Future Tense

How Taiwan and Singapore Have Contained the Coronavirus

A mask-clad worker with a handheld machine walks on a street amid potted plants before billows of smoke.
A worker disinfects an area of the Xindian district to prevent the spread of COVID-19 in New Taipei City, Taiwan, on Monday. Sam Yeh/Getty Images

On Dec. 31, Taiwanese officials learned that China had alerted the World Health Organization of a “pneumonia of unknown cause.” Though they had very little information, Taiwanese officials quickly sent health workers to the country’s airports to assess the passengers of all direct flights from Wuhan, the epicenter of the coronavirus, for symptoms before they could exit the plane. Since then, Taiwan has continued to be vigilant. Despite being just 81 miles off the coast of China, which has more than 80,000 documented cases of COVID-19, Taiwan has managed to contain the outbreak. While South Korea and Japan, its neighbors to the north, have 7,755 and 1,277 known cases of COVID-19, respectively, Taiwan has experienced just 48 cases and one virus-related death.

So how did an island of 24 million with considerable economic, geographic, and cultural ties to China—more than 850,000 Taiwanese citizens live in mainland China, and about 400,000 more work there—manage to defy expectations and contain the outbreak, and can other countries follow suit?

Part of Taiwan’s success has been due to its early response, says a new article in the Journal of the American Medical Association. While other countries waffled on acknowledging the danger of the outbreak, Taiwan took action immediately under the guidance of its National Health Command Center, which the country established after the deadly SARS outbreak in 2003 that killed 73 people there. In early January, in response to the then-new outbreak, the NHCC set up Taiwan’s new Central Epidemic Command Center. Among other things, the CECC has set the price of masks and allocated government money to mask production.

Taiwan “rapidly produced and implemented a list of at least 124 action items in the past five weeks to protect public health,” said Stanford Health Policy’s Jason Wang, a co-author of the article. “The policies and actions go beyond border control because they recognized that that wasn’t enough.” These actions include proactively finding new cases, quarantining suspicious cases, stopping flights from China, creating policies for schools and businesses, rationing mask purchases to reduce prepper panic, establishing a hotline to report suspicious symptoms in oneself or others, offering hand sanitizer in nearly all public buildings, and requiring fever checks for people entering schools and other public buildings. The measures have helped to assuage public panic—even as the Taiwanese economy has suffered—and public schools, for instance, are already back in session.

Big data and technological innovation are at the heart of these measures. Taiwan integrated its national health insurance database with its immigration and customs database to create big data for analytics, according to the JAMA article. This has alerted officials to potential cases during individual doctor visits. It’s also enabled the government to classify individuals’ risks of infection on the basis of travel history, and to track those who have visited high-risk zones via mobile phone. These steps effectively prioritize public health over individual liberty. They’re not as draconian as, say, Micronesia’s drastic travel ban (which has so far staved off the virus entirely), but they are a reasonably invasive form of surveillance.

Transparency has been essential. While China, for example, has received serious criticism for censoring critical information about the outbreak, the Taiwanese government has asked television and radio stations to regularly broadcast new information, and its Centers for Disease Control announce new cases each day. Meanwhile, government approval ratings have soared. (President Tsai Ing-wen’s approval rating went up from 56.7 percent in January to 68.5 percent in February, Voice of America reported.)

Taiwan isn’t the only the country that has successfully minimized the effects of COVID-19. Singapore, with only 178 cases, no deaths, and a slowing rate of infection, has also managed to contain the virus. Like Taiwan, Singapore took precautions after SARS—and then after the 2010 swine flu—to prepare for the next outbreak, and it was one of the first countries to restrict the movement of people who had recently traveled to China or parts of South Korea. It’s also imposed strict home quarantines, Fortune reported, which require individuals to report their location to the government. Singaporean officials have even started mapping out the transmission of the virus with the help of a new serological test. However, Singapore’s case is fairly singular: It’s a contained city-state with extensive health care infrastructure and a highly centralized government. And, as Harvard researchers wrote in a new study that’s yet to be peer-reviewed, Singapore “has historically had very strong epidemiological surveillance.”

Despite their unique circumstances, Singapore and especially Taiwan show how effective a centralized, rapid, and proactive response to pandemics can be. As U.S. confirmed cases rise to more than 1,000, with 31 deaths, we’re discovering that the U.S. has been limiting COVID-19 testing simply because we don’t have enough tests. Our president, who is attempting to “force-of-will a pandemic into not being a pandemic at all,” treats the virus as a hoax. Meanwhile, “[i]n Taiwan, diverse political parties were willing to work together to produce an immediate response to the danger,” said Robert H. Brook, a co-author of the JAMA article.

As for specific advice for the U.S., Brook said, “In a country as complex as the United States, there needs to be a sharing of intelligence on a real-time basis among states and the federal government so that action is not delayed by going through formal channels.” Now that Anthony Fauci, the nation’s top immunology official, has broken with the White House by acknowledging the severity of COVID-19 in a hearing before the House Oversight Committee on Wednesday, there’s perhaps more hope for collaboration and sharing of information. The New York Times reported, however, that the hearing soon devolved into a partisan feud over Trump’s response to the outbreak.

For more on the impact of the coronavirus, listen to this week’s episode of the Political Gabfest.

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