Vaccines are not the only fruit

Taiwan and other places show there is another way to respond to covid-19

September 2021

There’s more than one winning strategy

When the covonavirus began spreading widely in early 2020 governments had two basic options.

They could try to:

1 – eradicate the virus by isolating people and tracking their movements, or

2 – fight the virus with vaccines.

At the start, most countries took the first option, and tried to control the spread. But many quickly abandoned this approach as the number of infections grew, and there was a backlash against restrictions on individual freedom. They then switched to the second option, and focussed on the development of vaccines.

In Taiwan, and a few other places, the government took the first path, and stuck to it.

Which fared better?

Approach A Vaccine-based strategy

With a vaccine-based strategy, companies first have to develop and manufacture suitable vaccines, people need to receive them, often twice, and then wait until they become effective. If their effectiveness lasts a short time, people need to get booster shots. Vaccines also have to be administered to the vast majority of the population to have the desired effect.

As well as costing lots of money, the vaccine-focussed approach takes months to work. During that time, if the policy of tracking and eradication has been largely abandoned, the only way to protect people is to encourage them to isolate as much as possible, and ask them to wear face masks. The vaccine approach is also risky: new variants can make vaccines less effective, or even render them useless.

A vaccine-based strategy also means that a lot people will still get infected with the virus. Hospitals will fill up and those with other medical problems won’t always get the treatment they should. When infections get out of control, as they will at times, people still have to be forced to stay at home and schools have to be closed.

All this carries difficult consequences.

Being cooped up for a long time, even voluntarily, makes many people depressed, and many others angry. When schools close, children don’t get educated. The endless uncertainty means trust in governments declines. Domestic violence increases, as do relationship problems. Suicides and accidental deaths rise too.

As a result of this approach the overall death rate in the US and UK is currently 18% above the long term average. The number of people suffering from long-covid has also mushroomed, bringing potentially difficult health consequences for tens of millions of people in the future.

While many parts of the economy have suffered from the disruption, the pharma sector and a few other businesses have boomed. Overall though, the economies of the countries which have taken this approach have mostly stagnated or shrunk.

Approach B Eradication strategy

The strategy adopted in Taiwan (and New Zealand, Hong Kong, Singapore, Cambodia, Vietnam and China) has been altogether different. These places have stuck with the policy of eradication, at least until the value of the vaccines was proven.

In China this has sometimes meant nailing people into their homes for weeks to stop the spread of the virus.

But it doesn’t have to be like that. Taiwan and these other places have shown that it’s possible to control the spread of infection more humanely.

It IS possible to get people to maintain a distance from each other, wear a mask and wash their hands as long as they see it makes sense. Reflecting on the situation in the US and Europe helps here, as does a society more doubtful about the notion of unrestrained personal freedom.

It IS also possible for people to sanitise their hands when they get on a bus and scan a QR code when they go into a shop. It IS possible for restaurants to operate with social distancing and supplement their income with deliveries. It IS possible to track and trace the contacts of those who get infected and isolate them. It IS possible to shut the borders and insist that even fully-vaccinated returning citizens spend 14 or, in Hong Kong, 21 days in a government managed quarantine facility at their own expense.

It IS possible to do all this while the vaccines are being developed, proven, and distributed. If a new variant emerges, it’s impact should be manageable.

What are the consequences?

Better to have a selection of tools

Some parts of the Taiwanese economy have grown, other parts have not. Many small businesses and those dependent on tourism have closed. But the high tech sector has boomed.

Overall though, the Taiwanese economy is growing at its fastest rate in decades, with exports at record levels. Schools and universities have remained mostly open.

The eradication approach also means that hospitals have not been over-burdened with covid cases and have carried on as before. Long-covid is almost unknown. We meet people every week who have never heard of it.

The number of infections has also remained small. When there was an unexpected surge in cases in Taiwan earlier this year, restrictions were imposed for several months until numbers were brought back under control.

Compared to the long term average, the death rate in Taiwan has risen by just 0.5%. With vaccines more easily available, and their value better proven, a clearer path ahead seems to be emerging. Even so, with China making Taiwan’s access to vaccines difficult, barely 5% of the population is currently fully protected, though more than 40% have had a first dose.

In contrast, too great a focus on the vaccine-strategy alone seems to have forced many people onto a roller-coaster existence of ups and downs, with moments of great terror and joy, but no clear idea about when the journey will end.

Taiwan and other places show it doesn’t have to be like that.

Thankfully, that message seems to be slowly getting out.