Taiwan has successfully dealt with pandemic diseases through a strategic plan involving surveillance, contact tracing, social distancing, stockpiling antivirals and vaccines. Lessons from SARS and H1N1 pandemic response have strengthened Taiwan's preparedness. Taiwan shares disease information and provides aid internationally to support global health efforts toward pandemic control.

1. May 24, 2017
Dr. Jih-Haw Chou
Director-General
Taiwan Centers for Disease Control
Taiwan’s Approach to Dealing with Pandemic
Diseases and international cooperation
Pandemic Preparedness and Response
in Taiwan
~ Influenza ~

2. • Background
• SARS experiences
• Influenza Pandemic Preparedness Plan
– 4 strategies and 5 lines of defense
• Response to 2009 H1N1 Pandemic
• Taiwan’s Global Health Efforts
• Conclusion
2
Outline

3. Health Statistics of Taiwan
• Population: 23.5millions (in the end of 2015)
– aged population (above 65 years) reached 12.5%
– crude birth rate 9‰ ; crude death rate 7‰
• Life expectancy
– male: 77 years; female: 84 years
• Leading death causes
– cancer, cardiovascular diseases & cerebrovascular diseases
• National Health Insurance covers 99% of the population
• Proportion of annual health expenditure to GDP is 6.2%
3

4. Major Events & Outbreaks of
Communicable Diseases after 1990
1990s 2000s 2010s
1997-98
Dengue fever
2002
Dengue fever
2007-2008
Dengue fever
1998
Enteroviruses(EV71)
2003
SARS
2008
Enteroviruses(EV71)
2009-10
H1N1 pandemic
4
1999 TCDCset up

5. SARS Outbreak in Taiwan (2003)
Economic lost 5billions US dollars
5(Source: WHO. SARS: How a global epidemic was stopped. 2006)

6. Lessons We Leaned from SARS
• Delayed alert & reporting
• Hospital infection
• Ineffective commanding system
• Logistic burden
• High cost of quarantine
• Social panic : poor communication
• Economic loss : 5 billion US dollars
• Lack of inclusive international cooperation

7. Formulation of Preparedness Efforts
7
Antivirals
Interruption of
Transmission
Surveillance
Influenza
Vaccine
Maintenance of
Medical System Functions
Community Epidemic
Control
Border Control
Individual and Family
Protection
Containment Aboard
MAJOR STRATEGY
LINEOFDEFENSE
National Influenza
Pandemic Preparedness
Plan
(Preparedness Plan)
• Highest guiding principles
• Requisition of budget
Influenza Pandemic
Strategic Plan
(Strategic Plan)
Response Guidelines
• Outline of various control measures
• Employed by all authorities to
develop their practical plans
• Formulated specific operating
details

8. 8
Indicator Surveillance
Virology Surveillance:
• CDC Contracted Diagnostic
Virology Laboratories
• Lab Automated Reporting
System
Event monitoring
• Domestic and International
Media
• CDC 1922 Call Center
• PMDS (TFDA)
• International IHR cooperation
Syndromic Surveillance
• Real-time Outbreak & Disease
Surveillance
• National Health Insurance
Administration
• National Death Registry
Dissemination
Local Health Departments
Press Release
International IHR Cooperation
Early Detection:
• Border Fever Screening
• Sentinel Surveillance
• School-based Surveillance
• Populous Institutions
Surveillance
Influenza Surveillance 1/3

9. Interruption of Transmission 1/3
• Individual and Family Level
– Personal hygiene practices
– Isolation
– Quarantine
• Community Level  Social Distancing
– District Quarantine
– Enhancing Infectious Control: Public Gathering, Public
Transport
– Canceling Public Gathering Activities
– Suspending Classes or Closing School
– Closing Public Place
– Rapid Containment
– Sheltering
– Travel Advisory
– Cordon Sanitaire
9

10. Antivirals
• Stockpile to cover minimal 10% of population
• Multiple Stockpile: Tamiflu®, RelenzaTM, Rapiacta®, Avigan®
• Stockpile, allocation and provision of the antivirals
• Strategy for administration of the antivirals: treatment,
prophylaxis and rapid containment
10

11. Influenza Vaccine
• Seasonal Influenza Vaccination Program
– Nationwide in-School Influenza vaccination (NISIV) program
• Stockpile ‘Pre-Pandemic’ Influenza Vaccine
• Priming the high risk population (H5N1)
– Urgent procurement of pandemic vaccines
• Established the priority groups for pandemic vaccination
Reduce severe illness and death effectively
11

12. 12
Milestones of Influenza Pandemic Preparedness
Year Month Landmarks
2003 12 Started stockpile of antivirals
2004
1 Amended Communicable Disease Control Act
9 Commenced regular Preparedness Meeting at the DOH level
12 Included novel influenza virus infection as a notifiable disease
2005
5 National preparedness plan approved by Executive Yuan
7 Conducted the first cross-sector table-top drill for influenza pandemic
8 First NSC meeting chaired by the President
11 Commenced regular Coordination Meeting at the cabinet level
2006
1 Launched local influenza vaccine production program
7 Initiated continuity plan across government sectors & industries
2009 4
The Central Epidemic Command Center (CECC) of H1N1 was established
and operated 303 days
2010 8 WHO declared the world moving into the post-pandemic period

13. Response: 2009 H1N1 pandemic

14. 5/20 first
imported
case
14
Taiwan’s response to the 2009 H1N1 pandemic
Containment
Border Control
Case management
Public panic response
Vaccination
Mitigation
Surveillance
Public health interventions
Healthcare provision
2009.4 ~ 2009.6 2009.6 ~2010.3 2009.11 ~2010.11
APR MAY JUN JUL AUG SEP OCT NOV~FEB
4/28 WHO→phase 4
4/30 WHO→phase 5
6/11 WHO→phase 6
4/28
• CECC establish
• H1N1 was list as
Category 1
notifible disease
2009
7/2
community
outbreak
7/171st
severe
case
7/31 1st
death5/27 1st
native case 2010
2/23
CECC
diaband
6/19
• H1N1 was moved
to category IV
notifible disase
11/1
H1N1
vaccine
program

15. 15
Mortalities from 2009 H1N1 Pandemic
in Taiwan and OECD Countries
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
20.0
Mortalityratepermillionpopulation
0
500
1,000
1,500
2,000
2,500
3,000
Mortality rate per 1 million population
Number of deaths
Death count for non-OECD Countries: Mainland China (797), Hong Kong (73)

16. Lessons learned from H1N1 (2009)
• Lessons learned from SARS contributed significantly to the
response to H1N1 flu pandemic
• Rebuilding public trust in vaccine safety with better
communication strategies is an utmost important task
• Maintaining or expanding the seasonal influenza vaccination
program may strengthen the health care system and increase
our pandemic vaccination capacity
• International cooperation and collaboration are vital
• Better preparedness is always worthy
16

17. 17
Taiwan’s Global Health Efforts
• Continuously share disease surveillance informaion
• Share avian influenza virus sequences, isolates, information of
antiviral resistance, and treatment experiences with the
international community
• Conduct training programs on laboratory diagnosis and
epidemiology investigation for public health workers of other
countries.
• Donate Personal Protective Equipment (PPE) to countries in
urgent need
• Send experts to other countries to help disease control

18. Conclusion 1/2
Taiwan is Ready to help the WHO
achieve what its constitution states:
18
“The enjoyment of the highest attainable
standard of health is one of the fundamental
rights of every human being, without
distinction of race, religion, political belief, or
economic and social condition.”

19. Conclusion 2/2
Epidemic control needs cross-border efforts
Every piece of the world is indispensable

20. 20
Thanks for Your Attention!