Crowds at
the Vroesepark in Rotterdam over the weekend.
Could the 'liberal' Dutch have learned from
Taiwan's approach to coronavirus?
Taiwan’s Covid-19 measures could be seen as intrusive.
But seven people have died there, compared with 5,000 in the Netherlands
Cha-Hsuan
Liu and Jaap Bos
Tue 19 May
2020 13.17 BSTLast modified on Tue 19 May 2020 13.35 BST
The whole
world has been struggling to contain the coronavirus and “flatten the curve”,
but Taiwan has had no curve. Out of a population of 24 million, only 440 people
have tested positive for Covid-19, and there have been just seven deaths.
Compare that with the Netherlands: while it is similar in size to Taiwan with a
population of 17 million, well over 5,000 lives have been lost to the virus.
What has made
the difference? Clearly, the Netherlands is not an island that could cut itself
off from the rest of world, lock down completely and thus contain the disease.
Taiwan is – but Taiwan didn’t do that either.
Public
spaces in Taiwan, restaurants, shops and schools, have all remained open since
the initial Covid-19 outbreak in Wuhan. Life in Taiwan has continued pretty
much the same as before. What Taiwan did however, was opt for a complex
tradeoff involving virus containment strategies and information gathering,
while balancing individual autonomy with trust and control.
But let’s
first consider the Dutch situation. As Covid-19 hit the Netherlands in March
2020, the public was simply advised to restrict travelling to and from
“affected areas”. When the crisis rapidly worsened, almost all subsequent
efforts were directed at minimising the spread of the disease and reducing the
influx of patients into hospitals.
The Dutch
prime minister, Mark Rutte, appeared on television and said that as he trusted
citizens to behave responsibly, it would suffice to request that people
remained at home as much as possible, observed the 1.5-metre distance protocol,
and self-quarantined or self-isolated when feeling unwell. Since no mass
testing for Covid-19 took place, the number of infected people and information
about who they were or where they had been was anybody’s guess.
To minimise
transmission of the virus, schools, offices, restaurants and bars were closed.
Work that could not be “contactless” was suspended, and all public gatherings
were cancelled. But no complete lockdown, as in Italy or Spain, was deemed
necessary. This was seen as too much of an invasion of our Dutch privacy. When
the day-to-day numbers of Covid-19 deaths started to drop below 100 per day, it
was considered a vindication of the policy of “intelligent lockdown”.
Taiwan’s
decisions have been partly motivated by its lack of trust in the information
shared by China and by Taiwan’s exclusion from the World Health Organisation at
China’s insistence. These factors have required it to be self-contained and to
insist, within a democratic framework, on a policy of maximum health
information transparency, both with and from the Taiwanese population. Taiwan’s
history and culture means there is a strong emphasis on the collective over the
individual. But its longstanding experience with epidemics such as Sars in
2003, and bird flu in 2013 have also been influential in shaping the response.
From the
outset, Taiwan’s president, Tsai Ing-wen, took aggressive steps to prevent a
possible epidemic, such as a travel ban on visitors from China and other
epidemic regions (Europe’s travel bans came much later).
Taiwan’s
approach relies essentially, however, not on its citizens’ anonymous individual
responsibility, but on a completely transparent form of supervised
self-discipline. And although the Taiwanese measures are considerably more
intrusive, paradoxically, they result in a remarkably liberal policy.
A
centralised epidemic command centre (the CECC) was quickly activated to provide
immediate information, including detailed surveillance of the movements of
infected people.
If anyone
reports to a hospital with Covid-19 symptoms, the hospital is obliged to report
to the CECC, which then traces the patient’s recent whereabouts and draws up an
anonymised “footprint” for them in public spaces, such as supermarkets or
restaurants. Mobile phone service companies are asked to send out text warnings
to anyone else who may have been in these spaces at the time. A typical message
reads:
“Epidemic
Alert. You have been in the proximity of an infected person. Please maintain
self-health management, keep to social distancing rules, wear a mask in public
and wash hands regularly. If you have any physical complaints, please contact
your local healthcare provider.”
All this is
done on the basis of confidentiality; the infected person is never identified.
Taiwan has
also introduced an “electronic fence” system. This allows local authorities to
monitor the whereabouts of a quarantined person. It uses mobile phone signals
to detect if an individual leaves their designated quarantine area; if they do,
the authorities are immediately notified.
While
Taiwanese citizens are aware that intensive monitoring involves an invasion of
their privacy, the vast majority acquiesce in the use of personal data and are
willing to comply with government regulations. Equally, mask-wearing in Taiwan
has become a cultural norm. It is considered a moral virtue to protect others
from one’s own infection, so as to break the chain, for the benefit of all.
So could a
country like the Netherlands have learned from the Taiwanese approach? The
Dutch government contemplated the voluntary use of a coronavirus tracking app
to alert a user if they had been in contact with a confirmed case, but
dismissed it after a national debate about privacy and security. Meanwhile,
Rutte and his cabinet have started to implement a four-month plan to relax
restrictions.
A key
difference, though, is that the western emphasis on autonomy and liberal
values, so solidly rooted in Dutch culture, assigns responsibility for the
collective health of a nation to the individual, whose behaviour is neither
especially informed nor monitored. Ironically, Dutch residents have paid for
this unsupervised self-governance with heavy restrictions on their right to
free movement, considerable uncertainty and a high death toll. In contrast,
Taiwan has demanded more monitoring and compliance of its people, but the
result is a healthier population, greater certainty, and ultimately more
liberty.
• Cha-Hsuan
Liu is a lecturer in social policy and public health at Utrecht University;
Jaap Bos is associate professor at the department of interdisciplinary social
science at Utrecht University
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