What NZ can learn from Taiwan about pandemic preparedness
New Zealand’s approach to the Covid-19 pandemic won international acclaim after measures such as border closures, widespread testing and initiating a historic nationwide lockdown helped eliminate the deadly virus from within our midst.
But it’s the proactive stance adopted by another island nation some 9000 kilometres away that has been singled out as the “most effective and least disruptive of any country” in the world.
Battle-hardened after facing the Sars and H1N1 swine flu pandemics in 2003 and 2009 respectively, Taiwan benefited from strong pandemic preparation and extensive public health infrastructure to fight Covid-19 – crucially, without the need to lock down.
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The approaches taken by Taiwan and New Zealand are scrutinised in the study, in which Kiwi academics compare notes with counterparts from the National Taiwan University and the Taiwan Centres for Disease Control.
By the end of August, Taiwan – population 23 million – had reported 488 cases and seven deaths, while New Zealand’s team of five million reported 1397 confirmed cases and 22 fatalities.
Taiwan, which has very close historical and cultural links with mainland China, was quick to spot the outbreak partly because business people on the ground began reporting in December that something strange was happening in Wuhan.
Taiwanese officials began examining people arriving from Wuhan on December 31 – some 10 days before China admitted there was an outbreak of a strange virus – and blocked people from Wuhan travelling to the island from January 23.
Taiwan’s superior response has sparked renewed calls for a large-scale inquiry into New Zealand’s overall Covid-19 response from the academics, led by Dr Jennifer Summers.
Prominent epidemiologists, professors Michael Baker and Nick Wilson – both previously advisers to the Government during the pandemic – also contributed.
University of Otago Professor of Public Health Michael Baker was part of the group that advised the Government on coronavirus. Published June 16.
Baker says while both countries adopted elimination strategies – where the end game was total suppression of the virus – there were key differences.
“The thing about Taiwan that was so remarkable is that by starting early and doing the case-based work and managing their borders very carefully, they were able to avoid a lockdown, and that’s really the big difference,” he says.
“They took what is really a very effective proactive approach, and New Zealand took a very effective reactive approach, so we waited until the pandemic was already getting established in New Zealand, and then we reacted very effectively.”
A World Health Organization doctor caused some consternation this week when he suggested that lockdowns should be the last resort to control Covid-19. Published October 14.
New Zealand implemented one of the most stringent lockdowns in the world to reach the same outcome as Taiwan – eliminating the virus.
‘’We had the same goals, but Taiwan did it better by starting earlier and using a lot of other methods that meant that transmission was prevented,” Baker says.
Thanks to its close trading links with Wuhan, Taiwan was able to act very early, on the same day the World Health Organisation was alerted to the outbreak.
Taiwan benefited from having a Centres for Disease Control in operation, and a National Health Command Centre dedicated to responding to emerging threats like pandemics, says Summers.
“The agency had the authority to coordinate [between] government ministries and departments, a national cohesive response. And they did that from day 1.”
Despite Taiwan’s exposure to China and dense population, the self-governed island had a substantially lower incidence rate of the virus at 20.7 cases per million people compared with New Zealand’s 278 per million.
New Zealand was on the back foot thanks to historically low levels of public health investment, the authors said, and its comparative inexperience in dealing with epidemics. It was forced to rely on its Influenza Pandemic Plan to guide its response in the early stages.
This was problematic as the plan wasn’t designed to be adapted to different diseases with diverse characteristics, with Summers describing it as a “major limitation to New Zealand’s response to Covid-19”.
It was based on the mitigation strategy of ‘‘flattening the curve’’ and delaying the epidemic peak to reduce the health impacts, the report said. The strategy was eventually abandoned when Prime Minister Jacinda Ardern announced in March that the country would go into lockdown and pursue elimination.
Taiwan also benefited from having extensive digital technologies for contact tracing and very clear quarantine rules.
Like other Asian centres, Taiwan has a well-established mask-wearing culture. Its government had a strong policy of supporting production and distribution of masks to all residents, “securing supply, and providing universal access to surgical masks … from February 2020 onwards”, the study says.
People were required to wear masks in confined indoor environments, including subways, as well as during periods where there was no community transmission.
In contrast, until August, health officials here resisted calls from public health specialists, including Baker, to promote mass masking.
The study has numerous recommendations, including the development of effective border management policies and associated infrastructure to allow responses to be swiftly scaled up as outbreaks occur.
More robust quarantining rules as well as more secure facilities for incoming travellers should also be stood up, as well as the development of better digital solutions for things like contact tracing, it says.
In essence, the study says New Zealand authorities should examine Taiwan’s response for “transferable elements that could improve [our] current response”.
“I would say that New Zealand has had a bit of a warning with Covid-19, and we can see the grim reality, not just here in New Zealand, but also in other countries,’’ Summers says. ‘’We can take the lessons and experiences of Taiwan, and what they have done over the past 20 years to develop our own defences against a future pandemic.” .
Measuring the Covid-19 responses to August 2020 – by the numbers
- Total confirmed cases: 488
- Covid-19 death toll: 7
- Total tests performed: 177,317
- Estimated population: 23 million
- Population density: 652 people per square kilometre
- First case: January 21, 50+-year-old woman returning from teaching job in Wuhan
- Total confirmed cases: 1397 (excluding probable cases)
- Covid-19 death toll: 22
- Total tests performed: 766,626
- Estimated population: 5 million
- Population density: 18.4 people per sq km
- First case: February 28, woman in her 60s who arrived from Iran via Bali
- Universal public health system
- High-level leadership
- Both had daily press conferences
- Public health messaging
- Targeted financial support made available
- Pandemic preparedness planning and public health infrastructure (Taiwan)
- NZ locked down, Taiwan didn’t
- Established digital contact tracing systems (Taiwan)
- Established culture of mask-wearing in Taiwan
- NZ slower to introduce border controls than Taiwan