Taiwan’s COVID-19 Vaccination Against Biological and Political Viruses

Written by Chunhuei Chi.

Image credit: 副總統施打疫苗 by 總統府/Flickr, license CC BY 2.0

Taiwan has accomplished a remarkable effective epidemic control during the first 16 months of the COVID-19 pandemic. It experienced a record of more than 250 consecutive days without any domestic cases since June of 2020. On 31 December of 2020, more than 70,000 people attended a live concert in Taitung to celebrate the New Year, which may seem surreal for visitors to Taiwan.

After Taiwan swiftly contained four potential domestic outbreak crises, it was brought to the reality of the pandemic in late April of 2021 when a pilot violated strict quarantine laws. This incident sparked a series of domestic outbreaks that the nation thought they could have mitigated again.

Before the outbreak on 20 April 2021, Taiwan (with a 23.8 million population) had 1,047 COVID-19 cases and 11 deaths. Although Taiwan effectively controlled the new outbreak by mid-July, the total cases increased to 15,662 with 787 deaths by 30 July (as of 13 September, the total cases were 16,093, with 839 total deaths).

Its highly effective pandemic control in 2020 contributed to Taiwan’s ill-preparedness for this outbreak and, thus, became a victim of its own success. In addition, its COVID-19 vaccine procurement was one of the most critical policies that made Taiwan vulnerable to new outbreaks.

Taiwan’s government procured 30 million doses of vaccines in 2020. However, only around 400,000 doses were delivered before the new outbreaks because of the global supply shortage. Even with the limited vaccines available, it was difficult for most Taiwanese to perceive the benefit of vaccination when there were no domestic cases, which contributed to the citizens’ hesitancy for vaccination. However, after the new outbreaks, the situation was completely reversed, and people became anxious for vaccination amidst its shortage.

While most nations face the same difficulties of securing COVID-19 vaccines that have been under-supplied, Taiwan faces an additional unique obstacle. That is China’s interference in its vaccine procurement. Given that such interference is expected, Taiwan needs to take extra efforts than most nations to secure enough vaccines. Its policy priority and complacency led to the vaccine shortage crisis. The policy priority was to promote Taiwan’s domestic development of the COVID-19 vaccines, which is vital for Taiwan’s vaccine self-sufficiency given its political challenges. When the outbreak occurred, there were two hopeful candidates for domestic vaccines, the Medigen and the UBI, whose progress was behind most of the world’s major successful COVID-19 vaccine developers. The government was banking on its highly effective pandemic control measures to buy Taiwan some time for its domestic vaccines to become available. Unfortunately, the timing of the spring outbreak did not cooperate and resulted in a vaccine shortage crisis that also turned into a political crisis.

Although the Medigen vaccine received an emergency use authorization (EUA) on 18 July, it was too late to relieve Taiwan from its outbreaks. Further, Taiwan’s progress in vaccination has also been falling behind many Asian nations, in contrast to its other highly effective pandemic control policies. As of 12 September 2021, Taiwan has only 4.4% of its population fully vaccinated, compared to the world’s average of 30.0%.

Besides the SARS-CoV-2, Taiwan has been fighting another ferocious virus that is political in its effects. During the pandemic, China launched an all-out offensive to demonstrate its success in controlling the COVID-19 epidemics while discrediting or interfering with Taiwan’s pandemic control effort. One notable event was that China successfully blocked Taiwan’s procurement of 500 million Pfizer-BioNTech vaccines from Germany in January 2021. Simultaneously, China has been pushing very hard to sell its domestic vaccines to Taiwan but faces strong resistance from the government (Taiwan banned the importation of vaccines made in China) and the public that do not trust vaccines made in China.

Before the pandemic, international media identified Taiwan as the target of China’s disinformation attacks. However, the new outbreak coupled with vaccine shortage provided the golden opportunity for China’s escalated disinformation attacks, which the CCP named “cognitive warfare.”

Further, Taiwan faces a small segment of politicians and citizens who do not value democracy or freedom and favour authoritarian China’s taking over Taiwan. They are wilful accomplices to China’s propaganda and disinformation. During the spring outbreak, they relentlessly criticized the government and spread disinformation (often originated from China) on the efficacy and safety of the Oxford-Astra Zeneca vaccines, the only vaccine Taiwan had in early spring. When Taiwan’s FDA granted its domestic vaccine Medigen, again, they were trying to discredit the vaccine and launched attacks on its quality. Further, the pro-China opposition party even filed a lawsuit against the Minister of Health and Welfare and FDA.

Once the disinformation attacks from outside (China) and within intensified, they spread like viruses that can potentially destabilize society. As Taiwan’s government fought against those political viruses, both the U.S. and Japan noticed the imminent political crisis and began to donate vaccines to Taiwan.

Those donated vaccines are not just biological vaccines but are also political vaccines that can neutralize disinformation that works like political viruses. Several other nations followed to donate vaccines to Taiwan, including Lithuania, Slovakia, Poland, and the Czech Republic. These nations demonstrated their strong solidarity with Taiwan, despite China’s fierce opposition. Moreover, these vaccines are also economic vaccines to maintain the stable supply of semiconductor chips to the world.

One collateral damage of vaccine disinformation is some Taiwanese were led to believe only Pfizer-BioNTech is the “best vaccine.” The result is Taiwan’s unique vaccine hesitancy. This is where individuals delay vaccination until they can get the Pfizer-BioNTech vaccine.

Not to be caught with another vaccine shortage, Taiwan’s government worked with two tech companies and the Tzu Chi Merit Society to procure 15 million doses of Pfizer-BioNTech vaccines while also procured 36 million doses of Moderna vaccines for 2022 and 2023. Moreover, it expands the production capacity of Medigen vaccines. Taiwan’s ability to effectively contain the spring outbreak that was dominated by the Alpha variant (and some cases of Delta variant) without the benefit of mass vaccination, however, complicated its attitude towards vaccines. Fuelled by misinterpretations of nations that have achieved a high population fully vaccination rate but are still experiencing a new surge of cases—such as the U.S.—many Taiwanese and the media believe the only way to contain the pandemic is to continue what Taiwan does best, strict border control and isolation-quarantine coupled with mobility restrictions.

For Taiwan to move toward the post-pandemic era, it must be understood that its main challenge is political rather than biological. Besides fighting disinformation and external and internal attempts to divide Taiwan and undermine its control effectiveness, it needs to consider the vaccines’ critical role in ending this pandemic. Further, the criticism of its government’s vaccine under-preparedness has shifted Taiwanese to inward-looking and toward vaccine nationalism. This is a departure from the highly self-confident Taiwan of 2020 that boasted about being capable and willing to assist other countries. To live up to its slogan “Taiwan can help, and Taiwan is helping,” Taiwan will need to regain self-confidence with a robust vaccine policy and become outward-looking, including offering vaccine aid to countries in need.

Chunhuei Chi is Professor and Director of the Centre for Global Health, Oregon State University.

This article was published as part of Politics of Vaccination special issue.

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