A local medical professional, second right, teaches foreign personnel how to conduct a test for enterovirus-related illnesses during a disease-fighting workshop co-organized by Taiwan and the U.S. in Taipei City last year. (Photo courtesy of Centers for Disease Control)

Taiwan is willing and able to share its expertise in disease control, medical training and universal health coverage through meaningful participation in the World Health Organization.

Since 2015, Taiwan has hosted six international disease-fighting workshops under the Taiwan-U.S. Global Cooperation and Training Framework (GCTF) to strengthen the regional capacity to respond to emerging and re-emerging infectious diseases. The workshops are co-organized by the Taiwan Centers for Disease Control (CDC) under the Ministry of Health and Welfare (MOHW) and its U.S. counterpart. More than 120 officials and specialists from about 20 Indo-Pacific countries have attended these events to learn about tackling public health risks like chikungunya, dengue fever, enterovirus-related illnesses, Middle East respiratory syndrome, tuberculosis (TB) and Zika.
 
Kicking off in late April, the most recent workshop is focusing on drug-resistant TB. According to CDC Director-General Chou Jih-haw (周志浩), this topic was chosen due to the growing threat posed by the disease in several regions including Southeast Asia. “Taiwan has had great success in combating this challenge,” he said, adding that the number of new cases of multidrug-resistant TB under management in the country dropped to about 100 in 2018 from around 400 a decade ago.
 
The nation has recorded similar progress in tackling other strains, with the overall incidence rate of TB falling to 37 for every 100,000 people last year, down from 73 in 2005, CDC statistics show. “We’re willing and able to share our expertise with any country confronting this threat,” Chou said.
 
Major Contributions
 
GCTF training camps are just the tip of the iceberg in terms of Taiwan’s efforts to support international health development. “Once a recipient of foreign aid, Taiwan is giving back to the world by providing help where it is needed most,” MOHW Minister Chen Shih-chung (陳時中‬) said. “The nation is making indispensable contributions to the global health network.”
 
A prominent example of its work in this regard is the Taiwan International Healthcare Training Center. Established in 2002, the MOHW-administrated facility offers foreign personnel instruction in fields spanning clinical medicine, traditional Chinese treatments and health care management. By the end of last year, around 1,500 professionals from 65 countries and territories had completed courses organized by the center.
 
Equally impactful is the Global Medical Instruments Support and Service Program. Launched by the MOHW in 2005, it has integrated efforts by hospitals across Taiwan to provide equipment to developing nations. More than 5,400 items have been shipped to medical institutions in 33 countries and territories under the project.
 
According to Chen, through these and a myriad other programs, Taiwan has conclusively demonstrated its commitment to strengthening global health, and warrants inclusion as an observer in the 72nd World Health Assembly (WHA)—the decision-making body of World Health Organization (WHO)—May 20-28 in Geneva. “Taiwan is seeking professional, pragmatic and constructive participation in the WHA, as well as technical meetings and activities of the WHO, so it can share this knowledge and give back to the world,” he said.

Indonesian health professionals visit the National Taiwan University Hospital Minimally Invasive Surgery Training Center and learn about the hospital’s medical records system in August 2018. (Photo courtesy of National Taiwan University Hospital)

Dr. Chu Chia-yu (朱家瑜), CEO of National Taiwan University Hospital’s (NTUH) International Medical Service Center, echoed the minister’s observations. “Taiwan is at the leading-edge in many medical fields,” he said. “Because of its rapid transition from aid recipient to donor, Taiwan is ideally placed to offer guidance.”
 
The NTUH facility has been tasked with upgrading health services in Indonesia as part of the MOHW’s One Country, One Center initiative. Under the project launched in 2018, six local medical centers have been assigned responsibility for extending cooperation and providing training courses for personnel from India, Indonesia, Malaysia, the Philippines, Thailand and Vietnam, respectively. Last year, 336 medical professionals received instruction in Taiwan through this program, which was expanded in 2019 to include Brunei and Myanmar.

While NTUH has been offering training to Indonesian medical personnel since 2014, its budget for related efforts has increased 15 times due to the One Country, One Center initiative, according to Chu. “Our partner institutions tell us what areas they would like to focus on such as cancer treatment or geriatric care, and we design programs to meet their specific requirements,” he said, adding that last year 31 Indonesian medical personnel flew to Taiwan for monthlong courses developed by NTUH.
 
Chen said that by providing curriculums tailored to the precise needs of partner hospitals, the One Country, One Center program is achieving real improvements in health care delivery. “We also expect participants to become seed trainers upon returning home, deepening the long-term impact of the project.”
 
Meaningful Support
 
Taiwan’s international assistance also extends to the field of disease control. Among related efforts, CDC specialists are working with overseas counterparts to formulate strategies for reducing incidences of dengue in Bandung on Indonesia’s Java island and TB in Vietnam’s Quang Ninh province. According to Chou, Taiwan’s experience in fighting dengue can prove invaluable in Southeast Asia. “Our success in combating this disease is one of the most important and inspiring stories Taiwan has to tell,” he said.
 
In 2015, more than 40,000 people fell ill with dengue in Taiwan. The government responded by establishing the National Mosquito-Borne Diseases Control Research Center in April 2016 in northern Taiwan’s Miaoli County, as well as its branch office in the southern city of Tainan the following January. Equipped with state-of-the-art laboratories, the facilities under the MOHW-supported National Health Research Institutes work to strengthen methods for locating mosquito breeding sites and develop new substances to combat vectors of viruses like dengue and Zika.
 
Thanks to the efforts of the center and the MOHW, which instituted a host of prevention measures such as new diagnosis protocols and health screenings at airports, Taiwan recorded just 183 domestic cases of dengue last year and zero fatalities from the disease. The CDC is also developing a cutting-edge test kit that is expected to significantly strengthen detection efforts, Chou said. Expected to go into mass production in the near future, it is the world’s first rapid diagnostic device capable of identifying different serotypes of the virus, he added.
 
Taiwan’s commitment to enhancing disease control is further evidenced by its decision to invite foreign experts to conduct the Joint External Evaluation (JEE) in 2016. This voluntary process was developed by the WHO to help countries recognize critical gaps in their human and animal health systems so as to improve preparedness and response measures. Taiwan was just the eighth country in the world to undergo such an evaluation and is scheduled for its follow-up JEE next year.

Taiwan citizens and residents of all ages enjoy convenient and affordable access to high-quality medical services thanks to the National Health Insurance program. (Photo by Huang Chung-hsin)

Indispensable Know-How
 
According to Chen, Taiwan’s achievements in tackling dengue, TB and other diseases are made possible by the nation’s blue-ribbon universal health coverage system. That is why the most important experience it has to share with the world is the development of the National Health Insurance (NHI) program, he said.
 
Instituted in 1995, the NHI covers more than 99 percent of the population, including citizens, prisoners, foreigners studying, working and residing in Taiwan, and newborns of non-nationals. It offers convenient and cost-effective access to a comprehensive range of high-quality services spanning Western and traditional Chinese medicine and dental care. “Taiwan has long achieved the WHO goal of universal health coverage,” the minister said. “Since the establishment of the NHI, no one in Taiwan faces bankruptcy due to medical bills.”

Treatment is available at affordable prices thanks to the equitable contribution model. NHI premiums are set as a proportion of an individual’s income, currently 4.69 percent, with insured workers, employers and the government contributing 30, 60 and 10 percent of this amount, respectively. There is also a 1.91 percent supplementary premium on large bonuses, stock revenues and other non-wage earnings.
 
The number of treatments and medications covered by the NHI has consistently been expanded over the years. Among the recent additions is an antiviral drug for hepatitis C. Its inclusion is expected to significantly boost public well-being as the illness, a major cause of liver cancer, affects an estimated 400,000 people in Taiwan, according to the MOHW.
 
This year, the government has allocated NT$6.54 billion (US$212.3 million) to roll out the drug to all hepatitis C patients in Taiwan. Its aim is to eradicate the disease locally by 2025, five years ahead of the WHO target for eliminating viral hepatitis worldwide.
 
In a survey conducted by the ministry last year, 86.5 percent of respondents expressed satisfaction with the NHI. “It can serve as an important reference for other nations in the development of world-class universal health care systems,” Chen said.
 
With its expertise in disease control, training and universal coverage, Taiwan can make major contributions to realizing the WHO’s goal of Health For All and U.N. Sustainable Development Goal 3 of ensuring healthy lives and promoting well-being for all at all ages. “Attending the assembly as an observer would allow us to forge mutually beneficial partnerships and eliminate a gap in the health security network,” Chen said. “With Taiwan’s involvement, I believe the international community will be far better prepared to meet global health challenges.”