Government and governance, Health | East Asia

9 August 2021

Taiwan’s focus on health expertise as the means to tackle the pandemic crisis functioned well in 2020, but an outbreak in July has shown its approach wasn’t without its faults, Tsung-Ling Lee writes.

During the COVID-19 pandemic, political influence has been transferred to the hands of unelected scientific experts as governments worldwide have rushed to address the immediate threat of the virus.

This has had its benefits, but as a result, democracies have been transformed into technocracies during the global pandemic, especially when it comes to health policy. Driven by the need to address a genuine public health threat, a technocracy is arguably more agile, more responsive in coordinating essential health delivery services, and more able to draw upon available scientific evidence to inform national pandemic responses.

However, the pandemic is more than a public health crisis, as the United Nations has recognised. It is also a humanitarian crisis, and governments relying on health technocrats for decision-making can be prone to overlooking the structural inequalities that create particular vulnerability to COVID-19.

Taiwan’s pandemic response exemplifies the strengths and weaknesses of this type of governance. Lauded as the ‘gold standard’ for pandemic management, Taiwan has earned international praise for the country’s relative successful response when the pandemic first broke out.

However, a cascade of missteps beginning in late April 2021 resulted in the worst outbreak Taiwan has seen so far. While it remains small compared with much of the world – having recorded just short of 800 deaths – that Taiwan’s streak was broken highlights the weaknesses of a technocracy. Lessons from Taiwan’s outbreak, and how it managed to get on top of it, could offer valuable insights into this form of government during a global pandemic.

From a public health viewpoint, technocracy as a form of governance functioned extraordinarily well for the first 500 days of the pandemic in Taiwan. For almost 16 months, there was no significant local transmission. With its COVID-19 taskforce consisting of experts with public health and medical backgrounds, science drove Taiwan’s mitigation strategy during the first year of the pandemic with great success.

More on this: Taiwan navigates COVID-19

This scientific expertise led the government to a proactive approach, focused on risk-based border control and digitally assisted contact tracing, along with population-based interventions like universal mask wearing and distancing guidelines. Through an open and transparent pandemic response with daily briefings, the government engendered trust and support from the public for all of 2020 and the first half of 2021.

Then, in late April 2021, a cluster of locally transmitted cases erupted. Between 14 and 15 May, cases increased six fold, from 29 to more than 180, catching the public by surprise. Beginning in mid-May, the country introduced a semi-lockdown, school-aged students moved to online learning, and the government encouraged remote work where possible to break transmission chains.

While the number of confirmed cases remained relatively low by international standards, the outbreak quickly overwhelmed health systems in two major cities during its peak.

Most importantly, policy missteps preceded the outbreak, such as the shortening of quarantine for flight crews from five days to three, infection control breaches at quarantine hotels, and low uptake of vaccination amongst first responders. In addition, the proliferation of disinformation and fake news on vaccines and COVID-19 have polarised public opinion and undermined solidarity.

At the same time, Taiwan also faces additional challenges largely as a function of geopolitics, and tensions with China have obscured Taiwan’s vaccine procurement, according to the government.

Further, the Taiwanese government also operates without the technical support or resources provided by the WHO to its member countries. Likewise, the full vaccination rate in Taiwan remains low, in part because of shortage of vaccines, though it is rising steadily.

More on this: Technocracy: a solution or a problem of its own?

While Taiwan has largely gotten on top of its outbreak, how it happened underscores the weaknesses of this form of governance.

Technocracy has become a ubiquitous feature in the national pandemic response, but decisions made by technocrats are not without blind spots. For instance, one of the initial clusters, spread in tea parlours – some of which functioned as adult entertainment venues – was overlooked as a potential hotspot.

Reluctant to cooperate with contact tracing, teahouse visitors and workers did not want to disclose details out of embarrassment, and the government’s technocratic framework had no plan B.

Fear of stigma impeded the speed of the ‘test, trace, track and treat’ philosophy which had worked so well during the first year of the pandemic.

Naturally, some form of technocratic governance will likely retain its presence in Taiwan until the whole world fully emerges from the pandemic. Yet, there is a need for the government to address the uneven impacts of the pandemic on society, and this can’t be left to epidemiologists alone.

The pandemic is more than a public health crisis, and policymakers fighting it need to recognise that structural vulnerabilities embedded within society need to be addressed. For example, limiting access to traditional dry markets, which has been floated by health experts, would affect older people more than young adults, so how can this uneven impact be accounted for in policy?

Likewise, economic effects of the pandemic are likely to impact women and young adults more as the unemployment rate climbs, and frontline health workers have an increased risk of struggling with mental health. A technical lens alone is not sufficient for addressing the unequal social and economic impacts of the pandemic.

While Taiwan’s approach functioned well during the first year, as the pandemic continues, it is beginning to show cracks. A focus on expertise clearly has its place, but governments across the region should look to Taiwan and be wary of the weaknesses of giving technocrats insufficient support outside their areas of expertise.

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