What NZ can learn from Taiwan about preparing for a pandemic

New Zealand’s approach to the Covid-19 pandemic gained international recognition after measures such as border closures, widespread testing, and the initiation of a historic nationwide shutdown helped to remove the deadly virus from our environment.

But it is the proactive stance taken by another island nation some 9,000 kilometers away that has been hailed as “the most effective and least disruptive of any country” in the world.

The response to the Taiwan pandemic is lauded in a study involving researchers from the University of Otago in Wellington published in The Lancet Regional Health: Western Pacific medical magazine Wednesday night.

Battle-hardened after facing the Sars and H1N1 swine flu pandemics in 2003 and 2009 respectively, Taiwan benefited from strong pandemic preparedness and extensive public health infrastructure to combat Covid-19, which is crucial, without the need to close.

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The approaches taken by Taiwan and New Zealand are analyzed in the study, in which kiwi academics compare notes with their counterparts from the National Taiwan University and the Taiwan Centers for Disease Control.

By the end of August, Taiwan, with a population of 23 million, had reported 488 cases and seven deaths, while New Zealand’s team of five million reported 1,397 confirmed cases and 22 deaths.

Taiwan, which has very close historical and cultural ties to mainland China, was quick to spot the outbreak in part because businessmen on the ground began reporting in December that something strange was happening in Wuhan.

Taiwanese officials began screening people arriving from Wuhan on Dec. 31, about 10 days before China admitted there was an outbreak of a strange virus, and they blocked people from Wuhan traveling to the island since Dec. 23. from January.

Taiwan’s superior response has sparked renewed calls for a full-scale investigation into New Zealand’s overall Covid-19 response from academics, led by Dr. Jennifer Summers.

Also contributing were prominent epidemiologists, Professors Michael Baker and Nick Wilson, both advisers to the Government during the pandemic.

Baker says that although both countries adopted elimination strategies, where the end game was total virus suppression, there were key differences.

“What’s remarkable about Taiwan is that by starting early and doing case-based work and managing their borders very carefully, they were able to avoid a lockdown, and that’s really the big difference,” he says.

“They took what is really a very effective proactive approach and New Zealand took a very effective reactive approach, so we waited until the pandemic was already setting in New Zealand and then we reacted very effectively.”

New Zealand implemented one of the strictest locks in the world to achieve the same result as Taiwan: eliminating the virus.

“We had the same goals, but Taiwan did better by starting earlier and using many other methods that meant transmission was avoided,” says Baker.

Thanks to its close business ties with Wuhan, Taiwan was able to act very early, the same day the World Health Organization was alerted to the outbreak.

Taiwan benefited from having a functioning Center for Disease Control and a National Health Command Center dedicated to responding to emerging threats like pandemics, Summers says.

“The agency had the authority to coordinate [between] government ministries and departments, a cohesive national response. And they did it from day one. ”

Despite Taiwan’s exposure to China and dense population, the autonomous island had a substantially lower virus incidence rate of 20.7 cases per million people, compared to New Zealand’s 278 per million.

New Zealand was on the defensive thanks to historically low levels of investment in public health, the authors said, and its comparative inexperience in managing epidemics. She was forced to rely on her Influenza Pandemic Plan to guide her response in the early stages.

This was problematic as the plan was not designed to accommodate different diseases with varying characteristics, and Summers described it as a “significant limitation to New Zealand’s response to Covid-19.”

It relied on the mitigation strategy of “flattening the curve” and delaying the peak of the epidemic to reduce health impacts, according to the report. The strategy was finally abandoned when Prime Minister Jacinda Ardern announced in March that the country would enter a lockdown and seek removal.

Taiwan also benefited from extensive digital technologies for contact tracing and very clear quarantine rules.

Like other Asian centers, Taiwan has a well-established mask-wearing culture. His government had a strong policy of supporting the production and distribution of masks to all residents, “ensuring supply and providing universal access to surgical masks … as of February 2020,” the study says.

People were required to wear masks in close quarters, including the subway, as well as during periods when there was no community broadcast.

In contrast, until August, health officials here resisted calls from public health specialists, including Baker, to promote mass masking.

The study has numerous recommendations, including the development of effective border management policies and associated infrastructure to allow responses to scale up rapidly as outbreaks occur.

Stronger quarantine rules should also be advocated, as well as safer facilities for inbound travelers, as well as the development of better digital solutions for things like contact tracing, he says.

In essence, the study says that New Zealand authorities should examine Taiwan’s response for “transferable elements that could improve [our] current answer ”.

“I would say that New Zealand has received a little warning with Covid-19, and we can see the sad reality, not only here in New Zealand, but also in other countries,” says Summers. “We can draw on the lessons and experiences of Taiwan, and what they have done over the past 20 years to develop our own defenses against a future pandemic.” .

Measuring Covid-19 responses as of August 2020 – in numbers

TAIWAN

• Total confirmed cases: 488
• Number of deaths from Covid-19: 7
• Total tests performed: 177,317
• Estimated population: 23 million
  • Population density: 652 people per square kilometer
• First case: Jan 21, woman over 50 returning from teaching job in Wuhan

NEW ZEALAND

• Total confirmed cases: 1,397 (excluding probable cases)
• Number of deaths from Covid-19: 22
• Total tests performed: 766,626
• Estimated population: 5 million
• Population density: 18.4 inhabitants per km2
• First case: February 28, woman in her 60s who arrived from Iran via Bali.

Key similarities

• Universal public health system
• High level leadership
• They both had daily press conferences
• Public health messages
• Specific financial support available

Key differences

• Planning for Pandemic Preparedness and Public Health Infrastructure (Taiwan)
• New Zealand blocked, Taiwan not
• Digital Contact Tracing Systems Established (Taiwan)
• Established culture of wearing masks in Taiwan
• New Zealand is slower to introduce border controls than Taiwan