Taiwan has until now contained the spread of Covid-19. At the time of writing, Taiwan has not only “flattened the curve” of infections but has kept its confirmed cases below 500, even though it has been more than two months since it saw its first case. Less than 1% of the more than 60,000 tests that it has conducted so far have been positive.

1. Taiwan's Response to Covid-19 Is a Lesson in Managing Risk
By Dr.Mahboob ali khan
Taiwan has until now contained the spread of Covid-19. At the time
of writing, Taiwan has not only “flattened the curve” of infections but
has kept its confirmed cases below 500, even though it has been more
than two months since it saw its first case. Less than 1% of the more
than 60,000 tests that it has conducted so far have been positive.
How did Taiwan keep the coronavirus at bay? Using the Risk
Governance Framework developed by the International Risk
Governance Council (IRGC) helps us understand the strategies Taiwan
has adopted to fight Covid-19.
Early Pre-Assessment and Appraisal to Control Risk
Staff at Taiwan's Centers for Disease Control (CDC) noticed posts on
Taiwan’s online forum PTT on December 31 about a disease similar to
severe acute respiratory syndrome (SARS) spreading in Wuhan, China.
The CDC staff member quickly informed his colleagues at CDC which
then sent an email to the World Health Organization (WHO) asking for
more information. Taiwan’s government immediately held an inter-
ministerial meeting to appraise the risks, and implemented new
processes to control these risks. Beginning December 31, passengers
on flights from Wuhan had to undergo health screenings before they
were allowed to disembark the plane. Taiwan’s Vice Premier Chen Chi-
mai said that Taiwan was, “the earliest country to activate epidemic
prevention measures against this disease.”
Characterization and Involvement of Other Stakeholders to Manage the Risk
In order to more effectively manage this risk, the government on
January 8 listed the new respiratory disease as a category 5
communicable disease, granting legal power to enact new measures.
This would include the power to put people on forced quarantines.
Taiwan’s CDC visited local hospitals and negative pressure wards in
Wuhan to learn more about the disease, so as to be able to
characterize the virus itself. On January 15, it identified the hazard as a

2. “severe pneumonia with novel pathogens.” As the threat became
clearer over the course of January, with more cases of the new disease
cropping up in other parts of Asia, Taiwan’s authorities activated the
Central Epidemic Command Center (CECC) to involve other
stakeholders and government agencies in managing the risks. All these
steps happened before Taiwan saw its first Covid-19 case.
Development of Risk Scenarios and Corresponding Risk Governance Options
Taiwan saw its first confirmed case on January 21. As part of its risk
assessment, Taiwan developed five scenarios on how the coronavirus
outbreak could develop, and the adjustments to the risk governance
options it would have to make. The Ministry of Health and Welfare
Department of Medical Affairs director Shih Chung-liang said that if
suspected cases continued to increase, the CECC would move into one
of the next scenarios, centralizing its Covid-19 treatment in 21
hospitals. If the pandemic continued to get worse, the next scenario
called for 100 hospitals to be designated as isolation hospitals.
Stringent Testing Protocol to Cut off Source of Risk and
Strengthening Healthcare Organizational Capacity to Cope
The government decided on January 5, 2020, that they would conduct
retrospective testing of individuals who had traveled to Wuhan 14
days prior and who had fever or respiratory infections. On February
12, the CECC also decided to trace severe respiratory cases from
January 31 and who had tested negative for influenza to be tested for
Covid-19. Of the 113 tissue specimens tested, one was found positive.
Testing was later expanded to high-risk groups such as medical and
healthcare workers who develop fever or respiratory symptoms, in
order to prevent cluster infections from forming within the healthcare
institutions and disrupting Taiwan’s healthcare organizational
capacity. Of the 1,852 healthcare workers who had been tested as of
April 15, all have turned out negative.
As part of its risk assessment of its organizational capacity, Taiwan
also decentralized Covid-19 testing to 167 small hospitals. The
“infrastructure upgrades and data management experience” Taiwan

3. has also integrated its patient records and travel history for more
efficient tracking of travelers who developed Covid-19 symptoms, as
well as develop an efficient mask rationing system.
Conducting “Concern Assessment” to Address Socio-Emotional
Aspects of Risk
Taiwan understood the pertinence of provisioning surgical masks to
avoid panic buying and price gouging. The government invested more
than US$10 million to increase face mask production in Taiwan from
1.88 million masks a day in January to 15 million by april. A mask
rationing system was also implemented allowing each adult resident
to purchase two masks a week initially, which has now been increased
to nine masks every two weeks. Prices were also fixed at US$0.16 per
mask. Heavy penalties were enforced for price gouging.
In addition, the delaying of the opening of schools by two weeks acted
as a precautionary measure to prevent the virus from
spreading. Providing parents with 14 days of “disease prevention
childcare leave” was also part of the concern assessment, knowing
that current societal values and norms at workplaces in Taiwan might
make it difficult for parents to take leave to take care of their children.
Effective Risk Communication to Build Trust and Confidence, and
Reduce Panic
The CECC organizes daily briefings on the new cases confirmed as well
as new measures to be implemented. Taiwan’s Health and Welfare
Minister Chen Shih-chung who heads the CECC has also become a key
facilitator in this risk communication process.
Taiwan’s Premier Su Tseng-chang is also another key facilitator of the
risk communication – on the day the first Covid-19 case was confirmed
in Taiwan, he immediately addressed Taiwanese on his social media
platforms. When a bout of panic buying occurred when cases spiked
in mid-March from repatriating Taiwanese, Su also put up a
Facebook poster reminding Taiwanese to buy more food and eat
healthy, reminding his audience that Taiwan is a food-producing
country. Such clear risk communication has helped to allay the
concerns of Taiwanese, reduce uncertainty, as well as build

4. confidence and trustworthiness in the government’s ability to handle
the virus.
Expanded Risk Governance: Ethical, Legal and Human Rights Concerns
There are still gaps in Taiwan’s responses. Former director Chou Kuei-
Tien at the Risk Society and Policy Research Center (RSPRC) at the
National Taiwan University believes that there is a need for more
grassroots, stakeholder engagement in the risk governance process.
Nonetheless, RSPRC postdoctoral research head Chao Chia-wei
highlighted how the decentralized g0v (pronounced “gov zero”) civic
tech community was active in using the online community
infrastructure to develop open-source maps to track the stocks of
masks at pharmacies, as an example of stakeholders and citizen
scientists working together with the government on a social initiative
– Taiwan’s Minister without Portfolio Audrey Tang had provided the
National Health Insurance (NHI) data on pharmacy locations and mask
stocks for the maps.
Chou also pointed out that the public had privacy concerns about the
use of GPS data to track individuals on quarantine, the integration of
health records with travel data, and one particular case when the
travel history of an undocumented worker was released. Chou also
highlighted other ethical, legal, and human rights issues, such as when
the CECC announced a travel ban on medical workers in Taiwan at the
start of the pandemic – a decision it later reversed due to pushback.
Chou pointed out that the lack of a legal advisor on the CECC is a
concern.
Heightened Awareness of Risks due to Taiwan’s Geopolitical Situation
Taiwan has historically had to monitor diseases coming out of China.
Much attention has been paid to how Taiwan learned from SARS in
2003, which hit Taiwan hard – it had the third most number of cases
and deaths, with 346 confirmed cases and 73 deaths. It lesser known
that Taiwan has also been fending off the African swine fever (ASF).
The latest ASF outbreak started in China in August 2018 and has
since spread to more than 10 countries surrounding, but not including
Taiwan, which is enforced strict customs controls on meat products.

5. Effective Risk Governance to Ensure Resilience and Basic Functionality
of the System
While many countries undergo lockdowns, people in Taiwan go about
their daily lives, but with their masks on. This has been possible
because the risk management strategies described above. To fight
future diseases that are to come, and to enhance its preparedness,
Taiwan is also setting aside US$133 million over the next seven years
to setup a disease prevention center, which will also look into the
research, development and testing of vaccines and
biopharmaceuticals, as well as distributing rations.