Expert: Adjusting its vaccination strategy is key for Taiwan to cope with the threat posed by the Delta variant

After Taiwan confirmed a new local coronavirus cluster case caused by the highly contagious Delta variant on September 8, public health expert Chi Chunhuei says Taiwan needs to make necessary adjustments to its pandemic-curbing tactics in order to avoid another major local outbreak.

DW: Taiwan identified another local cluster case caused by the Delta variant on Wednesday. What are the major challenges that the highly contagious variant will bring to Taiwan’s strategies for combating the pandemic?

Chi Chunhuei: The local outbreak caused by the Alpha variant in May was the first time that Taiwan had to cope with a large-scale outbreak, which caught Taiwan off guard in the early stage of the outbreak. The Alpha variant’s transmission rate is 50% higher than the original coronavirus, so Taiwan wasn’t able to get used to the higher transmission rate.

At the same time, Taiwanese people may have taken advantage of the fact that the island has survived four previous local outbreaks, so when Taiwan failed to contain the outbreak in May within a short time, the outcome became quite different from before.

After containing the last local outbreak, Taiwan is now facing the even more contagious Delta variant, so I think Taiwanese authorities should adopt even stricter quarantine policies and investigation. The Central Epidemic Command Center should also get involved with rolling out new measures when necessary. They should avoid waiting for local authorities to report the situation back idly.

When the local outbreak began in May, Taipei City and New Taipei City, the epicenter at the time, were sometimes slow with their responses, so since the Delta variant’s transmission rate is 50% higher than the Alpha variant, Taiwan’s response can’t be too slow this time.

As I’ve mentioned before, Taiwan has ignored the threat posed by virus transmission through aerosol and focused more on virus transmission through droplets. However, the methods to prevent droplet transmission and aerosol transmission are quite different, and there has been more evidence showing that coronavirus is mainly transmitted through aerosol rather than droplets.

I’m not sure if Taiwan has changed the focus of its prevention measures, but I remember previously, Taiwanese officials focus more on prevention measures targeting droplet transmission. Most restaurants use plastic partition to prevent droplet transmission of the virus, but this method is only useful against transmission through droplets.

A recent study published in the academic journal “Science” by a team of researchers from Taiwan has proven mask-wearing and keeping a good air circulation as the effective methods of preventing virus transmission through aerosol.

The study also pointed out that the plastic partitions that are widely used in restaurants across Taiwan are actually counterproductive to preventing virus transmission through aerosol as it will disrupt air circulation. Since we know the viral load that patients infected by the Delta variant can transmit is 10 times higher than the viral load that patients infected by the original coronavirus, it is important for people in Taiwan to properly wear their masks indoors while maintaining good air circulation.

Another thing that surprised me is that a teacher at the preschool where the latest local outbreak began went to work even though she was already showing suspected symptoms. This shows that Taiwan’s public health education related to the pandemic may be insufficient and there is still room for improvement. Public health officials should urge citizens to avoid interacting with colleagues and go get tested when they are showing suspected symptoms.

DW: Following the latest local outbreak, there are some discussions about how the government should adjust the pandemic alert level. How do you think the Taiwanese government can make the right decision about adjusting its pandemic-curbing measures when they are dealing with the more transmittable Delta variant?

Chi Chunhuei: Determining when to raise the pandemic alert level is a very difficult decision for leaders. Taiwan kept the alert level at level three for more than two months during the last local outbreak, and the soft lockdown has inflicted serious damages to people in the middle and lower class in society. While people in the upper-middle class can enjoy the luxury of working remotely, people in the lower-middle class can’t really enjoy the luxury.

Taiwan’s current labor condition doesn’t allow people in the lower-middle class to enjoy the benefits of working remotely and the problem was reflected during the last local outbreak. Factories still needed to maintain operation during the level three alert but the government couldn’t afford enough protection for the factory laborers.

Additionally, small business owners still needed to try to make a living during the soft lockdown, but their businesses were seriously affected by the relevant measures during the level three alert. These are factors that the government should consider, which makes it very difficult for the government to decide when is a good time to raise the alert level. They need to choose between life and livelihood.

This is also not the first time that Taiwan deals with a local outbreak caused by the Delta variant. In May, a grandfather and his grandson brought the Delta variant to their local community in Pingtung county. After spotting some small-scale local outbreaks, local authorities immediately imposed small-scale quarantine and testing, which helped to curb the spread of the virus successfully.

I think the Central Epidemic Command Center is trying to determine the exact source of this latest local outbreak within a short time, and if they can determine the source of infection in time, they can use high density and small-scale quarantine and testing to stop the variant from continuing to spread. But if they can’t determine the exact source of infection within a short period of time, they might need to consider adopting broader measures to combat the latest outbreak.

Additionally, if the Taiwanese government raises the alert level too easily, it can cause pandemic fatigue, meaning some people will still not comply with the elevated measures when the government raises the alert level. They need to consider whether it is better to raise the alert level across the entire island or to only raise the alert level in certain parts of Taiwan.

I think even if the government needs to raise the alert level to combat the latest outbreak, they may not need to elevate it across the entire island simultaneously. I think the CECC is considering whether they can find an intermediate level between level two and level three. If they raise the alert level to level three, it will create a huge negative impact on Taiwan’s economy.

Another challenge facing Taiwan is its low vaccination rate, and I think the government should reconsider its vaccination strategy amidst the local outbreak caused by the Delta variant. It was the right strategy for Taiwan to focus on enhancing the first-dose vaccination rate, but results from other countries have shown that one dose of vaccine offers very low protection against the Delta variant, while two doses of vaccine can offer enough protection.

We need to understand that the goal of developing vaccines for COVID19 is not to prevent infection but to prevent hospitalization and deaths after infection. So far, many Taiwanese media outlets have seriously misinterpreted the results of the vaccination campaign in the US. They keep claiming that since the outbreak remains serious in the US despite the high percentage of people getting two doses of vaccines, it shows that vaccines are useless.

This is a total misinterpretation, as the goal of getting vaccinated is not to prevent infection, but to prevent death and hospitalization. The biggest problem that Taiwan is facing is that the rate of people being fully vaccinated is less than 5%, so after the Delta variant reaches the community level in Taiwan, the Taiwanese government should adjust its vaccination policy. They should focus on letting those who have high risks of developing serious symptoms or die from infections get their second dose of the vaccine. It is to both lower the death rate and prevent medical institutions from being overloaded.

DW: When do you think Taiwan might be able to change the goal of combating the pandemic from reducing the number of daily cases to coexisting with the virus?

Chi Chunhuei: I think when the rate of people being fully vaccinated reaches at least 50%, Taiwan can gradually enter the phase of coexisting with the virus. When there aren’t enough vaccines for Taiwan’s entire population, authorities should focus on letting elderlies and those with chronic diseases get fully vaccinated.

If Taiwan can raise the rate of people being fully vaccinated to 50% and if the drug companies can release highly effective medication to treat patients infected by the virus, Taiwan can quickly get to the stage of coexisting with the virus. I’ve said many times that while this pandemic will be over, the virus will never disappear. Coexisting with the virus is definitely the next stage.

This interview was first published in Mandarin on DW’s Chinese website.