Last month, I returned to Connecticut from a nearly three-month visit to relatives in Taiwan. In both directions of travel, I was able to experience the stark contrast between the COVID-19 situations in the two countries. Since the pandemic began, Taiwan has had fewer than 1,000 cases of COVID-19, and only nine deaths. Over a stretch of nine months between April and January, there was just one — that’s right, one — recorded community-based infection, the others being imported. Scaling these numbers up to the population of the United States, imagine if our country were now nearing its 14,000th case and 130th death from the disease, as opposed to 28 million cases and 500,000 deaths. Taiwan never went into lockdown, did not suffer major unemployment and did not require massive emergency governmental spending to stem socioeconomic losses. People work, shop and dine together in restaurants; children attend school in person and play together mask-free in parks.
What is the secret to Taiwan’s success? I believe that it hinges on the mutual attitudes of both the government and the people. The government, having recent enough experience with the SARS respiratory virus in the early 2000s, recognized very quickly the seriousness of a disease that spreads simply by people sharing the same space and breathing. As early as the end of December 2019, after learning of a mysterious cluster of pneumonia cases across the strait in Wuhan, Taiwanese officials moved swiftly to action, screening incoming Chinese air passengers for fever and establishing a coordinated plan for a possible regional or global outbreak. While most of the rest of the world was caught off guard, Taiwan’s quick response was enabled by post-SARS legislation and digital technologies that could provide rapid distribution of PPE to every citizen and integrate national ID cards with real-time geospatial data tracking, contact-tracing and check-in procedures at the entrances to all organized gatherings. The technology proved successful in a dramatic early instance of notifying, and testing as needed, more than 600,000 potential contacts of 3,000 disembarking passengers from a cruise ship that had identified onboard COVID-19 infections. The government has responded to subsequent cases with equal efficiency.
The Taiwanese people, also vividly remembering the SARS experience, were quick to take personal action. There may be an element of cultural luck, in that frequent hand-washing was already common practice, the etiquette of personal greeting doesn’t necessarily require hugs or handshakes and many people were already accustomed to wearing face masks to protect their lungs during daily motorcycle commutes. Masks are now mandatory on public transportation and in governmental offices and many businesses, but they are optional in open spaces — I often wore my mask even when not required, so as not to feed any possible stereotypes of Americans.
The more important aspect of the people’s response, in my opinion, has been their general attitude to following governmental directives. By and large, the Taiwanese citizenry shares a common trust in its leadership regarding internal affairs, buoyed by an enduring high standard of living and excellent national health care. Critically, this trust includes a willingness to sacrifice some freedom for the sake of public welfare. Like almost all incoming travelers, Taiwanese citizens included, upon arrival into the country I needed to stay in strict quarantine for 14 days. Even one step outside my apartment could have resulted in a $3,500 fine. There were certainly times when I wished I could enjoy a stretch outside in the often-empty small park that was tantalizingly 50 meters away from my front door, but I was informed by authorities that my cellphone’s location was being monitored, and I also knew that neighbors were alerted to my presence and situation by several visits from the police to check on me during the first few days of quarantine. In contrast, aside from filling out a declaration of my intent to self-isolate after last week’s arrival at JFK airport, I was basically free to enforce that document on my own, with little fear of actually getting caught if I were to stray.
What can we learn from Taiwan, and how much of their example can be scaled to the United States? Taiwan has more than 20 million people, about four-fifths of whom are packed into urban areas as densely populated as New York City, so its epidemiological challenges are comparable to those of any large country. Some would say that Taiwan has the advantage of being an island nation, but the basic infrastructures of today’s customs and immigration at international ports of entry are similar around the world. Some would say that compared to the United States, Taiwan’s relatively homogeneous ethnic majority could foster greater commonality of public opinion, but that stereotypical perception must accede to the fact that U.S. political polarization substantially crosses ethnic lines. Instead, I think the most pertinent factor of the Taiwanese pandemic success circles back to the concept of individual freedom and privacy, which have been considered sacrosanct elements of the United States’ domestic policy.
Living in Taiwan for the past few months, I experienced firsthand how a nation can afford its citizens and guests ample freedom of lifestyle while at the same time employing governmental power — and yes, a degree of surveillance — to ensure efficient operation of a healthy society. While it’s probably too late for the United States to fundamentally shift its COVID-19 strategy, perhaps we will be better prepared for the next pandemic if we’re willing to establish infrastructure, such as greater authority for the CDC to utilize mobile phone technology for contact tracing, that inevitably sacrifices some of our personal privacy for public good. But to do that, Americans will need to regain their trust in government, which will require dedicated effort by leaders and constituents alike.
DAVID EVANS is a Professor of Earth & Planetary Sciences and the Head of Berkeley College. Contact him at david.evans@yale.edu.
Editor’s Note: In the last sentence of the fourth paragraph (In contrast, aside from filling out a declaration of my intent to self-isolate after last week’s arrival at JFK airport…), last week was incorrect. It was last month.