The resilience of Taiwan's health system to address the COVID-19 pandemic

A new book by world-leading economists gives clear advice on how to mitigate the COVID-19 pandemic: “Act Fast and Do Whatever It Takes” [1]. Yet, countries that have done so are the exceptions rather than the rule and one of them is Taiwan. With 446 cases and 7 deaths as 22nd of June 2020 in a population of 23.8 million, Taiwan has remained relatively unscathed so far despite its proximity to the virus epicentre [2]. How was Taiwan able to respond the way it did? Here, we examine Taiwan’s response using the World Health Organization (WHO) health system building blocks [3]. The Taiwanese government’s response to COVID-19 has been characterised by speed, vigilance and decisiveness. As early as 31st December 2019, when the first reports of a novel virus in China emerged, Taiwan began to screen arrivals from Wuhan, imposing home quarantine on those with fever and or respiratory symptoms. By 20th January 2020, the government activated their Central Epidemic Command Center (CECC), which operated well in combating the outbreak of severe acute respiratory syndrome (SARS) in 2003, to coordinate cross-ministry efforts in handling the new pandemic. On 23rd January, Taiwan was the first country to ban visitors from Wuhan, and this travel ban was progressively extended to other affected countries. From 19th March, Taiwan banned the entry of non-residents and imposed home quarantine on all returning residents [4]. The American experience is a reminder that lack of health insurance for large parts of the population is a major barrier to mounting an effective outbreak response [5]. Taiwan has a single-payer national health insurance (NHI) scheme that covers more than 99% of the