airline passengers went online on February 16. Passengers entering Taiwan can input their health information online prior to their flights or upon entry and later receive a health declaration pass to their cell phones upon arrival.[45] The online system is meant to help passengers quickly clear immigration and border control. Travelers’ information from the National Immigration Agency is integrated with the National Health Insurance Database as well as the tracking systems for the 14-day quarantine.[46] Front-line health care workers can spot potential infection cases based on their patients’ travel history and symptoms and take immediate measures.[47] Travelers arriving from high-risk countries have had their movements around the island individually tracked, with measures taken to prevent the spread of the virus to local communities.[48] 

Quarantine Enforcement

Taiwanese and foreign travelers arriving from high-risk foreign countries are subject to home quarantine for 14 days. Incoming travelers are prohibited from taking public transportation when leaving the airport and instead must take specially designated taxis or rental cars.[49] Local civil officers check in with people who are required to home quarantine at least once a day.[50] They also reach out to people who have had close contacts with confirmed cases twice a day.[51] Taiwan health authorities constantly monitor cell phone signals to determine whether people in home isolation and quarantine have left their residence.[52] If cell phones are turned off or people leave their homes, the electronic tracking system will alert local authorities including the police to trace their whereabouts.[53] Foreigners who enter the island without a Taiwanese phone number will be given a mobile phone by health officials.[54] Violators of home quarantine or isolation can be fined between US$3,000 and US$33,000.[55] There have been highly publicized cases of people who were found to have broken their quarantines and slapped with hefty fines. In March, one man who left his residence prior to finishing his mandated quarantine received a maximum fine of US$33,000.[56]

Lessons Learned

Taiwan’s successful COVID-19 experience has demonstrated the imperative of early intervention to limit the spread of the coronavirus. In a public health crisis, speed is of the essence. But it is also the government’s overall containment strategy that has been key in preventing the astronomical infection and death rates as seen in the United States, Russia, India, Brazil, Iran, and many other areas around the world. First, the Taiwanese government and its people took the novel coronavirus seriously, and did not wait for China or the WHO to respond. There was a strong central government response to COVID-19, led by a willing president whose administration harnessed a whole-of-government approach and provided timely and accurate information to the public. Taipei undertook comprehensive and efficient contact tracing and quarantine enforcement utilizing big data and digital and geofencing technologies. Finally, Taiwanese society deserves credit for wearing masks, practicing social hygiene, and putting the safety of the broader population first and foremost. They have accepted a higher level of government surveillance and intrusion into their daily lives, especially knowing that health personnel are monitoring their movements from their cell phones while they are in home quarantine. The China Model is not the only way to fight COVID-19; Taiwan’s experience is testament to the counterargument that democratic governance is indeed compatible with pandemic prevention and containment.