SARS reveals public health breakdown in Taiwan

By John Chan
30 June 2003

Although the World Health Organisation (WHO) lifted its SARS (serious acute respiratory syndrome) travel advisory on Taiwan on June 17, the island’s people are still bearing the cost of an epidemic that resulted directly from the erosion of conditions in the public health system. By mid-June, 698 people, many of them medical personnel, had been infected and 83 had died.

As in other SARS-infected regions throughout the world, Taiwan’s outbreak began from a single case, when an infected man from Hong Kong visited his brother in Taipei in March. Like Toronto, Canada, the supposedly “advanced” medical system in Taiwan soon proved incapable of handling a serious infectious disease.

As late as April 21, Taiwan’s health officials were still hailing their “success” in preventing SARS at an international conference in Taipei, drawing contrasts to the situations in China and Hong Kong. The ruling Democratic Progressive Party (DPP) government proclaimed the superiority of Taiwan’s “liberal democratic ideals” over mainland China’s protracted cover-up of the disease.

Within days, two of the capital’s major hospitals—the Taipei Municipal Hoping Hospital and the Jen Chi Hospital—were affected. Hoping Hospital was shut down on April 24 when the situation spiralled out of control and 200 patients and 900 staff were compulsorily quarantined. Both Taiwan’s vice premier Lin Hsin-yi and Taipei Mayor Ma Ying-jeou were involved in the decision.

But because further protective and trace monitoring measures were not taken, SARS infections spread to the nearby Huachang Public Housing Complex and Gandau Hospital. Local residents were not alerted beforehand about the SARS danger.

Conditions in other major cities across the island were similarly chaotic. SARS spread from north to south within medical facilities. By mid-May, infections had reached the Kaohsiung Chang Gung Memorial Hospital in the southern city of Kaohsiung.

Dr David L. Heymann, a WHO director, told the New York Times on June 17, Taiwan was the only country that had suffered a serious outbreak after the WHO issued its SARS warning in March. “There was no central coordination mechanism, so it was very difficult and complicated to trace all transmissions,” he commented.

The SARS upsurge generated fears and uncertainty throughout Taiwan. Ordinary people had been told that the only ones at risk were businessmen and employees in China. Suddenly, the danger extended across the island. Streets were emptied and foreign tourists fled. Service industries ranging from airlines to restaurants were devastated and retail sales collapsed. “Cut-throat sale” and “last day clearance” signs appeared everywhere.

The impact deepened Taiwan’s existing economic crisis. The government’s new forecast for this year’s economic growth is 2.89 percent, down from 3.68 percent in February—the severest slowdown since the collapse of the US stockmarket bubble in 2000. According to a June 2 Financial Times report, 10 Taiwanese banks have non-performing loans exceeding 10 percent of their totals.

The resulting hardship is affecting millions of people, particularly the 700,000 unemployed—a jobless army first produced by the Asian financial crisis in 1997. Without pension and unemployed benefits, they are not covered by the public healthcare insurance system set up in 1995.

Seriously over-worked and under-paid, the nurses who combated SARS in the hospitals suffered heavy infection rates. Their average wage is six to ten times lower than a physician’s income and they work twice as long as mainland Chinese nurses.

A nurse’s union leader commented in Taipei Times on May 23: “Taiwan’s nurses have long been the disadvantaged majority in the medical world. They are a silent group, carrying the biggest workload but receiving the lowest salaries. When hospitals want to reduce their costs, nurses are the first to be laid off. The nursing staff is viewed as a unit which spends money without making contributions. They face streamlining, wage cuts and growing quality demands.”

Medical officials made scapegoats

It is widely recognised that the poorly funded hospital system, lack of protective equipment and shortage of nursing staff contributed to the outbreaks.

However, with the support of all major political parties, the government and prosecutors have blamed two medical officials. One is the former director of the Disease Control Centre, Lin Jung-ti and the other, Wu Kang-wen, was an infectious disease director at Hoping Hospital.

The Taipei District Court prosecutor has charged both with “negligence of duty that caused damage”. If convicted, they face up to 10 years in jail. Similar investigations are underway against health officials and hospital staff in Kaohsiung. The former director of Taipei City’s health council also resigned under heavy media pressure.

Whatever “errors” these officials might have committed in their handling of SARS, they are simply being made scapegoats. The resort to prosecution demonstrates that Taipei is just as ready as Beijing to use state repression to divert attention from the underlying causes and government responsibility. In both countries, free market restructuring has undermined the public health system.

Just months before the SARS outbreak, a government proposal was under discussion requiring wage earners to pay another $US880 million for the National Health Insurance Program—the second rise in the price of coverage since September.

Although media coverage is now full of debates on whether the DPP government was responsible for the SARS outbreak, the opposition parties like the Kuomintang (KMT) and the Peoples First Party (PFP) have offered no different policies.

In fact, many of Taipei’s cost-cutting policies were developed under the KMT regime, as recently as 2000. It was KMT chairman Lien Chan, then the Premier, who introduced legislation in 1995 authorising the government to increase health insurance payments to as high as 6 percent of a worker’s income without requiring parliament’s permission.