8 votes

To prepare for future pandemics, we can learn from the OECD's top two performers: New Zealand and Iceland

3 comments

  1. [3]
    EgoEimi
    (edited )
    Link
    Unsure why the authors chose to look at only OECD countries. Inarguably Taiwan's performance is far more remarkable than New Zealand and Iceland's, given its human proximity to China. China has...

    Unsure why the authors chose to look at only OECD countries. Inarguably Taiwan's performance is far more remarkable than New Zealand and Iceland's, given its human proximity to China.

    China has more international traffic with Taiwan than any other country, so Taiwan was exposed to the initial outbreak earlier and harder than any other country.

    Despite that and having a population of 24 million living in very dense cities with high levels of interpersonal contact, the country achieved virtually zero cases and deaths during the pandemic until it eased border controls late 2022.

    Taiwan's strategy:

    • Taiwan's CDC's media monitoring unit detected rumors of atypical pneumonia in Wuhan, which gave the government warning that something was happening.
    • In response to the SARS outbreak, Taiwan established a central health command center:
      • Centralize communication between authorities at all levels: central, regional, and local.
    • Integration and data-sharing between various agencies.
      • National Health Insurance Administration and the National Immigration Agency integrated patients' NHI data with their travel history. All hospitals could see patient travel history. Government could identify high-risk individuals for electronic monitoring.
    • Biosurveillance: digital fencing. The USAF has an interesting paper on how Taiwan implemented and enforced a soft surveillance system in a society that was wary of its authoritarian martial rule era.
      • People entering the country were subject to mandatory location tracking through their phone and quarantine in an assigned hotel room.
      • Quarantining travelers were provided for.
      • When someone stopped reporting their location, the police would be dispatched to physically verify their location.
      • There was a heavy penalty of NT$1mil (or ~US$32k) for breaking quarantine.
    • Effective public communication
      • Public health procedures were disseminated
      • The penalty for purposefully breaking quarantine was made well known
    • Public compliance and cooperation
      • Taiwanese culture is shame-based (see Guilt–shame–fear spectrum of cultures), so people were motivated to not break protocol and infect others.
      • Societal consensus created immense peer pressure to comply with public health measures.
    8 votes
    1. [3]
      Comment deleted by author
      Link Parent
      1. NaraVara
        Link Parent
        I don’t know if NZ and Iceland are really “like to like” among OECD countries. They’re both small, island nations for whom most of their inbound travelers are there for tourism. The state of New...

        I don’t know if NZ and Iceland are really “like to like” among OECD countries. They’re both small, island nations for whom most of their inbound travelers are there for tourism. The state of New York alone has 4x the total population of New Zealand and can’t just lock out its borders.

        8 votes
      2. EgoEimi
        Link Parent
        It's interesting that you mention this. Now I think about the study that, given the trolley problem of killing three seniors vs. three youths, found that people in collectivist cultures—namely...

        I definitely felt scared of infecting others as well - but not sure if this was a common feeling. There is some similarity to the Taiwanese narrative about protecting others - the vaccination campaigns targeted younger people to vaccinate in order to protect their friends and family.

        It's interesting that you mention this. Now I think about the study that, given the trolley problem of killing three seniors vs. three youths, found that people in collectivist cultures—namely East Asian—were more likely to spare the elderly, hypothetically because those East Asian cultures place heavy emphasis on respecting elders. Link to article describing study.

        The prospect of endangering the elderly may be cultural anathema to many Taiwanese. In contrast, I observe that many Americans—particularly conservatives—tended to view catching COVID as an individual risk.

        The 'vaccine passport' was not well implemented. In hospitality venues for example, they would have had to hire an extra staff member to verify vaccine passports and check them against ID. Most of the time you wouldn't get checked.

        The 'mask exemption' system was a total joke. You would just email the agency and they would provide a print-out card saying 'I have a mask exemption', without actually going through a process to vet if an exemption is required. An actual exemption could supposedly be obtained through the medical system but you could just print the card and go on about your way.

        Disease poses a fundamental challenge for modern societies that cherish liberty: it's clear that voluntary compliance is insufficient because so long as a significant minority of the population does not comply with health measures, disease will spread. So how much civil liberty do we need to suspend to stop disease, and how much will a society tolerate?

        We were "fortunate" that COVID was only slightly deadly, with a CFR (case fatality rate) of 0.5~1%. Despite the tragedy it inflicted on millions of individual families, its CFR still pales to SARS' 10% CFR, MERS' 34% CFR, and Ebola's 50% CFR. Luckily those couldn't spread easily. But what if a new, equally infectious disease emerges with, say, a whopping sustained 3% CFR?

        I wonder if we'll have the infrastructure and will to confront that challenge, or if we'd repeat the missteps of the COVID pandemic again.

        6 votes