Covid risk incentivises cooperation in Indo-pacific
China’s neighbour Taiwan has been greatly successful in containing Covid-19.
TOKYO: The novel Coronavirus Disease 2019 (Covid-19) continues its exponential growth worldwide. Governments reported nearly 50,000 deaths and almost 1 million infected, of which about 200,000 have already recovered. Many countries or regions are in lockdown. The 2020 Olympics have been postponed, and Wimbledon cancelled for this year.
The World Health Organization (WHO) has been under global scrutiny ever since its 11 January 2020 tweet “WHO does not recommend any specific health measures for travellers to and from Wuhan, China”. Then, WHO went so far as to tweet on 14 January 2020 “Preliminary investigations conducted by the Chinese authorities have found no clear evidence of human-tohuman transmission”. This, after Taiwan informed WHO as early as 31 December 2019 that human-to-human transmission was underway, since Taiwanese doctors maintain collegial ties with Chinese doctors. The “spin” from
WHO is that the multilateral does not even currently give Taiwan observer status (that it had previously), and therefore could not have taken cognizance to alert the world. Also this, despite the reality in today’s social media world that even Supreme Courts take note of information suo moto submitted online. Finally, China’s official confirmation of person-toperson transmission came as late as 20 January 2020. This is not the first time that WHO has been accused of tardiness; it has been heavily criticised for its handling of the Ebola epidemic in 2015, which killed more than 10,000 people in Africa, and still others.
WHO has been on the defensive as this is the first time in its 72-year history that a non-medical doctor is its Director-general. Dr Tedros Adhanom Ghebreyesus’ PHD is on “The Effect of Dams on Malaria Transmission”. Several countries are salivating at pinning the blame for catastrophic handling on Dr Ghebreyesus and installing their own yes-man/yes-woman. At the heart of the problem is the inability of national bureaucracies to go beyond funding unreformed multilaterals built in the immediate postworld War era, that appears anachronistic today. Japan is the third-largest official donor to the WHO and its Finance Minister Taro Aso, who uses colourful language, sent shock waves at WHO headquarters by describing in a parliamentary meeting, WHO as CHO or Chinese Health Organization, implying loss of confidence and therefore likely funding cuts. A telephone call was hastily arranged between Dr Ghebreyesus and Japan’s Prime Minister Shinzo Abe where Dr Ghebreyesus attempted to placate Japan by promising support for the postponed Tokyo Olympics and for multi-country clinical trials for the Japanese antiviral drug favipiravir against Covid-19.
Wuhan was the epicentre of the pandemic, the first large city to be catastrophically affected as early as October/november 2019, and its 11 million inhabitants quarantined on 23 January 2020 under direct orders of China’s President Xi Jinping. Other columnists reported that local bureaucrats in Hubei Province attempted to deal with the “Sars-like” problem locally, even taking harsh action against the whistle-blower Dr Li, now deceased, who attempted to alert the world. When the situation got out of hand, the central Chinese government swung into action with a heavy hand, but even today not revealing all details that might have helped the rest of the world to come to a realistic containment strategy.
Taiwan is just 81 miles away from China and 850,000 Taiwanese out of the total population of 23 million live and work in China, and last year nearly 3 million Chinese visited Taiwan. There are a large number of flights connecting Taiwan and China. Because Covid-19 occurred before the Lunar New Year during which millions of Chinese and Taiwanese were anticipated to travel, Taiwan quickly took specific steps for case identification, containment, education and resource-allocation for protecting public health. Taiwan integrated its national health insurance database with immigration and customs database and utilised big data analytics to generate real-time alerts during clinical visit based on travel history and clinical symptoms to assist case identification. It utilized QR code scanning and online reporting of travel history and health symptoms to make risk assessments based on flight origin and travel history within the previous 14 days. Those with high risk travel history were quarantined at home and tracked through their mobile phone to ascertain that they remained at home during the incubation period. Taiwan even proactively sought out patients with severe respiratory symptoms from the National Health Insurance database who had tested negative for influenza and then retested them for Covid-19. Government provided food and encouragement for those under quarantine. After the SARS outbreak, in year 2004, Taiwan established the National Health Command Center, to be an operational command point for direct communications among central, regional and local authorities. Taiwan has achieved great success in these efforts, having suffered only five deaths from Covid-19, and just 329 cases, negating the models that predicted a very different picture.
The Taiwan-who interaction imbroglio is regrettable since the current Vice President of Taiwan, Dr Chen Chien-jen, is an academic PHD epidemiologist, who has experience in managing response to the SARS pandemic as Health Minister nearly 20 years ago. The Vice President-elect, Dr William Lai Ching-te, too is a public health specialist and medical doctor.
Likely in response to the squandered global opportunities to rely on expertise from countries like Taiwan, rather than being obsessed with politics, the US Congress overwhelmingly passed amidst the Covid pandemic, a law signed by the US President on 26 March 2020 providing additional support to Taiwan. It recognised Taiwan’s unique relationship with the US, Japan, India and Australia in the Indo-pacific. The concept of the Indo-pacific, that has replaced Asia-pacific as a defining principle, was invented by Japan’s PM Abe in his “Confluence of the Two Seas” speech to Indian Parliament in 2007—alluding to the Indian and Pacific Oceans, and the book by Mughal Prince Dara Shikoh, who sought understanding between religions and ethnicities.
Among the most urgent priorities, as I have argued in these columns, is to have a proven cocktail of antiviral drugs that can eliminate infections and prevent death even in those who get viral pneumonia. It has been done before in hundreds of diseases, especially diseases that once carried a deathsentence such as SARS and AIDS. It is only then that the world can fully get back to normal. Within the Indopacific alone, India-japan should collaborate on accelerated clinical trials for favipiravir, as India-us is collaborating on antiviral remdesivir.
After his first term as PM, Shinzo Abe travelled as an Opposition leader to Taiwan and also to India. In Taiwan, then-president Ma even made Mr Abe take a taxi, regarded as disrespect to a former PM. By comparison, in India, then-opposition leader Shinzo Abe was welcomed with open arms, and hosted to a speaking opportunity at the Indian Council of World Affairs filled with JNU faculty. Mr Abe has since had a soft corner for India, something he also picked up from his grandfather Nobusuke Kishi’s (also a PM) high regard for India as the country that refused to accept reparations from Japan and yet did not make a song-and-dance about that magnanimity. Incidentally, the current President of Taiwan, Dr Tsai maintains a cordial relationship with PM Abe.
The mentioning by the US Congress of Taiwan’s relationship with India in the new law did not happen by accident. Taiwan’s erudite President, Dr Tsai Ing-wen, then Opposition leader, was hosted in India in 2012 by a good friend, Prof Madhav Nalapat, India’s first professor of geopolitics, despite nearly apoplectic reactions from some officials of India’s Ministry of External Affairs, who seem to constantly fear implications of any new initiative. Dr Tsai took a 16hour train ride from Delhi to Mumbai, enjoyed the sights, sounds, cuisine and could frequently be seen walking down the streets of Mumbai with other members of her delegation. She stayed in an unpretentious but quality hotel and set an example in simple conduct.
These above examples show that people-to-people diplomacy focused on expertise and experience uncomplicated by the strident statements of bureaucrats, diplomats and politicians accustomed to creating and then resolving those manufactured controversies (made hilariously comprehensible by the TV series Yes Minister), have been making the vital difference. It is high time that global institutions are suitably redesigned for the information age and especially the post-covid era. Dr Sunil Chacko holds degrees in medicine (Kerala), public health (Harvard) and an MBA (Columbia). He was Assistant Director of Harvard University’s Intl. Commission on Health Research, served in the Executive Office of the World Bank Group, and has been a faculty member in the US, Canada, Japan and India.