New Zealand and Taiwan have both been internationally lauded for their successful responses to COVID-19, the latter recording just 544 cases of the virus - and now the countries have teamed up to share their secrets in a new study.
Local health researchers have swapped notes with their Taiwanese counterparts regarding their respective responses to the pandemic, the results of which have been documented in the paper, 'Potential lessons from the Taiwan and New Zealand health responses to the COVID-19 pandemic', for The Lancet Regional Health - Western Pacific journal.
Although Taiwan detected its first case of the virus on January 21, a month earlier than New Zealand, the East Asian country has reported significantly fewer infections per million people (20.7 vs 278.0 confirmed COVID-19 cases per million population respectively).
According to its latest data, Taiwan has recorded just 544 cases of COVID-19 in a population of more than 23.8 million, 495 of which are considered to have recovered. Seven people have died from the virus.
In New Zealand's team of five million, there have been 1556 confirmed cases and 25 deaths. Twenty-five new infections were reported on Wednesday, although 23 were imported.
The researchers acknowledged that Taiwan already had extensive public health infrastructure in place prior to the pandemic. Largely mapped out following the SARS outbreak in 2003, the systems were developed so they could be adapted to new pathogens, allowing the government to respond more rapidly and proactively to COVID. In doing so, the country avoided a stringent lockdown - an aggressive method New Zealand implemented twice this year to eliminate the spread of the virus.
Based on the notes, the authors of the study have identified key aspects of both models that could be adopted elsewhere, as countries across the world continue to grapple with COVID-19. The researchers agreed that Taiwan had a more proactive response while New Zealand's approach was more reactive, noting Taiwan is in an "a stronger economic position" due to avoiding lockdown measures.
Given that, there are elements of Taiwan's COVID response that New Zealand could learn from, in preparation for a future, potentially far more severe pandemic.
Unlike New Zealand, Taiwan immediately implemented health screening for all air passengers starting December 31 - the same day the World Health Organization was informed of the outbreak in Wuhan. By late January, its health officials had already put in place more extensive border screening for all new arrivals.
New Zealand's first case, recorded on February 26, initially coincided with the first set of entry restrictions for Chinese foreign nationals. Although both New Zealand and Taiwan did not impose wider restrictions to non-citizens until March, with New Zealand officially closing its borders to non-residents on March 19, Taiwan's earlier introduction of screening measures is "likely to have influenced the relatively lower case numbers", according to the researchers.
Taiwan's well-developed pandemic plan has also relied heavily on extensive contact tracing through manual and digital approaches and access to travel histories, the researchers noted, resulting "in fewer locally acquired cases".
The study found that New Zealand's contact tracing could have been strengthened by developing its digital method - the NZ COVID Tracer app - more rapidly.
The 'digital diary' technology, allowing New Zealanders to record their movements in the event of a community outbreak, was not available until May and "had limited functionality with initially poor uptake by the public", the study noted. A manual function has since been added, allowing Kiwis to document locations where QR codes are not present.
As of Wednesday, there were 2,311,700 users registered on NZ COVID Tracer. The app has recorded a total of 95,433,191 poster scans, and users have created 3,985,810 manual diary entries.
As in many Asian countries that had experience with SARS, Taiwan already had an established culture of public face mask use. It also has a policy supporting the production and distribution of masks to all residents, securing the supply, and providing universal access to surgical masks during the COVID-19 pandemic from February onwards, the study noted.
Taiwan also required the public to wear masks in confined, indoor environments - notably subways - even during periods without evidence of community transmission.
In contrast, health officials in New Zealand did not promote the use of face masks until August, despite science-based advocacy from a broad base of public health and clinical experts worldwide. Only following the Auckland outbreak in August did health officials mandate the use of masks on airplanes and public transport. However, they are no longer essential under level 1 of the alert level framework.
Public health infrastructure
Unlike New Zealand, Taiwan also already had a national alert system and a strong public health response in place prior to COVID-19's emergence, allowing its government to respond quickly to the outbreak. The authors of the study recommend the following:
- implement enhanced national and regional disease and outbreak surveillance systems, including sentinel surveillance and specialised systems such as wastewater testing
- develop effective border management policies that can be implemented quickly
- establish more robust quarantining rules and more secure facilities for incoming travellers
- further develop both conventional and digital solutions to contact tracing and isolation/quarantine monitoring
- develop an effective means of face mask distribution and promotion in case a border control failure occurs.
The study also recommends developing systems for evaluating pandemic responses and has suggested an official inquiry into New Zealand's response "would be valuable" given its comparison to Taiwan. The inquiry would help shape the necessary changes to our laws and public health infrastructure, the study says.
Read the full study and its recommendations here.