【by Daiwie Fu, June 2022】
Topics like “Taiwan, hailed for its gold standard Covid strategy, now faces potential for lots of deaths” (Telegraph, 6/May), or “Once a zero-Covid poster child, island learns to live with the viruses” (Guardian, 9/May) suddenly popped out in British papers early this May. Apparently Taiwan’s Covid-19 pandemic control policy has gone through a major, but problematic shift. This shift cannot simply be understood by the developments in recent months, it would need to dig into the depth of Taiwan’s major epidemic control institution CECC (Central Epidemic Control Center), including its recent history, its moral assumption, medical expertise, and its interests under Taiwan’s DPP (Democratic Progress Party) administration.
CECC is headed by Taiwan’s minister of Health and Welfare Chen Shih-Chung 陳時中 for more than two years since the outbreak of Covid-19 pandemic. In stead of being the so-called “zero-Covid poster child,” there were of course many early crisis situations badly managed by CECC, including the notorious scramble for face masks. In general, CECC is a very powerful and authoritative unit by law. It has a structure dominated by command center and expert groups with medical doctors only, and it can command supports from various ministries in Taiwan’s administration. It regularly offers a daily news conference at 2pm, which is the only public window to society at large. Its high power is understandable only in short term pandemic emergency situation. However, after more than two years in power, it has become quite authoritarian and even arrogant against timid media reporters. Very often its news conference was reduced only to strong policy announcements, if not show stage performance of CECC and DPP administration.
Some preliminary comments here would be about Taiwan’s own problematic Covid vaccine production: the Medigan Covid-19 vaccine (MVC 高端). It was strongly supported by DPP government as a MIT (Made in Taiwan) product, with TV propaganda of Taiwan’s president Cai, also backed up by former vice president and eminent public health expert C-J Chen 陳建仁. While MVC is made from an unusual biomedical process (CHO cell protein), the more serious problem is in its defective clinical trials. It has only gone through the first two phases, without the critical mid-term result of the third clinical trial. This is quite problematic and defective if compared with other more standard Covid-19 vaccines that had received EUA from other major countries, EU or WHO. Dr. Chen and other experts of MVC intend to justify MVC’s problematic clinical trial by claiming that MVC had used a special/new methodology of “immune-bridging” 免疫橋接 to compare MVC with other major vaccines. And if the comparison results are positive for MVC, then it is justified in skipping the entire third clinical trial. However, this “bridging” methodology was not accepted by US, EU or WHO and thus cannot get important EUAs from them. This shows the problematic medical expertise of MVC and was also criticized by Taiwan’s other eminent biomedical scientists such as P-J Chen陳培哲.
As a result, MVC had only low acceptability within Taiwan’s general public, even if it had managed to get Taiwan’s own EUA. Yet CECC strongly supported MVC from the very beginning by pre-ordering a huge amount of MVC vaccines with very expensive price. And due to low acceptability in Taiwan, many of them were wasted after expiration dates. As Taiwan’s DPP administration was wrong about its expectation of MVC, and was also hesitant and very late in buying adequate foreign vaccines, plus unwilling to buy them from or through China, Taiwan’s population was late and difficult to get adequate vaccines to stop Covid-19 viruses like Alpha. Quite a few infected died, and for a time Taiwan had the highest mortality rate in the developed and East Asian countries (4.99% in 2020-21)! Big controversies had also erupted about whether CECC was fair in distributing precious foreign vaccines or was favorable mostly to officials in DPP administration or to other privileged people.
If Taiwan had been called a zero-Covid poster child, it was probably due to two things: a general public acceptance and availability of face masks in the middle phase of Covid 19 control. This comes from the efforts and accommodations of Taiwan’s public, waiting in long queues before drugstores, and also comes from the efforts of our “face-mask-making national teams” 口罩國家隊 in quickly producing massive, inexpensive face masks. Taiwan’s administration should have some credits in organizing these national teams. The second thing is Taiwan’s relatively low Covid cases during the initial phase of Omicron virus. This was roughly the moment in many Euro-American and East Asian countries like Korea, Singapore, and Japan, when they were having sky-rocketing Omicron cases per day. A simple reason for the low Covid cases was that Taiwan had made very strict border controls (邊境嚴管) to people from abroad: a general PCR examination upon entry plus 14 days quarantine for everybody. CECC was originally very reluctant to implement these measures, despite of constant criticisms from the public and oppositional parties. CECC preferred directly sending people from abroad to pandemic control hotels for two weeks quarantine. After several severe group infections in quarantine hotels and airport, plus seeing many record breaking Covid cases abroad, CECC finally adopted a general and strict measures in airport since July 2021. And this makes Taiwan’s low Covid cases in comparisons with those of quite a few other countries until March of 2022.
Towards the end of 2021 and early 2022, quite a few countries ranging from Euro-America to Asian, a new pandemic control or “retreat” strategy had emerged: to live with the virus. Partly due to long term fatigue from controls, but also due to fuller vaccinations, plus of course the need for economic recovery from lockdowns and restrictions, the new strategy had gradually spread out, against quite a few doctors’ reservations of course. South Korea for example, it has boldly announced this strategy and aims for “returning to normal life” in Nov. 1st of 2021, when it has about a daily 2500 Omicron cases and an accumulated 2858 deaths since 2020, with a 3rd vaccination rate less than 50% nationwide. The pandemic control center of South Korea did not know then that 8 months later, Omicron had infected more than a third of its population (the highest infected cases in 17/March being four hundred thousands), with 8.5 times of deaths as a result. Taking only this year’s deaths from Omicron, South Korea’s fatality rate is 0.11%, about the same with France, but higher than Singapore, Australia and New Zealand. In reflection, is South Korea’s “living with virus” strategy from last November a wise and matured strategy? I very much doubt that.
In comparison, Taiwan’s pandemic control has been late in adopting this fashionable “living with virus” strategy. However, apparently Taiwan’s DPP government did not wish to lagging too much behind this Euro-American world new trends, it seems to have quietly decided to go for it early this spring, when in 7/March CECC announced to a somewhat relaxation of the strict border controls from 14 to 10 days, so called the “small relaxation” 微解封, in a time when Taiwan’s daily Omicron cases is smaller than 20. This policy was naturally under criticism, in a society which is used to the zero-Covid policy. A month later, DPP government and CECC formally announced in 7/April a “new Taiwan model” which stressed a balance between economic growth and “disaster mitigation” 減災, admitting Taiwan’s current difficulty for zero-Covid. This was announced in a time when Taiwan’s O cases have gradually picked up to hundreds. Mainstream media had often blamed the sudden rising of O cases simply to the extreme spreading power of Omicron, while forgetting about the fact that it was preceded by one month of CECC’s dubious “small relaxation” policy.
After announcing the new Taiwan model, DPP government pushed further relaxation policies both formally and informally, when O cases perform triple jumps. A famous example of how CECC’s chief Chen underestimated the power of Omicron is this. When asked by a reporter in 12/April (with 551 O cases) CECC press conference about when Taiwan’s daily O cases would exceed one thousand, Chen estimated that it would be in the end of April. But this O cases number should jump over one thousand only three days later: 15/April with 1209 O cases! Examples like this and many others show that CECC, while recklessly going for a “living with virus” (LWV) policy, had grossly underestimate the power of Omicron and also very poorly prepared for that fashionable new policy. As our O cases in triple jumps, the availability of “rapid test” kits were in severe scarcity and expensive, nor the Omicron medicine like Paxlovid was easy to find behind extremely bureaucratic red taps. Without engaging in responsible public hearing debates and parliament considerations for this new policy, DPP government had marshalled its dominant propaganda to indoctrinate the public with this supposedly good and inevitable LWV wave from “the West.”
One important informal channel for this LWV was propagated by an adjunct biomedical researcher-cum-propagandist, M-S He 何美鄉, famous for her public provocations and popular for her lectures in DPP’s central party assemblies. In early April, He had publicly spread the idea that getting infected by Omicron is something not to be feared, actually “a blessing,” due to its expected strong immunity after recovery, but without carefully warning the dangerous potential of Omicron to high risk populations, the problematic duration of this immunity, nor about the already much discussed Long Covid residual symptoms. Although CECC did not publicly endorse He’s provocation, her problematic ideas dovetailed well with DPP’s new strategy and are popular in DPP’s gossip channels. However, public suspicion of this LWV policy remained strong: TPOF’s poll (26/April) showed 46.3% of the opinions against LWV, with only 45% for it.
Some important social and medical criticism emerged in this May to criticize DDP’s LWV strategy. A noted journalist W-C Chen 陳文茜 wrote “Stories of three women in Covid pandemic” (7/May), criticizing CECC’s reckless LWV policy which ignores the precious lives of small children, who had no vaccine to protect themselves, and Taiwan’s elderly people, who obviously suffer as the main death toll for this Omicron wave through LWV. Taiwan’s DPP government, wrote Chen, should not consider human right only in terms of their sorrow political prosecution (by KMT) in the past and the right to vote in the present. “Every human being under Taiwan’s ruling class, should be able to live a reasonable life with dignity.” Also a medical doctor S-T Chiu 邱淑緹, a former CDC manager, in 10/May supported Chen’s moral argument and raised, from US experience, more medical questions about this problematic LWV policy. Perhaps echoing Dr. Fauci’s earlier suspicion, Chiu even questioned the very conception of herd immunity in the present Covid pandemic context. And the current process in living with (or fighting against) Omicron are by no means the “final war” in this pandemic, as DDP’s administration claimed to be so in order to call upon people to endure Taiwan’s rocketing high O cases and record-breaking deaths in this April and May. As of 30/May, Taiwan’s O cases in 2022 are 1.84 million and 1312 deaths, thus the official case fatality rate is 0.071%. Although this rate seems still “a bit low,” if compared with other equally reckless East Asian country figures under similar LWV policies now available. But this rate would definitely go up, as Taiwan’s major wave of O cases is just reaching its high plateau, a major wave which is about three months late than other countries that had gone through their own major waves. Thus as we move forward to 13/July, Taiwan’s case fatality rate was up to 0.17%, higher than Japan, South Korea, and Singapore.[1]
Leaving aside issues of number, I now focus first on questions of morality and justice about this pandemic controls and its LWV policy. I begin with W-C Chen’s moral and social criticism of LWV. By what moral or political right do Taiwan’s DDP government and CECC have in pursuing a LWV policy that puts in grave danger most elderly people over 80 and small children under 5? Is this because of the demands of Taiwan’s economic recovery, or the profits of its ruling classes? It’s true that a healthy economic recovery in “returning to the normal life” is important for more people than the ruling classes. (But it’s interesting to note that Taiwan’s economy last year with a zero-Covid policy was pretty good, with a 6.28% economic growth, highest in 11 years.) How are we then to balance between economic recovery and the costs of hardship and deaths of the weak in population? And though they are the weak, they are parents and grandparents, or are the precious darlings, of the strong in population. This is a serious public and moral issue in changing the common conception of pandemic control from protecting people from diseases into something else. It thus needs to be debated and decided publicly. It is way beyond the usual pandemic control business and its authoritarian CECC decision process. Furthermore, the issue here is again beyond the DPP administration, naturally deliberation and debate are needed in public and to settle down in the parliament, if not by a national referendum.
My second question is about the social fabrics of Taiwan’s weak in population, especially the elderly people. CECC’s daily press conference begins by reporting only about the daily O cases, deaths, and the number of moderate to severe O cases, plus the percentage among the deaths of having chronic diseases, or of taking how many shots of vaccine. All these figures are only about individual’s medical conditions, not even concerning meaningful public health figures, let alone about the social and anthropological fabrics of these unfortunate elderly people. Perspectives of social sciences, social works, social and anthropological studies of medicine are basically excluded from our CECC expert circles. However, socially understanding Taiwan’s population weak and elderly is crucial to mitigate the disasters faced by them. For example, those elderly people stay or live in Taiwan’s various long-term care institutions長照機構, usually the most hard-hit area in LWV policy, as already shown in South Korea’s experience (35% of the total deaths, even if 90% of them already had three vaccines, much higher than that in Taiwan).[2] In this sense, social fabric helps are more important than how many vaccines they as individuals had taken. But traditionally, Taiwan’s medical institutions do not care much about the social fabric of the patients or elderly, conveniently they pass this burden to their “family.” Thus elderly people live in long-term care institutions, plus those staying home within fragile family networks or with other young but careless family members, or even those living alone, if not homeless, are naturally the high (social) risks people—not the medically high risks. And Taiwan’s CECC and its medical circles had hardly paid attention to them.
AUTHOR
Daiwie Fu, National Yang-Ming Chiao Tung University, Taiwan
NOTES
[1] This short article was originally finished at the end of May, while only this sentence here was added at 23/July. Thus, as also warned by Taiwan’s noted public health scholar Chan Chang-chuan 詹長權in 17/July, concerning the Omicron mortality rates of every ten years age level of Taiwan compared with those of Japan since Jan. to July this year, Taiwan’s rates are generally 6 times higher, and especially for the 0-9 years old level, Taiwan’s rate is 14 times higher!
[2] Close to 30% out of the total deaths in the final two weeks of May come from Taiwan’s similar institutions.