Crafting the Taiwan Model for COVID-19: an Exceptional State in Pandemic Territory
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Volume 18 | Issue 14 | Number 9 | Article ID 5423 | Jul 15, 2020 The Asia-Pacific Journal | Japan Focus Crafting the Taiwan Model for COVID-19: An Exceptional State in Pandemic Territory Ian Rowen developed and democratically governed Abstract: Taiwan was the first country to country that anticipated a health crisis and anticipate the threat of COVID-19, to send a calmly contained the virus—with only 55 medical team to investigate the initial outbreak confirmed cases of local transmission and in China, and to implement a comprehensive seven deaths as of July 2020, according to its and successful public health response that Central Epidemic Command Center (CECC). avoided repeated infections or catastrophic Astonishingly, the contested state of lockdowns. Counter-intuitively, Taiwan’s Taiwan—recognized (formally as the Republic success was achieved in part due to its of China) by only 15 other countries and exclusion from international bodies such as the marginalized in international organizations World Health Organization, which led it to such as the World Health Organization adopt a highly vigilant approach to health (WHO)—emerged in many ways as the most threats, especially those that emerge in China, normal country in the world whose irredentist claims impinge on Taiwan’s participation in the international community Taiwan’s success owed to past experience with and constitute an existential military threat. SARS, extreme wariness of China (Leonard, Taiwan’s response to COVID-19 was recast by 2020; Schubert, 2020), and a highly responsive its diplomatic representatives into “The Taiwan public health administration coupled with Model”, a formulation used to pursue increased universal health coverage, designed in part international recognition and participation. based on the counter-example of the US’s uneven and expensive system (Scott, 2020). An additional counter-intuitive factor, acknowledged even by Taiwanese medical Introduction authorities, may have been Taiwan’s exclusion from direct participation in the WHO, which led An “unexplained viral pneumonia” was first leaders to take a highly precautionary approach reported in Wuhan, China on December 31, (Lin et al., 2020; Watt, 2020). 2019. Taiwan’s authorities, accustomed to paying close attention to threats from China, Yet, even before the outbreak of COVID-19, anticipated the possibility of infection and Taiwan had already been caught within a new implemented a plan to contain it. After the round of tension and uncertainty between novel coronavirus SARS-CoV-2 epidemicChina, which claims its territory, and the US, spiraled out of control in Wuhan, China’s with which it has a complicated relationship as central government locked down the country guarantor of security and constrainer of after the disease had already begun to spread sovereignty. At a different conjuncture, such an abroad. With most of the world locking down or event might have engendered greater efforts suffering catastrophic losses due to thetowards regional if not national collaboration. contagion that was later named COVID-19, It unfolded instead in a time and region rattled Taiwan stood alone as an economicallyby talk of a new “Cold War”, with Hong Kong 1 18 | 14 | 9 APJ | JF activist Joshua Wong figuring his city as a 21st not send support until 50 days after Taiwan’s century Berlin. Its liberation, argued Taiwanese call for help, and only after the PRC gave sociologist Wu Jieh-min, required a USpermission. This episode marked the first time guarantee of Taiwan’s defense as the front line that representatives of a UN-affiliated agency of democracy (Wu, 2020). officially visited the island since the 1971 UN General Assembly decision to expel the As the disease invoked a global state of “representatives of Chiang Kai-shek”, which exception, the exceptional state of Taiwan inaugurated Taiwan’s isolation from the crafted a diplomatic campaign to expand its international diplomatic community (Chen, international space. Taiwan’s officials used its 2018). successful public health management to enhance the national image, expand space for After 8096 reported cases and 774 casualties, international participation, and assert Taiwan’s SARS was contained globally in less than one sovereignty and distinction from China. The year through aggressive quarantining and country’s public health approach, whichcontact tracing of infected patients. Despite the included inbound travel bans, wide mask tragedy of individual deaths, and the severe coverage, and contact tracing, was alsodamage to affected economies, the rapid presented, perhaps improbably, as a replicable containment was hailed by many as a triumph approach for other countries to follow. This of global health governance. Still, SARS diplomatic campaign included designing and accelerated an already-ongoing reorganization promoting the so-called “Taiwan Model” of of global health governance designed to health governance, and coining and circulating address the risk of emerging infectious disease. two slogans: #TaiwanCanHelp, andIn particular, the WHA sped up its revisions to #HealthForAll. its International Health Regulations (IHR), which are the only legally-binding international To understand Taiwan’s public health treaty on global health governance. However, governance and the diplomatic campaign it the IHR, as an international treaty structured precipitated, it is necessary first to take a brief through UN mechanisms, can only be ratified trip back in time to consider how the response by UN member states, which made Taiwan to SARS (Sudden Acute Respiratory Syndrome), ineligible to sign (Fidler, 2004). a disease caused by an earlier novel human coronavirus, set the stage for “The Taiwan For Taiwan, which suffered 73 deaths, the third Model”. highest number after China and Canada, SARS was a tragedy, but also a lesson to better prepare for future health threats, knowing they Taiwan and the World Healthmay be multiplied by diplomatic isolation (Lin Organization: From SARS to SARS-CoV-2 et al., 2020). To address this, Taiwan continued its campaign to join the World Health SARS, caused by deadlier but less infectious Association (WHA), the UN representative body coronavirus, hopped from an animal to a that governs the WHO. human in China in 2002 and then travelled to a Taiwan that was poorly prepared to receive it. During negotiations over the IHR revision, Initial suppression of reports about the disease Taiwan’s diplomatic allies supported the in China exacerbated the severity of the inclusion of a clause for “universal application”, outbreak there and abroad. Taiwan’s crisis was which could potentially include Taiwan. At the worsened by the slow and politically-next session, PRC representatives responded constrained response of the WHO, which did by declaring that the new IHR applied to all of 2 18 | 14 | 9 APJ | JF “Chinese territory”, including Taiwan, and state votes. Such coordination included signed a confidential Memorandum ofcultivating relationships with candidates whom Understanding (MOU) with the WHOthe PRC supported for Director-General, Secretariat to enforce its claim. The MOU, including Tedros Adhanom Ghebreyesus of which was later leaked, stipulated that Taiwan Ethiopia, confirmed in 2017 (Buryani, 2020). should not be allowed to participate under the Dr. Tedros went on to sign an MOU in support name of “Taiwan” or “ROC”, that its invitee list of China’s Belt and Road Initiative, and must be approved in advance by the PRC, and traveled to Beijing to praise Xi’s proposal to that all communications between the WHO and pave a “medical silk road” that same year Taiwan must be conducted through contacts in (Murphy, 2018). China. For the next several years, Taiwanese health authorities chose instead to conduct most communications with the WHO through “Wuhan Pneumonia” their longtime contacts at the US Centers for Disease Control. On 31 December 2019, the same day Wuhan police announced that they were investigating In 2008, Taiwan received a limited welcome doctors for spreading unsubstantiated rumors into the WHO following the election of and “disturbing social order”, municipal health President Ma Ying-Jeou, who had pursued officials released information about a viral closer economic and political ties with China. pneumonia that had infected visitors to a In January 2009, with the assent of the PRC, seafood market. The statement said that there WHO invited Taiwan to establish a direct point was no clear evidence of human-to-human of contact through IHR mechanisms totransmission, and claimed that, “The disease is exchange information on health emergencies. It preventable and controllable”. Wuhan police also allowed Taiwanese officials to log in to the detained more doctors for sharing warnings in WHO’s Event Information Site, where it could private Wechat groups, as scientists in Wuhan, examine advisories shared between member Shanghai and Beijing identified the pathogen states. Furthermore, WHO promised that it and sequenced its genome. Early reports would send experts to Taiwan in the event of a suggested that, like SARS, the disease may health emergency. A few months later, with have originated in horseshoe bats, before only a few weeks’ notice, the WHO Director- jumping to humans through an intermediate General invited Taiwan, as “Chinese Taipei”, to species, possibly pangolins. join the meeting of the WHA as a non-voting observer, which did allow its representatives to Chinese officials did promptly report the make personal contacts share information.