Minister of Health and Welfare Chen Shih-chung’s expert leadership of the pandemic response team has made him a hero in the eyes of the public. (photo by Jimmy Lin)

According to Johns Hopkins University in the United States, as of late May 2020 more than 5 million cases of COVID-19 and more than 340,000 deaths from the disease have been confirmed worldwide.

The pandemic is being called the greatest threat to humanity since World War II and the most severe blow to the global economy since the Great Depression of the 1930s. Taiwan’s public has carefully navig­ated this new crisis and forged a Taiwanese model for slowing the disease’s spread that has won inter­national praise.

When global confirmed cases of COVID-19 reached 10,000 on February 1, 2020, Taiwan had just ten cases of its own, but recognized that it had nowhere near the number of surgical face masks it needed to protect its citizens. The government responded by taking control of domestic face-mask production, and on February 5 announced that it would establish 60 new face-mask production lines.

On February 6, the Taiwan Machine Tool and Accessory Builders’ Association became the first private-­sector institution to offer help to Taiwan’s then-nascent national face-mask team when its chairman, Habor Hsu, messaged Minister of Economic Affairs Shen Jong-chin to say that the machine-tool industry was ready to assist with manpower and resources.

The rapid, targeted actions of Taiwan’s national face-mask team have helped prevent an epidemic on our island and boosted our international relations. (photo by Jimmy Lin)

The national face-mask team

Although Taiwan’s machine-tool industry is the world’s third largest by exports, it lacked the necessary designs and components to build the machines. Adopting the mantra “We’re all in this together,” the association immediately gathered a list of the items needed to build the machines and then approached major manufacturers about providing the skilled workers necessary to assemble them. Hsu says that as association chairman he dropped a hint to ­HIWIN, YCM, Awea Mechantronic, and Goodway Machine, and the machine-­tool heavyweights then came through with more than 20 technical personnel and other support.

More used to competing fiercely with one another for orders, the sometime rivals pulled together on this project. Taiwan’s existing makers of face-mask machines had been able to produce only two machines in a month. But under pressure from the gathering pandemic, the group rapidly ramped up production, producing one face-mask machine in the first week, one every three days in the second week, and two per day in the third, completing all 60 within a month.

When Premier Su Tseng-chang called the group the “national face-mask team” during a visit to one of the factories, it fostered pride in their achievements and encouraged still other machine-tool makers to join the effort. Ultimately, some 2500 man-days of work went into the program over the 40 days from February 10 to March 20, producing a total of 92 face-mask machines that were subsequently turned over to mask manufacturers. This endeavor resulted in another “Taiwan miracle”: previously importing 80% of its face masks, Taiwan was by now making 15 million masks per day and had become the world’s second-­largest producer.

A prudent approach

Johns Hopkins University predicted in January that given Taiwan’s close proximity to China, it would likely have the second highest number of imported cases in the world. But the reality has been that while Europe and the US have suffered severe outbreaks, Taiwan has been a global bright spot for prevention, with only 400-some confirmed cases and fewer than ten deaths, even without a lockdown.

Taiwan has calmly and vigilantly held the line against the disease from the first. On December 31, 2019, the government began implementing on-board health checks on passengers arriving on direct flights from Wuhan. On January 20, 2020, it activated the Central Epidemic Command Center to directly coordinate preventive measures such as introducing border controls and combating false information.

Outgoing vice president Chen Chien-jen, an epidemiologist by training, has observed that after the SARS outbreak in 2003, Taiwan’s govern­ment conducted a comprehensive review of its epidemic response capability before amending the Communicable Disease Control Act to establish a communicable disease prevention command system, strengthen and restructure the Centers for Disease Control, and add infectious disease specialists to the CDC’s staff.

Minister of Health and Welfare Chen Shih-chung is leading the Central Epidemic Command Center (CECC) and releases daily updates on the pandemic. By publicizing preventive measures such as wearing a mask, thoroughly washing one’s hands, and maintaining social distance, the center has encouraged the public’s compliance. Private businesses and residential districts have also helped, responding to the government’s efforts to prevent transmission in public spaces by implementing disinfec­tion measures and temperature checks of their own. This collective action has enabled the public to adhere to govern­ment recommendations without sacrificing their personal freedom.

Taiwan’s shipments of face masks to other nations exemplify our ability to contribute to the international community. (photo by Chen Mei-ling)

IT soft power

Public-private cooperation has not only enabled these simple masks to help contain the spread of the virus, but also highlighted Taiwan’s soft power in terms of information technology and its public health system.

Taiwan Panorama visited mask-maker Motex, which is currently operating 11 production lines on two shifts. Two of those lines make masks exclus­ively for frontline medical personnel.

Motex Group chairman Y.C. Cheng experienced the 2003 SARS outbreak at first hand—he had to self-­isolate when returning to Taiwan from main­land China during the outbreak, and well remembers the discomfort of wearing a mask 24 hours a day. The experience made him realize just how important these seemingly insignificant masks are, and led him to invent a diamond-shaped version that is both more comfortable to wear and more close-fitting.

Confronted with the shortage of masks in the early stage of the COVID-19 outbreak, the government rapidly halted exports, added new production lines, and instituted a mask rationing system.

To make sure the public had convenient and equitable access to masks, on February 4 the National Health Insurance Administration (NHIA) made data on mask sales and inventory at all of the nation’s pharmacies available to the public.

Skilled programmers then integ­rated this information into a variety of “mask maps” that enabled the public to find nearby NHI pharmacies, see their mask sales hours, and check the size of their mask invent­ories through visual maps, chat robots, and voice assistants. Some of these tools even included positioning and navigation functions.

Minister Without Portfolio Audrey Tang also contacted these tech communities about creating a face-mask supply and demand database. With more than 100 mask-map apps and groups currently in existence, public-spirited tech communities have demonstrated the power of Taiwanese IT.

Cloud-based medical records

Linking the purchase of masks to people’s NHI cards made access both fair and convenient and has made Taiwan an international bright spot in this time of global crisis. Nobel-­laureate physician‡scientist Tasuku Honjo stated in a Japanese interview that Taiwan’s use of NHI card data as part of its disease prevention efforts was something others could learn from.

Taiwan’s government announced on the evening of February 3 that it would implement face-mask rationing on February 6. But many people might not realize that officials had to develop a complex programming architecture and a comprehensive IT system involving proof of identity, cash flows, and the logistics of mask deliveries in just two days.

Taiwan’s 2003 introduction of IC-chip NHI cards made this possible. These cards give medical practitioners access to cardholders’ med­ical and pharmaceutical records on cloud-based servers, which are updated each time a cardholder seeks care. Since 2015 the cards have also been able to serve as identity documents, which can be used for purposes such as filing taxes. This helped ensure the success of the mask rationing scheme.

In addition to being a race against the clock, epidemic control also relies on having tests that are sensitive enough to minimize the number of false negatives and thereby avoid sending infected people back into the community to spread the disease. In April, the Industrial Technology Research Institute’s BioMedical Technology and Device Research Laboratories announced the develop­ment of a portable nucleic acid test kit that produces results in 60 minutes and has a sensitivity of 90%. The size of a soda can, the device is small enough to be easily portable for frontline medical personnel, making it easier to screen high-risk groups in the community and at ports of entry. This will enable healthcare teams to immediately identify infected individuals while the disease is still in its incubation period. Production of the device is slated to begin in July.

Taiwan is helping

Lee Po-chang, director-general of the NHIA, has accompanied health and welfare minister Chen Shih-chung to the World Health Assembly in Geneva on several occasions as part of the Taiwan WHA Action Team. He states: “While Taiwan has long been barred from the World Health Organization for political reasons, whenever Taiwan’s NHI program or healthcare system come up at WHO research conferences, we always get a big thumbs up from all the nations there.” Sharing Taiwan’s COVID-19 response provides another example of how we can contribute to the international community in areas such as disease control and prevention, and in addressing other global health issues.

Taiwan has continued to do every­thing it can to contribute despite its isolation by the WHO. Since mid-April, with the US and Europe suffering badly from the pandemic, Taiwan has donated a total of nearly 10 million face masks to more than 20 European nations and 6 million to the US. Taiwan has also provided disease control resources and other medical supplies to Japan and Thailand.

COVID-19 reminds us of life’s impermanence and fragility. But Taiwan’s success in safeguarding lives through its strong and timely epidemic control measures stands as a beacon to the world in these dark times.

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