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25 May 2021

Why is Covid-19 resurging in Taiwan and across Asia?

Slugglish vaccination rates and complacent societies are undermining the continent’s pandemic success.

By James Chater

Taipei was strangely quiet last Sunday morning. As the city entered its first full day of near-lockdown restrictions, residents awoke to images of a pandemic long felt to be happening elsewhere: deserted city centre streets, empty subway stations and shuttered restaurants.

Taiwan, which has received international praise for its apparently airtight pandemic prevention, is currently contending with its first significant wave of domestically-transmitted coronavirus cases. After recording more than 250 days without a single local case, more than 3,500 local cases have been recorded since the new wave began.

The outbreak encapsulates a trend emerging across Asia. Countries initially lauded for their success in pandemic prevention are now either seeing cases creep up, or are battling stubborn third or fourth waves. In Japan, May has seen cases most days surpass 5,000, with seven-day averages matching its previous peak; in South Korea, a lengthy fourth wave has seen daily cases stagnate in the hundreds; and across Vietnam and Thailand and Singapore, infection rates are climbing after previous periods of stability. Experts in the region are now questioning whether the early successes of these countries have produced publics complacent to vaccines and basic preventative measures.

A majority of current cases in Taiwan have been linked back to a breach in quarantine by a China Airlines pilot. Numbers rose toward mid-May, before spiking to 180 last Saturday. The government responded by placing the capital Taipei and neighbouring New Taipei City – where most cases continue to be concentrated – under tier-three of four restrictions; indoor gatherings or more than five were banned, non-essential shops were to close and restaurants could only offer dine-in if strict social distancing measures were implemented. By Wednesday, as infections spread beyond original hotspots to cities in the south, health minister Chen Shi-chung announced all regions would be moving up to tier-three. On Tuesday, Chen confirmed those nationwide restrictions would be extended until mid-June as daily cases remain in the hundreds.

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Chunhuei Chi, professor of global health at Oregon State University, explained that Taiwan’s long period without domestic transmission could now prove detrimental. Relative stability in Taiwan had meant its vaccination program was less urgent and a lag had developed in up-to-date knowledge about the virus and its variants. Chi said that quick suppression of the odd local case earlier in the pandemic had “contributed to some complacency”.

Now, he continued: “Taiwan has become a victim of its own success.”

In South Korea, Japan and Vietnam as well – all of which were last year praised for their prevention methods – vaccination rates are slow; to date, the three countries have jabbed less than 8 per cent, 6 per cent and 2 per cent of their populations respectively. Mike Toole, a technical adviser to the Know Covid-19 Hub at the Burnet Institute in Melbourne, said that the likely reason for the slow roll-out was that, “Asian countries have largely been spared from the worst of the pandemic”.

In place of fast vaccine roll-outs, Toole explained that South Korea and Japan had been relying more on contact-tracing systems that were initially effective, but which now looked “overwhelmed”.

For both, administering the jabs – and not their supply – appears to be the key stumbling block. In late April, South Korea’s Disease Control and Prevention Agency announced it had agreed a deal with Pfizer for 40 million doses. That brought the country’s total number of doses to 192 million, enough to vaccinate almost the whole country twice, but vaccine rates still plateaued. Reports from Japan earlier this month revealed the country had tens of millions of unused doses.

This contrasts starkly with China where, despite a similarly sluggish start, vaccine rates have soared in recent weeks. On Monday, China administered more than 15 million doses, the sixth consecutive day it had delivered more than 10 million jabs.

[See also: Will Covid-19 mean another lost decade for Latin America?]

When the recent wave in Taiwan began, around 180,000 of its population – less than 1 per cent – had been vaccinated. Last Wednesday, 400,000 more AstraZeneca doses arrived in Taipei, purchased through the COVAX scheme. The pace of jabs has accelerated since the new wave began but, due to the time lag required for vaccines to become effective, Taiwan will have to rely on traditional measures of masks and social distancing to stop transmission in this wave from spiralling.

Alexandra Martiniuk, a professor of epidemiology at the University of Sydney, outlined the danger of complacency around vaccinations in places experiencing low rates of community transmission. She emphasised that once the virus is in the community it becomes very difficult to eradicate it completely; from that point on, Markiniuk continued,“you need a high [vaccine] coverage in your population to be stopping Covid in its tracks”.

Developments in the region will be watched closely by countries currently enjoying lower rates of infection. Toole said Australia – where low rates of domestic transmission have accompanied a lethargic vaccine roll-out – is watching Asia “with trepidation”.

Still, despite the upticks, claims of a total collapse of the region’s pandemic strategies are exaggerated. The implementation of tier-four restrictions in Taiwan would require 14 consecutive days of 100 cases with at least 50 per cent of unclear origin. At a press conference on Friday, health minister Chen Shih-chung responded forcefully to questions concerning the heightening of restrictions, saying that Taiwan was “absolutely not yet at tier four”. He elaborated that of Friday’s 312 local cases, only 72 cases had unclear origin, less than 25 per cent.

Professor Chi meanwhile, despite being optimistic about Taiwan’s capacity to bring this wave under control, also believes the outbreak holds an important wider lesson: “no matter how well a country protects its society from this pandemic, as long as the world is not safe, no country is safe.”

James Chater is a Taipei-based freelance writer. He tweets at: @james_chater

[See also: India’s nightmare shows Covid is becoming a primarily Global South pandemic]