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Report on Taiwan’s Public Health Emergency Preparedness Programs 10 Years after SARS

Image of report cover PDF: Report on Taiwan’s Public Health Emergency Preparedness Programs 10 Years after SARS
Tom Inglesby, Anita Cicero, Jennifer Nuzzo, Amesh Adalja, Eric Toner, Kunal Rambhia, Ryan Morhard
Date posted:
December 28, 2012
Publication type:

Center for Biosecurity of UPMC, December 28, 2012

Open access
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The Center for Biosecurity of UPMC is pleased to provide this review of public health preparedness in Taiwan, which was conducted initially at the request of Minister Wen-Ta Chiu, Taiwan Department of Health, when he visited the Center in August 2011 and later under an open-bidding contract. The purpose of this assessment is to document the noteworthy progress that has been made since the SARS outbreak in 2003, identify the strengths of Taiwan's public health preparedness systems, and recommend possible new or complementary approaches to improving preparedness and continuing to strengthen existing systems in advance of a future epidemic.

Executive Summary

This assessment was derived from background research on the origins, history, and current structure of Taiwan's public health and healthcare systems conducted by reviewing pertinent literature, government reports, and discussions with Taiwanese colleagues and by a week-long research visit to Taiwan that included extensive bilateral briefings with senior government, public health, and medical officials.

Photo of Tom Inglesby with Wen-Ta Chiu, PhD, Minister, Department of Health, Taiwan

Tom Inglesby, MD, CEO and Director, Center for Biosecurity of UPMC, and Wen-Ta Chiu, PhD, Minister, Department of Health, Taiwan, December 3, 2012.

Over the past 15 years, Taiwan has experienced several major outbreaks of infectious diseases, including Enterovirus 71, SARS, and 2009 H1N1 influenza. These 3 outbreaks illustrate the national urgency of and rationale for building strong preparedness systems and plans to control highly contagious disease outbreaks. Each outbreak spurred investments to improve response to epidemics and yielded systems that have proven useful in subsequent outbreaks.

Findings and Recommendations

Taiwan has made many impressive gains in boosting its national preparedness for public health emergencies. Over the past 10 years, the Department of Health (DOH) and the Taiwan Centers for Disease Control (CDC) have built a number of important and robust programs aimed at providing earlier detection and controlling the spread of infectious diseases. Indeed, many aspects of these programs should be emulated by other countries committed to improving public health preparedness.

Comparing Taiwan's current state of readiness with its readiness levels 10 years ago, it is clear that the country has made concerted and focused efforts to advance the health of its citizens and its critical public health preparedness programs. For example, Taiwan has achieved success in:

  • improving collection of disease surveillance data;

  • running a state-of-the-art Epidemic Intelligence Center that can integrate, analyze, and report on surveillance data from a variety of diverse sources;

  • creating a functional network of laboratories that can perform diagnostic tests and rapidly report results;

  • establishing a medical network that includes 6 respected Regional Commanders who can provide expert advice and recommendations to DOH and CDC on medical response and disease control issues in the event of an outbreak;

  • exercising systems to practice response activities and to regularly test readiness levels;

  • raising general awareness of the public and international travelers of the risks of infectious diseases and good practices for controlling transmission; and

  • investing in a domestic vaccine manufacturing capability to help ensure that Taiwanese people have access to influenza vaccines, even during times of worldwide surges in demand for vaccine.

In addition to the many essential preparedness programs established over the past 10 years, Taiwan is fortunate to have dedicated leaders and experts in government who are committed to improving national readiness for disease outbreaks. Taiwan's government servants who are responsible for these issues have a strong sense of purpose, and key personnel at all levels recognize that the systems will be challenged by new infectious disease outbreaks in the future.

The World Health Organization (WHO) and infectious disease experts and researchers around the world understand the serious challenge posed by emerging zoonotic infectious diseases, which include both new pathogens and mutated versions of existing pathogens. Therefore, it is critical in Taiwan and elsewhere to give priority to the continuing improvement of existing public health preparedness systems and programs.

This report proposes a range of suggestions for consideration and review by the DOH as it seeks independent views on possible improvements to existing systems. Taking into consideration its own priorities and resources, the DOH may wish to consider the following activities:

  • Exploration of the use of benchmarks to measure progress in building national preparedness;

  • Maintenance of modern technical capabilities in its surveillance and laboratory diagnostic systems;

  • Analyses to assess current personnel levels and future personnel needs;

  • Continuing assessment of the contents and adequacy of the national stockpile;

  • Review of how the current system of designated isolation hospitals would be tested if challenged by a highly contagious and fast-spreading infectious disease outbreak, and ways of bolstering critical care capabilities for infected patients;

  • Continued planning for scarce resource scenarios;

  • Consideration of the benefits of the current airport quarantine strategy;

  • Preservation of domestic capacity to manufacture vaccines for yearly use as well as in a crisis by further strengthening the current public-private relationship between government and the local vaccine producer;

  • Assessment of Taiwan's legal framework for response to communicable disease outbreaks to permit flexible decision making to minimize the spread of disease while effectively caring for infected patients;

  • Expansion of tabletop exercises and scenarios to include political leaders so as to increase political support and public awareness of the importance of public health emergency preparedness programs; and

  • Further publication of the many successes and lessons learned in Taiwan following the 2003 SARS outbreak so as to engage with the international community on these important topics.


The above suggestions reflect the fact that preparedness for public health emergencies is not an end state, but rather an ongoing commitment to support the people, information systems, technologies, and other assets that contribute to overall public health resilience in the face of infectious disease threats. We encourage Taiwan to maintain the state-of-the-art capabilities that will protect the people of Taiwan from future public health emergencies.



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