Position Statement 26: What we can learn from those who have responded best to the pandemic?

Our health in the time of an epidemic largely depends on our behavior – the decisions made by government officials and people’s readiness to comply with restrictions.

Our country is now seeing several hundred deaths a day, and yet many people in Poland do not follow even the basic recommendations regarding mask-wearing, social distancing, disinfection, and ventilation. Almost half of those eligible for vaccination have not been vaccinated, despite the fact that vaccines are effective and widely accessible. The reasons for this situation include insufficient state involvement in the fight against the pandemic and contradictory messages sent out by government officials on such topics as vaccination.

From an epidemiological perspective, government inaction should be considered reprehensible, given that the Poles took a serious approach to the pandemic at the beginning of 2020, and decision-makers were given a considerable dose of public trust and the time to implement adequate solutions. However, this time was wasted, and the public trust was exhausted. The practical absence of the state in the fight against the pandemic and failure to implement a policy of restrictions against unvaccinated individuals is probably a result of political calculations.

Was the decision to leave the Poles on their own in the face of the pandemic the only option? It is instructive to compare the measures taken by other societies to contain the pandemic. One interesting, but not isolated example is Taiwan, a society that has considerable experience in tackling similar pandemics. By anticipating the impending crisis early and issuing clear health recommendations on a daily basis, the Taiwanese authorities were able to provide the public with timely, accurate, and understandable information about the spread of the epidemic.

This is a special example: since the outbreak of the COVID-19 pandemic Taiwan has reported very few infections [Fig. 1] and deaths [Fig. 2] and no economic losses
[Fig. 3], and the level of restrictions has remained stable and low [Fig. 4]. There are many factors behind this successful response. In this position statement, we only describe those that should serve as examples of good practices also for us. Many of these are related to the approach to the fight against the pandemic: a clear strategy, professionalism of institutions, and good communication. Others cannot be imitated, for reasons that include Taiwan’s being an island.

Figure 1. Daily new confirmed COVID-19 cases per million people in Poland and Taiwan, 7-day rolling average. The red color corresponds to Poland, the green color corresponds to Taiwan. Horizontal axis: date (diagnosis month); vertical axis: number of cases. Source of data: JHU CSSE COVID-19 Data, https://github.com/CSSEGISandData/COVID-19.
Figure 2. Daily new confirmed COVID-19 deaths per million people in Poland and Taiwan, 7-day rolling average. The red color corresponds to Poland, the green color corresponds to Taiwan. Horizontal axis: date (month of death), vertical axis: number of deaths. Fractional values result from calculations per million people and a 7-day average. Source of data: JHU CSSE COVID-19 Data, https://github.com/CSSEGISandData/COVID-19

Figure 3 compares the current economic growth path with that projected before the outbreak of the COVID-19 pandemic. The chart shows gross domestic product (GDP) at constant prices. For the purpose of better clarity of comparisons, the value in 2019 has been normalized to 100. The economies being compared are those of Poland (orange) and Taiwan (blue). In 2020, the COVID-19 pandemic caused Poland’s economy to go into recession and “drop off” its projected growth path by about 6%. Almost all of the world’s economies experienced a similar situation, with varying degrees of intensity. According to current forecasts, the Polish economy will return to its pre-pandemic growth path in 2024. Taiwan is an exceptional example: its economy experienced no recession, and it even grew at a rate of 2% above the forecasts in 2020.

Figure 3. GDP in Poland (orange) and Taiwan (blue): the forecast before the COVID-19 pandemic (light colors) versus the current growth path (dark colors; the situation in 2019 is conventionally assumed to be 100). Source: Authors’ own calculations based on: IMF, World Economic Outlook Update, October 2019, and IMF, World Economic Outlook Update, October 2021.

Figure 4 compares the level of restrictions imposed in connection with the COVID-19 pandemic in Poland and Taiwan. The index presented here is a weighted average of eight categories and takes values from 0 to 100, where 0 indicates the situation before the pandemic and 100 indicates the most restrictive measures imposed in all categories. Taiwan introduced the first restrictions in January 2020, three months before Poland. Interestingly, for most of the COVID-19 pandemic, the restrictions in place in Taiwan have been less severe than those adopted in Poland. Taiwan went through the first three waves of the pandemic with a negligible number of infections and deaths and a low level of restrictions. The situation did not change until the emergence of the Alpha variant in May 2021. At that time, Poland was lifting restrictions as the third wave of infections was subsiding, while Taiwan was imposing more restrictive measures. Currently, they are at a similar level.

If we compare the charts showing the number of cases and deaths and the chart illustrating the restrictions, we will see clearly that Taiwan’s success did not result from the severe nature of the restrictions, but from efficient policies. This efficiency depended largely on professional institutions, a clear strategy, transparent communication, and the trust that citizens had in the authorities and in one another.

Figure 4: Index showing restrictions during the COVID-19 pandemic in Poland (orange) and in Taiwan (blue).
Source: Oxford COVID-19 Government Response Tracker, Blavatnik School of Government, University of Oxford: https://www.bsg.ox.ac.uk/research/research-projects/covid-19-government-response-tracker

Professional institutions

The factors behind Taiwan’s successful response to the pandemic include the preparation of institutions. This pertains to the education of the right personnel, the construction of laboratory facilities, and institutional readiness. After the SARS epidemic in 2003, the authorities in Taiwan established the National Health Command Center (NHCC) in 2004. The NHCC includes the Central Epidemic Command Center (CECC), which focuses on epidemic response and acts as the operational command point during epidemic crises. This institution also coordinates direct communication between central, regional, and local authorities, as well as the measures aimed at containing the epidemic and taken by various ministries, including those responsible for  transportation, the economy, labor, and education. Importantly, this is an expert institution that operates within the framework of public organizations and receives support from the authorities, but it is independent of politicians.

Thanks to well-coordinated actions on the part of highly professional institutions, Taiwan quickly developed and implemented not only a general strategy, but also 124 specific preventive measures, including air and sea border control, case identification (with the use of new technologies), quarantine of suspicious and confirmed cases, proactive efforts to find infected individuals and contact tracing, management of the resources needed to fight the epidemic, public education coupled with the fight against misinformation, negotiations with other countries and regions, formulation of policies towards schools and childcare, and support for businesses. Our team called for the establishment of such an institution in Poland in Position Statement 13: Lessons from the Pandemic from March 2021: “It is necessary to establish a network of independent and interdisciplinary expert teams or institutions that would provide reliable analyses for public health purposes. Such a system of independent experts and institutions improves the monitoring of the authorities by the public and ensures that the actions being taken are transparent and rational.”

In Poland, we are grappling with staff shortages in the Sanitary Inspectorate and in other institutions responsible for epidemic control. Monitoring remains poor, and only very basic pandemic data are made available to the public. This results from the chaotic creation of an information system already during the ongoing crisis. Creating a functioning monitoring system requires continuous efforts, not only on the part of IT specialists, but also – and perhaps especially – on the part of epidemiologists, diagnosticians, microbiologists, sociologists, psychologists, and public health experts.

The EU has institutions responsible for monitoring the epidemiological situation (the European Centre for Disease Prevention and Control, ECDC). However, the European monitoring system has repeatedly proved to be too slow, often due to the absence of adequate technical and human resources in member states, which has prevented the efficient communication of information to the European level. Likewise, an early warning system has been implemented by the World Health Organization (WHO) under the 2005 International Health Regulations (IHR). Under this system, each country has established a unit whose role is to monitor and assess events in terms of their significance for public health at the international level. However, Taiwan’s experience has shown that the provision of information alone may not be sufficient. Immediately after receiving reports of the outbreak of unusual respiratory infections, a team of experts from Taipei traveled to Wuhan to obtain additional information. A WHO team also visited Wuhan. The EU should also have a permanent mobile team that could support the EU countries in measures taken in response to unusual events of public health importance and simultaneously assess the situation from the perspective of the threat to our region, and representatives of Poland should be active members of such a team.

It is likewise necessary to have relatively uniform EU-wide standards of procedures for fighting the pandemic. For this reason, the development of such standards requires collaboration at the level of EU institutions and the relevant institutions in member states. We welcome the beginning of efforts to create a legal framework for new solutions, including those consolidating the role of the ECDC and EMA.

Reliable and clear communication of information about the pandemic

Taiwan has institutionalized pandemic communications. This means that the institution responsible for pandemic control (CECC), in tandem with a specially established communications commission, developed resources for the media (including social media), such as videos, memes, posters, drawings, and stickers. Informing and educating the public as well as fighting against misinformation have become the overriding goals of the Taiwanese government’s communication strategy. In addition to daily press briefings by the CECC and the  authorities for health and welfare, Prof. Chen Chien-jen, Vice-President of Taiwan and a prominent epidemiologist, regularly made public announcements broadcast from the president’s office and shared with the media. Those announcements reminded people of the need to maintain social distance, of when and where they should wear face masks, and of the importance of washing and disinfecting hands. Importantly, Prof. Chen and his wife volunteered to test the effectiveness of vaccines.

Interactive question and answer sessions were also introduced to alleviate individual concerns about the pandemic. Every citizen could ask questions and discuss their concerns via Facebook or Line (a popular messenger) or by calling a dedicated hotline. CECC’s official Line account also offered a popular question-and-answer service.

Other crucial elements of Taiwan’s strategy included positive messages about the pandemic – ones that motivated people, rather than scaring them. Moreover, the state hired comedians to create humorous messages and memes that conveyed reliable information and government decisions, and fought against COVID-19 misinformation. Such friendly attitudes were also observed in the strategy of encouraging citizens to maintain social distance. For example,  people were told to keep a distance equal to “three dogs” (using dog mascots, adored by the Taiwanese). Also, teddy bears were put on selected seats in restaurants to ensure sufficient distance between the remaining seats. We can see here that bans and restrictions are not the only forms of efforts to contain the pandemic. Of course, we should not copy such solutions but create similar ones, adjusted to the Polish culture.

Technology for education

Effective communication in Taiwan was possible thanks to universal access to information. This meant investing in the relevant infrastructure and computer hardware. Those measures were coupled with investments in education (also addressed to groups that are often digitally excluded) to fight misinformation and media manipulation. This need is also urgent in Poland. Such educational programs could be easily implemented by NGOs, charitable organizations, and youth groups educating seniors.

Concern for one another

Taiwan’s successful response to the pandemic was also possible because the Taiwanese share the belief that by complying with restrictions and adhering to government recommendations, they will protect not only themselves and their loved ones, but the society as a whole. This concern for others is the reason why regulations are perceived as justified. Concern for one another makes it easy to fulfill the potential locked in the community – in its resources and abilities. Together, we can do more and better. In Poland, such concern is insufficient, and so is action taken with others in mind.

Strict observance of the basic recommendations regarding mask-wearing, social distancing, disinfection and ventilation is good not only for us but also for other citizens. By taking care of ourselves, we are also taking care of others.

About the team

The Interdisciplinary COVID-19 Advisory Team to the President of the Polish Academy of Sciences was set up on 30 June 2020. The team is chaired by Prof. Jerzy Duszyński, President of the PAS, with Prof. Krzysztof Pyrć (Jagiellonian University) as deputy chair and Dr. Anna Plater-Zyberk (Polish Academy of Sciences) as its secretary. Other members of the team are:

• Dr. Aneta Afelt (University of Warsaw)
• Prof. Małgorzata Kossowska (Jagiellonian University)
• Prof. Radosław Owczuk, MD (Medical University of Gdańsk)
• Dr. Anna Ochab-Marcinek (PAS Institute of Physical Chemistry)
• Dr. Wojciech Paczos (PAS Institute of Economics, Cardiff University)
• Dr. Magdalena Rosińska, MD (National Institute for Public Health – National Hygiene Institute, Warsaw)
• Prof. Andrzej Rychard (PAS Institute of Philosophy and Sociology),
• Dr. Tomasz Smiatacz, MD (Medical University of Gdańsk)