Written by K. Thiruchelvam
Why have some countries responded to the COVID-19 pandemic more decisively than others? How have seemingly under-resourced countries performed better—in terms of the number of cases and fatalities—than their richer counterparts? These and other vexing questions have continued to confound many of us as we enter the third year of a pandemic that has brought governments all over the world to their knees.
Preliminary findings from ongoing research undertaken by Tsing Hua University examining the responses by Malaysia and Taiwan to the pandemic provide some clues as to why some of these discrepancies arise. The first of this two-part article will describe how governments in Malaysia and Taiwan have responded to the challenges of the pandemic on their health systems.
Malaysia’s COVID-19 Responses
Malaysia’s first COVID-19 case was detected on January 25, 2020, and since then, four distinct waves of transmission have led to a total of 2.76 million confirmed cases and over 31,513 deaths as of January 1, 2022. Malaysia’s success in the initial suppression of the COVID-19 transmission can be attributed to its previous experience with infectious diseases. According to Dr Noor Hisham, Director-General of Health:
“(Malaysia) acted promptly in responding to the COVID-19 pandemic. Partly this is due to our experience in containing past infections such as SARS (Severe Acute Respiratory Syndrome), Nipah virus encephalitis and MERS (Middle East Respiratory Syndrome). These outbreaks have made Malaysia more prepared to deal with such situations…”
This initial preparedness bolstered the resilience of the country’s healthcare system to cope with the increasing number of positive cases. However, when cases began to surge from July 2021 onwards, the country’s healthcare system was stretched to the hilt.
A combination of strategies including lockdowns, social distancing, contact tracing, testing, vaccination, and hygiene measures was adopted to put the brakes on the spread of the virus. Lockdown measures, however, have generated more pain than gain. Worse still, inconsistent enforcement of lockdown measures has invited criticisms and diminished perceptions of the government.
Vaccination has been one of the few bright spots in the country’s response to the pandemic. After an initial slow rollout, the immunisation programme gathered pace, with 78.2% of the Malaysian population fully vaccinated as of January 1, 2022. Two types of COVID-19 vaccines are being developed and are expected to be ready in 2024.
Communicating with the public about the importance of vaccination and other matters pertaining to the pandemic has been undertaken by the Ministry of Health and other relevant agencies utilising both conventional and digital media. The Director-General of Health conducts daily press briefings detailing daily COVID-19 cases as well as significant developments in the battle against the pandemic.
The war against this virulent pathogen demands unwavering focus and commitment from all parties. The Ministry of Health has been empowered to steer all health-related matters pertaining to Covid-19 while the National Security Council oversees the national response to the pandemic. While this arrangement worked well in the initial stages of the crisis, the surge in COVID-19 infections and the attendant containment measures resulted in fault lines among Ministries in response to the prevailing crisis. The government’s centralised management of the pandemic has been largely public-sector driven despite calls for a more inclusive approach.
Complacency crept into Malaysia’s crisis response following impressive management in the first six months of the pandemic. In September 2020, the government decided to hold a state-wide election in the state of Sabah, which subsequently resulted in a massive spike in cases throughout the country. The COVID-19 pandemic coincided with a period of political instability in the country, which complicated crisis management. Following the high vaccination rates, the country has been able to rein in the number of daily infections and is in the process of transitioning to an endemic phase with more restrictions eased.
Taiwan’s COVID-19 Responses
Taiwan has remained relatively unscathed to date despite its proximity to the epicentre of the virus. Until January 1, 2022, the country recorded a total of 17,050 cases and 850 deaths.
Drawing lessons from the SARS outbreak in 2003, the Taiwan government quickly established the Central Epidemic Command Centre (CECC), which has been entrusted with overall pandemic control and response measures. The CECC adopted a “precision prevention” strategy with the help of artificial intelligence technology to diagnose and trace possible cases. Long-term investments in additional capacity at the Centres for Disease Control (CDCs), hospitals and infectious disease laboratories were also undertaken. Additionally, the government ensured an adequate and affordable supply of face masks for healthcare workers and citizens by suspending mask exports and getting local companies to ramp up production.
Stringent border controls and strict quarantine enforcement characterised Taiwan’s COVID-19 mitigation approach. However, unlike many countries, lockdowns were avoided. In addition, a striking feature of Taiwan’s mitigation strategyis the adoption of big data analytics with the integration of its National Health Insurance (NHI) database and its immigration database. This allowed medical providers to access patients’ travel histories to generate real-time alerts for the early detection of cases.
Success in mitigating the pandemic has, perversely, slowed the uptake of Taiwan’s national vaccination programme until late April 2021. The dramatic increase in infections in May 2021 highlighted the population’s vulnerability to COVID-19 and the need for a robust vaccine deployment. As of December 31, 2021, 67.7% of the population have been fully vaccinated. Taiwan has recently launched its indigenously developed vaccine (MVC-COV1901), currently undergoing Phase 3 clinical trials.
As part of its overall pandemic strategy, the Minister of Health and Welfare, who also heads the CECC, holds daily press conferences reporting on the progress of the pandemic, changes in policies, and clarifying misinformation. These daily briefings help to allay people’s worries about the disease, thus improving public trust in government.
Additionally, a clear-cut institutional framework has ensured Taiwan’s decisive and coherent response to the pandemic. The Minister of Health and Welfare was designated the commander to coordinate and mobilise resources from across the public and private sectors to counteract the emerging crisis. Despite receiving occasional criticisms of excessive measures, the government enjoyed high public approval ratings for its handling of the crisis.
After 16 months or so with a minimal number of cases and deaths, the local population and government in Taiwan became complacent. According to Associate Professor Lin Hsien-ho of the National Taiwan University:
“There was a general assumption even with people showing symptoms that the probability of having Covid-19 was essentially zero…….Doctors were not taking it seriously, hospitals were not alert, they were not doing a lot of contact tracing. There was definitely a certain sense of complacency.”
Such complacency was highlighted when Taiwan relaxed its quarantine requirements for non-vaccinated airline pilots from an initial 14-day period to just three days, which led to the cluster outbreak that caused the wave of cases in May 2021.
Past experiences from earlier infectious disease outbreaks have helped Malaysia and Taiwan prepare early in confronting the COVID-19 pandemic. However, initial success in reducing the adverse effects of the pandemic led to complacency that triggered a dramatic increase in infections which, in the case of Malaysia, overwhelmed its healthcare capacity. In addition, political instability in Malaysia has compounded the difficulties in managing the crisis. The strong public support in the case of Taiwan is a result of the public being an integral partner of the government’s fight against COVID-19.
Responses to COVID-19 by Malaysia and Taiwan demonstrate several lessons as follows:
- Importance of preparedness, swift actions, and the use of technology in managing the pandemic;
- An effective coordinating organisation that is empowered to act responsively, decisively, and flexibly is crucial in responding to the manifold challenges following a pandemic;
- A whole of nation approach – inclusive of government, industry, NGOs, and society – is imperative in ensuring that resources, expertise and knowledge flows are utilised and mobilised optimally to protect public health, livelihoods and the economy;
- Constant vigilance must underpin the battle against the pandemic to avoid the deleterious consequences of complacency;
- Consistent enforcement of legislations/regulations/protocols must be applied equally to contain the pandemic effectively;
- Political stability is fundamental to the effective management of the pandemic to avoid unnecessary diversion of focus;
- Strategies for effective communication management are vital to ensure that they are able to influence, build trust and solidarity for the national pandemic efforts.
The responses by Malaysia and Taiwan as described above are a product of learning from previous experiences and the cumulative investments both countries have made in developing their respective institutions, infrastructure, human resources, and public-private partnerships. The pandemic has shown that countries that have invested and enhanced the development of these capabilities and capacities have demonstrated better outcomes through more effective responses and innovative approaches.
K. Thiruchelvam is presently a freelance consultant. He was earlier the Dean and Professor at the Perdana School of Science, Technology and Innovation Policy, Universiti Teknologi Malaysia (UTM). His recent article can be accessed here: https://doi.org/10.1177/0971721819873186.
This is part one of a two-part article. In this part, it is noted that effective public sector capabilities and capacities are critical for improved Covid-19 outcomes, according to findings from an ongoing study by Tsing Hua University.