To Ensure Vaccine Equity, Taiwan Should Adjust its Vaccination Program

Written by Kai-Ping Huang.

Image credit: 總統打疫苗 by 總統府/Flickr, license CC BY 2.0

Taiwan was an enclave during the global Covid-19 pandemic before a sudden outbreak in May 2021. The emergency response accelerated when students and employees were advised to stay at home. After that, everything came to a halt. The Minister of Health and Welfare, Chen Shih-Chung, delivers a daily live briefing to inform the public about infected cases and death tolls. The main concern was when the pandemic would end, and life could return to normal. In three months, the government suppressed the daily infected cases to two-digit numbers without an enforced lockdown. While the pandemic appears to be under control, the government remains wary of the constant changes to the situation due to the intrusion of the Delta variant.

To fight against Covid-19, there is only one solution for every country striving for a return to normality: vaccination. Herd immunity is the goal as advanced countries aim to vaccinate at least 75 per cent of their citizens. The discovery of different variants worldwide makes booster shots increasingly necessary to prevent severe symptoms even for the fully vaccinated. Although speed is vital, it is also essential to determine the proper order of vaccinations. The World Health Organization (WHO) has proposed a framework from which vaccination should be prioritised to decrease the death rate and disease burden, reduce societal and economic disruption, and ensure the ongoing functioning of essential services. Accordingly, priority should be given to populations with elevated risks of severe illness or death, populations at higher risk of infection and transmission, and those working in economically crucial but not essential sectors. It also recommends making government leaders and administrative personnel a priority group, but this group should be narrowly interpreted to include only a very small number of people.

Taiwan’s vaccination program largely follows WHO principles. The Advisory Committee on Immunisation Practices (ACIP) of the Centres for Disease and Prevention (CDC) recommends ten priority groups. While the first priority group is healthcare workers, the second priority group is central and local government staff who deal with epidemic prevention. In the second priority group, the first category is government leaders and administrative personnel. The recommendation specifically states that only a few people at each of the central and local epidemic command centres should be included in this category–the commander, deputy commander, and three staff members. In reality, both at the central and local levels, the numbers exceed those recommended. This number is 1,710 at the central level and 28,794 at the local level.

The growing number has prompted criticism, including accusations about why so many government officials prioritise vaccines while those at greater risk lag behind. Since vaccines are in short supply, the CDC has delayed the second dose of vaccine until 10 to 12 weeks after the first. In the case of the first three priority groups (medical staff, government officials, and essential personnel), the second dose is administered 28 days after the first. This results in the highest percentages of fully vaccinated people in the first three priority groups. According to the CDC statistics released on September 7, 2021, in each group, 74 per cent, 45 per cent, and 49 per cent of those vaccinated received the second dose. Meanwhile, only 9 per cent and 3 per cent of long-term care residents and elders over 75 years old have received the complete vaccination despite their high risk of developing severe symptoms and suffering a high death rate. Overall, more than half of the population has not yet been vaccinated. Compared with developed countries in the region (Japan, Singapore, South Korea), Taiwan ranks last for the percentage of the population that is either wholly or partly vaccinated.

In countries where vaccines are in short supply, vaccine equity has been a concern. Vaccines must be distributed quickly to save and protect people, but who gets priority is also debatable. The vaccination roll-out plans align with the public health objectives each government seeks to reach, whether it aims to prevent Covid-19 cases, hospitalisations, and deaths or reduce societal disruption and ensure the delivery of essential services. In February 2021, the government proposed a vaccination program with the first objective being “to prevent medical and epidemic prevention staff, as well as national security personnel, from becoming infected with Covid-19.” Such a strategy would have made sense in Taiwan when it was relatively safe. Indeed, vaccinating essential personnel would make them ready to fight against a pandemic if it occurred. However, things changed in May, and the elderly were most affected by hospitalisation and death. CDC’s priorities and objectives, however, did not change. With the arrival of the BioNTech vaccine, adolescents are given priority. Yet experts were confused by the decision to extend priority to under-22-year-olds. Working populations are waiting for their first vaccination, so such a move makes them feel deprived. The CDC may want to increase vaccination coverage, but it needs to provide convincing reasons for the vaccination plan. In addition to ensuring vaccines are delivered quickly, they should also be delivered effectively and equitably.

As people seek protection from vaccination, the order of priority groups exacerbates the plight of vaccine shortages. In addition, scarcity of vaccines also results from some government officials and groups who do not fit into government objectives cutting into the line. In turn, this leads to perceptions of injustice and unfairness, which have negatively affected the president’s approval ratings as well as those of her executive team. To ensure vaccine equity and protect the most vulnerable, the government should rethink vaccination program approaches. Many batches of vaccines have arrived in Taiwan, so the supply seems to be stable for the foreseeable future. Meanwhile, the Delta variant is confirmed to exist in some communities. Thus, the second pandemic wave appears to be arriving. Now, the CDC has more vaccines to offer, and hopefully, those who need them most will get them first this time around.

Kai-Ping Huang is Associate Professor at the Department of Political Science at the National Taiwan University.

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

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