Taiwan wins COVID-19 pandemic battle with face masks and becoming the second largest surgical mask producer in the world

by Roy Ngerng

Taiwan recognized the importance of face mask use right from the get-go when it started seeing the first COVID-19 case sprout up on the island state.

When Taiwan saw its first case on 21 January 2020, Premier Su Tseng-chang appeared on his Facebook to assure Taiwanese of the adequacy of face masks, and the Ministry of Economic Affairs (MOEA) detailed clearly the masks availability Taiwan had – the Ministry of Health and Welfare had a reserve of 45 million surgical face masks, which could be released to the public if needed, Minister Shen Jong-chin said. For a start, the Centers for Disease Control (CDC) also released an initial 2 million masks.

At that time, Taiwan was also producing 1.88 million face masks a day, which Shen said could be increased to 2.44 if demand requires. He also reassured the public that during the severe acute respiratory syndrome (SARS) outbreak, Taiwan was able to increase its production capacity by 2 million masks a day within just 15 days.

As Taiwanese started snapping up the masks in the early days of the pandemic, the CDC did make an initial about turn and said that people who were healthy did not have to wear masks, though CDC deputy head Chuang Jen-hsiang did however advise that people with upper respiratory infections and chronic diseases should wear masks outdoors and at crowded places.

Nonetheless, Taiwan understood very keenly the evolving threat to COVID-19 and quickly put together a plan to ensure adequate masks for its citizens.

To provide a steady flow of masks at the start, the government decided to release 4 million masks a day from its stockpile, and banned mask exports on 24 January. To ensure equitable access to masks, the government also announced that sellers of surgical masks would be fined up to NT$50 million under the Fair Trade Act if they inflate prices. And to ensure long-term supply, the government immediately ramped up production by taking over private sector production on 31 January.

The government coordinated the national mask production response by first pumping in NT$200 million on 31 January to assemble 60 production lines. It subsequently provided another NT$90 million on 5 March to build another 32 lines – the first 60 lines took only a month (from 5 February to 5 March) to assemble which would have otherwise took four to six months.

Within 40 days, the 92 lines were all up and functioning. At the end of April, the government conscripted another 22 lines to bring the total number of production lines to 114 production lines.

By the end of February, Taiwan was producing 6.6 million masks a day, which it increased to 10.3 million by the third week of March. By early April, Taiwan was producing 15 million masks and it reached 19.11 million by the end of May.

Requisition, rationing and banning of mask exports

Taiwan’s government started requisitioning all the surgical masks produced from early-February in a bid to ensure consistent supply, and also implemented a rationing system.

The government did not, however, requisition all the N95 masks produced in Taiwan. In fact, from 17 February to 17 March, the government only requisitioned 2.1 million masks a day from local companies. It was only from 8 April onwards, did it started requisitioning 3 million N95 masks a day.

While a controversy erupted over two lines owned by Singapore’s ST Engineering based in Taiwan, they were actually N95 production lines. The last batch of masks produced on 22 Jan, cleared customs on 29 January and the machines reached Singapore on 12 February. However, it is to note that the last batch of masks was bound for Korea and not Singapore.

In tandem with increasing mask availability, Taiwan also implemented a mask rationing system. At the end of January, a limit of three masks were initially placed on customers at each store where masks were sold, for a flat price of NT$6 each, but to better manage the mask rationing, the government decided to impose a ration of two masks per individual every week for NT$5, with the selling of masks centralized at the 6,280 pharmacies and 303 public health centers in partnership with the country’s Health National Insurance (NHI) system.

In this way, the NHI database could be used to keep track of the purchases and coordinate the demand and supply for mask production. As Taiwan’s mask production began to stabilize, the number of masks each individual was able to purchase was increased to three a week at the start of March, and from 9 April, this became nine masks every two weeks.

To facilitate easier access for mask purchases, Taiwan very quickly adapted its existing online tax paying system to develop an online mask purchase system. This was later expanded to kiosks at more than 10,000 convenience stores. All residents including foreigners on work passes have access to the masks using their NHI cards.

Hi-Life clerk handing over a mask over to a customer (Photo: Hi-Life)

The online access was also made possible due to efforts by Taiwan’s Digital Minister who also partnered with the local civic tech community to develop online open-source maps to track real-time face mask availability.

The government also ensured adequate masks are allocated for medical workers, drivers and schools.

Ramping of mask productions

Taiwan was so successful at increasing its mask production that today, it has become the second largest surgical mask producer in the world. It is also why Taiwan has been able to donate more than 20 million masks to countries in need of them – including to the United States, European Union and Latin America, countries under Taiwan’s New Southbound Policy in Southeast and South Asia, Australia, and New Zealand, as well as to Taiwan’s diplomatic allies.

Packages of face masks are unloaded from a cargo plane at Narita International Airport near Tokyo on April 21 2020. The 2 million face masks were sent by the Taiwanese government to Japan as an international contribution amid the spread of the new coronavirus. (Kyodo)

In fact, Taiwan’s effective mask implementation has also enabled it to involve citizens as part of its mask diplomacy – Taiwanese are even able to pledge the mask quota they are allocated as donations to other countries – to date, more than 5 million masks from over 665,000 Taiwanese residents have been received.

Taiwan’s mask production prowess could be attributed to effective government planning to ensure both adequate supplies and efficient rationing, whilst utilizing Taiwan’s manufacturing expertise to spearhead the response.

However, the reliance of Taiwan’s production capabilities is only one aspect of it – it is the farsighted thinking and preparedness of the government that ensured that Taiwan has been able to produce ahead of demand.

Today, Taiwan’s quick responsiveness to COVID-19 has enabled it to accumulate a mask inventory of between 200 million and 300 million masks, so much so that it has decided to reduce its mask requisition from 12 million masks to 8 million, thereby allowing excess masks to be sold on the open market.

Minister of Econmic and Affairs Shen Jong-Chin (center) and President Tsai Ing-wen (right). (Photo from Taiwan Presidential Office)

Minister of Economic Affairs Shen Jong-chin believed that this would allow local manufacturers to gain a foothold in the international market. Nonetheless, the government has arranged with suppliers to increase the requisition back to 12 million if mask stocks were to fall below 100 million.

With Taiwan’s mask strategy contributing to Taiwan’s effective COVID-19 response, this has also allowed the government to withdraw the military from the production lines, which it initially mobilized early February to help ramp up production.

In fact, the consistent access to masks and its widespread use has been lauded as a key reason why Taiwan has been able to keep its COVID-19 numbers low. The CECC’s Chang Shan-chwen estimated that mask use could filter out as much as 70% to 80% of aerosol particles.

As of the time of writing, Taiwan has only five COVID-19 active cases and has seen more than 61 consecutive days without locally-transmitted COVID-19 infections.

High testing rates of population

But Taiwan’s effective mask strategy is not the only reason why Taiwan has managed to effectively rein in the COVID-19 outbreak.

Taiwan has increased its testing capacity from 500 tests to more than 6,000 tests, and comparing the number of confirmed cases out of the tests conducted, Taiwan ranks third lowest in the world behind New Zealand and Australia.

Former Vice-President Chen Chien-jen who just stepped down last month explained that, “the lower the rate of positive tests [reflects] the broader […] coverage of tests of potentially infected people”. Chen is also a trained epidemiologist and advisor to the CECC on its COVID-19 response. Taiwan’s CECC also comprises medically-trained professionals which explain their sound science-based recommendations to contain COVID-19.

Even though Taiwan has only five active COVID-19 cases today, Taiwan has still ensured a total of 4,169 beds set aside for COVID-19 patients, including 963 negative pressure isolation wards, 1,031 isolation wards and 2,175 specialized wards. Testing can also be conducted across 45 testing sites.

Taiwan has also seen a reduction of influenza and enterovirus infections by 71.1% and 88.2% respectively, comparing the week of 31 May to 6 June with the same week a year ago.

Indeed, it is this Taiwan Model that Taiwan’s government is now propagating involving a transparent and honest approach within their democratic framework that has allowed Taiwan to successfully cope with COVID-19 and ensured that the coronavirus has minimally impacted daily living in Taiwan.

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