The whole world has been struggling to contain the coronavirus and “flatten the curve”, but Taiwan has had no curve. Out of a population of 24 million, only 440 people have tested positive for Covid-19, and there have been just seven deaths. Compare that with the Netherlands: while it is similar in size to Taiwan with a population of 17 million, well over 5,000 lives have been lost to the virus.
What has made the difference? Clearly, the Netherlands is not an island that could cut itself off from the rest of world, lock down completely and thus contain the disease. Taiwan is – but Taiwan didn’t do that either.
Public spaces in Taiwan, restaurants, shops and schools, have all remained open since the initial Covid-19 outbreak in Wuhan. Life in Taiwan has continued pretty much the same as before. What Taiwan did however, was opt for a complex tradeoff involving virus containment strategies and information gathering, while balancing individual autonomy with trust and control.
But let’s first consider the Dutch situation. As Covid-19 hit the Netherlands in March 2020, the public was simply advised to restrict travelling to and from “affected areas”. When the crisis rapidly worsened, almost all subsequent efforts were directed at minimising the spread of the disease and reducing the influx of patients into hospitals.
The Dutch prime minister, Mark Rutte, appeared on television and said that as he trusted citizens to behave responsibly, it would suffice to request that people remained at home as much as possible, observed the 1.5-metre distance protocol, and self-quarantined or self-isolated when feeling unwell. Since no mass testing for Covid-19 took place, the number of infected people and information about who they were or where they had been was anybody’s guess.
To minimise transmission of the virus, schools, offices, restaurants and bars were closed. Work that could not be “contactless” was suspended, and all public gatherings were cancelled. But no complete lockdown, as in Italy or Spain, was deemed necessary. This was seen as too much of an invasion of our Dutch privacy. When the day-to-day numbers of Covid-19 deaths started to drop below 100 per day, it was considered a vindication of the policy of “intelligent lockdown”.
Taiwan’s decisions have been partly motivated by its lack of trust in the information shared by China and by Taiwan’s exclusion from the World Health Organisation at China’s insistence. These factors have required it to be self-contained and to insist, within a democratic framework, on a policy of maximum health information transparency, both with and from the Taiwanese population. Taiwan’s history and culture means there is a strong emphasis on the collective over the individual. But its longstanding experience with epidemics such as Sars in 2003, and bird flu in 2013 have also been influential in shaping the response.
From the outset, Taiwan’s president, Tsai Ing-wen, took aggressive steps to prevent a possible epidemic, such as a travel ban on visitors from China and other epidemic regions (Europe’s travel bans came much later).
Taiwan’s approach relies essentially, however, not on its citizens’ anonymous individual responsibility, but on a completely transparent form of supervised self-discipline. And although the Taiwanese measures are considerably more intrusive, paradoxically, they result in a remarkably liberal policy.
A centralised epidemic command centre (the CECC) was quickly activated to provide immediate information, including detailed surveillance of the movements of infected people.
If anyone reports to a hospital with Covid-19 symptoms, the hospital is obliged to report to the CECC, which then traces the patient’s recent whereabouts and draws up an anonymised “footprint” for them in public spaces, such as supermarkets or restaurants. Mobile phone service companies are asked to send out text warnings to anyone else who may have been in these spaces at the time. A typical message reads:
“Epidemic Alert. You have been in the proximity of an infected person. Please maintain self-health management, keep to social distancing rules, wear a mask in public and wash hands regularly. If you have any physical complaints, please contact your local healthcare provider.”
All this is done on the basis of confidentiality; the infected person is never identified.
Taiwan has also introduced an “electronic fence” system. This allows local authorities to monitor the whereabouts of a quarantined person. It uses mobile phone signals to detect if an individual leaves their designated quarantine area; if they do, the authorities are immediately notified.
While Taiwanese citizens are aware that intensive monitoring involves an invasion of their privacy, the vast majority acquiesce in the use of personal data and are willing to comply with government regulations. Equally, mask-wearing in Taiwan has become a cultural norm. It is considered a moral virtue to protect others from one’s own infection, so as to break the chain, for the benefit of all.
So could a country like the Netherlands have learned from the Taiwanese approach? The Dutch government contemplated the voluntary use of a coronavirus tracking app to alert a user if they had been in contact with a confirmed case, but dismissed it after a national debate about privacy and security. Meanwhile, Rutte and his cabinet have started to implement a four-month plan to relax restrictions.
A key difference, though, is that the western emphasis on autonomy and liberal values, so solidly rooted in Dutch culture, assigns responsibility for the collective health of a nation to the individual, whose behaviour is neither especially informed nor monitored. Ironically, Dutch residents have paid for this unsupervised self-governance with heavy restrictions on their right to free movement, considerable uncertainty and a high death toll. In contrast, Taiwan has demanded more monitoring and compliance of its people, but the result is a healthier population, greater certainty, and ultimately more liberty.
Cha-Hsuan Liu is a lecturer in social policy and public health at Utrecht University; Jaap Bos is associate professor at the department of interdisciplinary social science at Utrecht University