Taiwan scrambles for vaccines after Covid-19 breaches its defences
- The island’s initial success story has turned sour with an outbreak that has infected more than 12,900 people and claimed 437 lives
- Taipei is now pinning its hopes on two local jabs as well as donations of overseas vaccines from the US and Japan
The island reported just 799 cases last year and seven deaths, while scores of other countries faced mounting fatalities, waves of infections running into tens or hundreds of thousands of people, and warnings of hospitals unable to cope.
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But Taiwan’s success story has turned sour in recent weeks after an outbreak – linked to staff at the island’s China Airlines – which began in late April started to spread. The outbreak has now infected more than 12,900 people and claimed 437 lives, sparking a scramble for vaccines that the island had failed to stockpile.
“Until earlier this year, Taiwan’s Covid-19 control had been very effective so the perception was we did not need vaccines or we had more time to wait for better vaccines. This was a major mistake,” said Su Ih-jen, who headed the Taiwan Centres for Disease Control (CDC) in 2003-2004, during the Sars epidemic.
“The fatal error was that the central epidemic command centre did not plan in advance,” said Su, who now leads a vaccine policy project at the National Health Research Institutes Forum, a think tank that advises the government. Taiwan was four to five months behind other governments in placing orders for overseas vaccines, which resulted in late shipments, he said.
Tsai Kun-chou, a lawyer with clients in Hong Kong and mainland China, said he managed to get his first shot in early May because he was planning to travel. “Many people want to get vaccinated as soon as possible to return to normal life,” he said.
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But Taiwan is finding it difficult to secure supplies quickly, and efforts to speed development of local vaccines have run into obstacles.
Catching up
Taiwan is a member of the World Health Organization’s Covax Facility global vaccine sharing scheme.
At the end of May, Taiwan’s CDC said it had secured agreements for 20 million doses from the Covax Facility, AstraZeneca and Moderna. It wants another 10 million from two local vaccine developers.
Taiwanese President Tsai Ing-wen said late last month that 2 million doses of imported vaccines were expected to arrive in June. The target is to have 10 million jabs by the end of August, including local shots.
She followed up with comments on specific challenges in obtaining overseas supplies, saying “Taiwan’s international situation is very difficult” – a reference to Beijing, which regards the island as a renegade province and has steadily sought to curb its presence on the international stage.
Tsai accused Beijing of blocking a deal with German vaccine producer BioNTech, which had given exclusive rights to China’s Shanghai Fosun Pharmaceutical to sell its vaccine in mainland China, Hong Kong, Macau and Taiwan.
Shanghai Fosun’s chairman Wu Yifang told state news service Xinhua on May 22 that the company was willing to supply Taiwan. When contacted for comment, Shanghai Fosun said it had nothing to add to the Xinhua report. In response to questions, BioNTech said it does not comment on supply discussions, adding that its goal is to provide vaccines to as many people as possible.
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As a result of the supply problems, Tsai has spoken of the need for Taiwan to focus on developing its own jabs, made by local companies Medigen Vaccine Biologics and United Biomedical. “It is our strategic priority to develop and supply local vaccines so that we will not have to depend on others,” she said on May 31.
Former CDC head Su said the problem with this approach was the limited clinical data available for the local vaccines.
Taiwan jab
Vaccines typically require final phase 3 trials among large numbers of volunteers to ensure safety and effectiveness before approval, but they need to be done in areas with high numbers of Covid-19 infections and Taiwan’s recent outbreak did not make the grade, according to Lee Ping-Ing, honorary director general of Taiwan Immunisation Vision and Strategy.
“Taiwan reports a few hundred cases a day. If we were to conduct phase 3 trials of tens of thousands of people locally, it would cost at least NTD 10 billion (US$361 million) and take one to two years to complete,” he said.
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To get around this, the Taiwan Food and Drug Administration (FDA) said on Thursday that local vaccines could be granted emergency use approval on the island based on trials involving at least 3,000 people.
Medigen Vaccine Biologics said its vaccine had met FDA safety and efficacy standards, based on the results of a phase 2 trial with about 4,000 participants. It had previously flagged it hoped to receive emergency use approval based on the trial results.
But rolling out vaccines prematurely could damage public trust, said Arnold Chan, an epidemiologist and director of the Health Data Research Centre at National Taiwan University.
“The government is doing something very risky,” he said. “There’s a reason you want things to be waterproof before you release them to millions of people. If something bad comes back, you at least have this very large database to defend yourself.”
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Tiffany Huang, a 28-year-old teacher in Taiwan, said: “I prefer not to get a local vaccine for now since it is still in phase 2 trials. I hope to have a vaccine that has met international standards.”
Huang plans to get married in September, but is not optimistic that the ceremony and banquet will be held as planned because of the Covid-19 outbreak.
Another method?
Yang Che-Ming, a professor at Taipei Medical University, said a local vaccine’s effectiveness could be tested by comparing the antibody levels it generated with those of a proven vaccine, although this alternative was still under discussion within the scientific community.
“This method would replace the placebo used in trials with an existing vaccine, providing extra incentives for people to join the trial as they would know they will be given a vaccine either way,” Yang said.
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Although Taiwan is not a member of the World Health Organization, its vaccine developers were eligible to apply for the health body’s global emergency use listing, a WHO spokesman said.
Winning WHO emergency use approval would be a milestone step, said Su at the National Health Research Institutes Forum think tank. “People who got a local vaccine that did not have WHO approval would not get a vaccine passport when they travel overseas.”
Public response
Taiwan has prioritised vaccinations for medical workers, frontline workers, and those over 75 years old.
In a poll by the Taiwanese Public Opinion Foundation from May 17-20, as many as 85 per cent of the 1,080 adults interviewed said they were worried family members may get the virus.
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The survey found almost half of respondents willing to take a vaccine proven to be effective and safe, regardless of its country of origin. Another 43 per cent said they would hesitate.
Max Liu, a postgraduate student in Taiwan, is keen to get vaccinated but said he is far back in the waiting line and would prefer an overseas shot as he does not fully understand the local vaccines.
“I support local vaccines and I hope they work, but I don’t see evidence that gives me confidence yet,” the 23-year-old said.
“I feel anxious, helpless and angry. We had one Covid-free year to prepare for a possible outbreak but we didn’t, leaving us with not enough vaccines available,” he said.
