Why Taiwan, long a COVID success story, is seeing a record surge in cases

Hong Kong — Nearly a year and a half after COVID-19 started its surge across the planet, the streets of Taiwan's capital Taipei only now stand strangely empty. Bustling night markets for post-sunset stir-fry and steaming noodles, streets with constant streams of buzzing mopeds and the raucous bar district of Ximending, where locals and foreigners drink under the skies, have all fallen silent. 

It's a stark reversal of fortunes. 

Throughout 2020, Taiwan was held up as one of the world's greatest coronavirus success stories — a streak of 253 days without a single reported infection, from April until December. 

But the COVID-19 situation in Taiwan is now more dire than it has been since the pandemic began. The island has seen five consecutive days of triple-digit new infections and a doubling of its total number of cases in just the past week. On Wednesday, all 24 million residents were put under a "Level 3" alert — one step away from a potential national lockdown.

Mask-wearing in public is now mandatory, with indoor gatherings limited to five people and outdoor to 10. All businesses and public venues have been ordered to close. In-person classes at all public and private schools have been suspended until at least May 28. 

Most of the viral hotspots are in the island's north, in Taipei and the larger municipality of New Taipei City, which completely surrounds the capital. The combined population in the area is about seven million, roughly equal to that of Los Angeles, or three times that of Chicago.                

"I hope that by maintaining social distancing and establishing a public health front, we can effectively suppress the epidemic," Taipei Mayor Ko Wen-je told CBS News on Wednesday. "This is the resilience of Taipei's citizens: They remain cautious but they do not panic."

Low vaccination rate

Fewer than 1% of Taiwan's 24 million residents have been vaccinated, making it the least vaccinated population in Asia and one of the 10 lowest-ranking places in the world with at least 100,000 people, according to data gathered by The New York Times.

For comparison, Asia's most-vaccinated country is Singapore, where about 33% of the 5.8 million residents have received at least a first dose. At least 48% of all Americans have had at least one dose.

Last week, as Taiwanese rushed to get the few available shots, critics accused both the people and their government of falling into complacency. 

But Taiwan's low vaccination dilemma is a function of both access and apathy — a lack of the former, and an excess of the latter. 

Geopolitics and vaccine supplies

To date, Taiwan has only received shipments of about 316,000 AstraZeneca vaccine doses — two-thirds from the global equitable supply initiative known as COVAX, with the rest directly purchased from the British pharmaceutical giant.

Taiwan's government has about 20 million doses on order, mostly of the AstraZeneca vaccine and a smaller amount of Moderna's, all of which is scheduled to arrive before June.

In a surprise announcement on Wednesday afternoon, Health Minister Chen Shih-chung said more than 410,000 doses would arrive later in the day from COVAX.   

A deal for 5 million more doses from Pfizer-BioNTech, however, has been indefinitely stalled, possibly amid political pressure from Beijing.

China has considered Taiwan a renegade province since the Chinese civil war ended in 1949 with the Communist Party taking over the mainland and the previous government maintaining effective control of the small island off its shore.

Taiwan refers to itself as a country, and 15 nations formally recognize Taipei as its capital rather than Beijing. The U.S. is not among them but ties have strengthened, both during the Trump administration and with President Biden in the White House.

China-based Shanghai Fosun Pharmaceutical Group holds distribution rights across Greater China, which includes Hong Kong, the former Portuguese colony of Macau, and Taiwan. Just as Taipei was about to sign the deal with Pfizer's German partner BioNTech, the German drugmaker backed out. The spokesperson for the Chinese government's Taiwan Affairs Office, Ma Xiaoguang, said any allegation of obstruction was "pure fabrication." 

Meanwhile, in Washington this week Taiwan's de-facto ambassador to the U.S., Hsiao Bi-khim said she was in talks with the Biden administration to procure more vaccine.

"The epidemic situation in Taiwan will be like a tight string: Under high pressure, it may snap at any time," Mayor Ko told CBS News, adding that the success of other countries' aggressive inoculation campaigns clearly demonstrated "the importance of having mass-vaccinations."

"The United States has always been a reliable friend, and we hope that the United States can help Taiwan obtain the vaccines we need quickly," he said.

President Joe Biden earlier this week pledged to send at least 20 million doses from the U.S. to other countries by the end of June. His administration has not, so far, listed any of those countries or territories. 

An excess of apathy

While the rest of the world endured months of suspended animation in 2020, Taiwan enjoyed a near-normal existence, save for the ubiquity of masks, which, as across most of Asia, never became a politicized issue.

Otherwise, Taiwan relied primarily on closing its border to nearly all would-be travelers. But the confidence that the success of those measures gave the population blurred into complacency, as quarantine measures were shortened to just three days for pilots of Taiwan's flagship carrier, China Airlines.

Shortly after, at least two cargo pilots who had recently flown through the U.S. and Germany were confirmed as some of the first positive COVID-19 cases in Taiwan. That grew to include at least a dozen pilots, several family members, at least one flight attendant, plus hotel staff at their quarantine hotel in Taipei and, notably, cases at the hostess bars in the capital's red-light district in Wanhua. Contact tracing became difficult, if not impossible, as people avoided association with the establishments and failed to identify themselves.  

The Taipei mayor told CBS News that "revealed a major blindspot in Taiwan's epidemic prevention mechanism, which is the existence of double standards. General visitors entering Taiwan must go through home quarantine for 14 days. Airline staff often fly internationally and are outside the protection of Taiwan's epidemic prevention measures, so they have a higher risk of infection."

As COVID-19 started to surge across the wider population in mid-May, so did the number of people who finally decided they needed a vaccine. On May 14, when Taiwan reported a record 29 indigenous cases in a single day, the number of people getting vaccinated also hit a record of more than 32,000.

That brought the total to more than 186,000 doses administered, and left roughly a similar amount of doses available in the country.

Taiwan's Centers for Disease Control had officially opened up vaccination to the general public a month earlier, in mid-April, for a fee of about $21. That policy was suspended earlier this week, with doses again being reserved only for higher-risk groups, including the elderly and health care workers. 

Now, as Taiwan's coronavirus caseload continues to rise, the island is paying the price for both the missteps of a few in leadership roles, and the apathy of the masses. 

With Taiwan's acknowledged experience dealing with the SARS virus outbreak in 2003, many expect the government to correct its course quickly. 

The next few weeks will be pivotal, and could mean life or death for some on an island once heralded as the safest place in the world during the COVID-19 pandemic. 

In:
• Taiwan
• COVID-19
• China