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How Long Will Taiwan Stick to Its Zero-COVID Approach?

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How Long Will Taiwan Stick to Its Zero-COVID Approach?

Taiwan is one of the few places still attempting to bring case counts down to zero amid the Omicron outbreak.

How Long Will Taiwan Stick to Its Zero-COVID Approach?

Vice President William Lai is flanked by a worker in full PPE while walking through the airport, January 30, 2022.

Credit: Office of the President, ROC (Taiwan)

Due to a combination of high vaccination rates and the more contagious Omicron variant, more and more developed countries are shifting to a “living with COVID-19” approach, lifting restrictions and accepting the virus as endemic. New Zealand and Singapore, both lauded for their COVID-19 containment efforts, have moved toward full reopening, counting on high vaccination rates to keep their populations safe.

Taiwan, however, is bucking the trend and sticking with its zero-COVID strategy.

Since an outbreak that began last May and peaked in June 2021, with 476 domestic cases reported on June 5, Taiwan has remained relatively COVID-free. By July 2021, daily case numbers for domestic cases returned to the single digits for the first time. August 25 saw the first day with zero cases since the start of the outbreak.

The 2021 outbreak took place after more than a year in which Taiwan was COVID-free. In 2019, Taiwan moved quickly to shut borders and boost the production of medical masks, alcohol sanitizer, and other medical supplies used to prevent the spread of COVID-19. Taiwan also instituted a QR code registration system at stores and other establishments for contact tracing. Contact tracing was used to track down COVID-19 cases and individuals who had been exposed to the virus. As such, last summer’s surge was the only major outbreak experienced by Taiwan of COVID-19 to date.

The 2021 outbreak began among pilots and airline staff at Taoyuan International Airport, Taiwan’s major gateway to the international world. The more infectious Delta variant contributed to development of clusters among pilots and other airline staff. Much political contention ensued around the Tsai administration’s decision to lower the quarantine period for pilots, as well as Taiwan’s then-lacking access to COVID-19 vaccines.

Life returned to some semblance of normalcy after last summer. But with inbound travel before the Lunar New Year and the emergence of the even more infectious Omicron variant, there were concerns that the situation was ripe for another wave of COVID-19 cases. These fears seemed justified when cases returned to about around a dozen per day in past weeks, then suddenly jumped to 82 cases on January 22. The spike in cases was linked to a cluster at the Farglory Free Trade Zone, primarily at the Askey Computer Corporation, as well as at the Ingrasys Technology Corporation, a subsidiary of FoxConn/Hon Hai.

This cluster was primarily among migrant workers, reminiscent of how clusters developed among migrant workers in Miaoli in June 2021 due to crowded conditions in factories and in the dormitories that migrant workers live in. As with other places in the world – Singapore being one often-raised point of comparison regarding clusters among migrant workers – COVID-19 reveals existing social inequalities, and this certainly was the case in Taiwan.

Particularly worrisome was that the sudden spike on January 22 was reminiscent of the initial explosion of COVID-19 cases in May 2021. Daily domestic case numbers increased from around a dozen cases per day to an explosion of 180 cases on May 15. The jump to 180 cases prompted a declaration of level three alert status – just short of a full lockdown – by the Central Epidemic Command Center (CECC), the government body headed by Minister of Health and Welfare Chen Shih-chung that coordinates Taiwan’s COVID response.

The January outbreak, though, did not follow that pattern. On January 23, 52 domestic cases were reported, with another significant cluster at the Port of Kaohsiung. Genetic testing later suggested that this was due to COVID-19 entering through the port and then spreading among port workers. In the same timeframe, multiple COVID-19 clusters were found at hospitals, due to spread from imported cases to medical staff or hospital residents.

Despite the uptick in cases, the CECC and Tsai administration did not announce a level three alert, citing the mild symptoms seen in domestic cases of the Omicron variant and the high rate of vaccination in Taiwanese society.

Indeed, when the COVID-19 outbreak took place last year, vaccination rates in Taiwan were low, partly because of fears of the side effects of vaccines amplified by the Taiwanese media, and also because Taiwan being COVID-free led to low interest in being vaccinated.

Taiwan’s first-dose vaccination rate currently is around 81.67 percent, with 74.62 percent second-dose vaccination coverage. There are plans to reach 50 percent booster shot coverage by the end of February. That being said, vaccination rates for Taiwan have stalled at around 80 percent, with the main reason thought to be vaccine hesitancy among the elderly.

Although January 26 still saw 46 domestic cases reported, daily domestic cases subsequently declined back to the tens, with some exceptions. The number of imported cases found through testing on arrival or in quarantine still remains high, due to increased inbound travel to Taiwan over the Lunar New Year holiday. It remains to be seen whether there will be any uptick of cases due to travel within Taiwan due to family gatherings.

According to the CECC, the Lunar New Year holiday saw the largest number of people put in quarantine since the COVID-19 pandemic began, with over 40,000 quarantined due to travel or contact with cases. At the same time, the CECC took a stance of not explicitly discouraging family gatherings. This contrasts with last year’s outbreak, when train and bus capacity was limited during holiday periods as the Dragon Boat Festival, with traffic volume on highways also reduced.

Even without government restrictions, many Lunar New Year gatherings were canceled nonetheless. Whether there are any effects from the holiday gatherings that did take place will become clear over the next week or two.

During this recent outbreak, for the most part, local mayors were not clamoring for a shift to level three alert status. With last year’s outbreak, pan-Blue mayors such as Taipei mayor Ko Wen-je and New Taipei mayor Hou You-yi – both of whom are thought to have presidential ambitions – sought to seem more proactive than the Tsai administration by escalating the COVID-19 alert status before the CECC did. They also declined to downgrade the alert status when the CECC gave the green light to do so.

Though Ko claimed with the recent outbreak that he intended to shift from the current level two alert to “level 2.5,” for the most part, local leaders may have been cautious about the economic impact from another shift to level three alert status. Another factor may have been the fact that the outbreak took place primarily in cities with DPP mayors, such as Taoyuan and Kaohsiung.

Consequently, while the outbreak seems to have been contained for now, it has raised questions about whether Taiwan will maintain its current zero-COVID strategy or not. Much international reporting has zoomed in on China as the primary example of a country that has continued to pursue a zero-COVID approach, but Taiwan has also maintained this strategy. However, Taiwan has primarily done this through voluntary measures and the widespread use of contact tracing, rather than the snap lockdowns used in China, which have sometimes been deemed authoritarian.

In Taiwan, government officials otherwise politically at odds – ranging from Minister of Health and Welfare Chen Shih-chung to Taipei mayor Ko Wen-je – have spoken of the need to eventually co-exist with COVID-19 since last year. There has been some recognition of the need to eventually accommodate COVID-19 from the onset.

That being said, when questioned by the media, Chen has stated that the CECC continues to adhere to a zero-COVID approach and that it believes Omicron can still be contained through a test, trace, and isolate regimen. Yet the CECC does not rule out that in the future, this approach might fail to contain more infectious variants of COVID-19.

Even as more than 300,000 people are vaccinated per day in Taiwan, primarily with booster shots, the fact that first-dose vaccination seems to have plateaued is concerning. The rapid spread of COVID-19 through Australia, which has a similar population and vaccination rate to Taiwan but now sees tens of thousands of cases after reopening, raises more questions about whether a relaxation of measures would tax Taiwan’s medical system.

Either way, there have generally been few domestic calls for lifting COVID-19 measures wholesale. With the Tsai administration having recently triumphed in a national referendum over the KMT, this could potentially be seen as a result of public approval of its successes in fighting COVID-19. And the Tsai administration is likely to be reluctant to squander this political capital by prematurely lifting COVID-19 measures.

The KMT, too, may hesitate to call for lifting COVID-19 restrictions. But it has attacked the Tsai administration for the effects on Taiwan’s economy from pandemic management measures in the past, calling for Chen Shih-chung’s replacement during periods when Taiwan’s COVID-19 situation was stable. The issue is expected to be increasingly debated going forward.