Avenues for Taiwan-India Health Cooperation
This is the draft version of an article published in the policy report Taiwan and India: Strategizing the Relations released by the Taiwan Asia Exchange Foundation (TAEF); editors: Alan Hao Yang & Sana Hashmi.
Introduction
The experience with COVID-19 pandemic has demonstrated that addressing public health concerns cannot be limited to any single country. At the same time, the slow decision-making and political undermining of multinational organisations such as World Health Organisation (WHO) has illustrated the challenges of behemoth organisations to deal swiftly with emerging infectious outbreaks. Consequently, smaller groups of nations and bilateral agreements tailored to take advantage of local expertise and catering to specific requirements are better poised to create long-lasting mechanisms for health co-operation. In this context, there is great potential for India and Taiwan to cooperate and effect improved health outcomes in both countries. This was made apparent by the initialisation of health cooperation between the two countries during the COVID-19 pandemic.
Cooperation during the COVID-19 Pandemic
As the COVID-19 pandemic initially spread across the globe, the Taiwan model for disease control attracted attention. These lessons, derived from the experience with the Severe Acute Respiratory Syndrome (SARS) in 2003, prepared Taiwan for quickly responding to COVID-19. A mixture of evidence-based rapid response, early capacity building and transparency in decision-making allowed Taiwan to curb the spread of the disease, without the accompanying strict lockdowns that have characterised the response of other countries. A key facet of this response was to make self-assessments on necessary measures, even before the WHO declared COVID-19 as a public health emergency of international concern on January 30, 2020[1]. Particular emphasis on quarantining and mask wearing – key lessons learnt during the SARS 2003 outbreak – helped Taiwan quickly rein in the outbreak at home. Taiwan simultaneously increased production of masks and other medical supplies. This allowed Taiwan to strengthen domestic supply and subsequently offer aid to other countries. In 2020, Taiwan donated over 51 million masks to more than 80 countries, contributing to their pandemic-fighting effort.[2] Taiwan was, thus, at the foremost of health cooperation right from the beginning of the outbreak.
Further, Taiwan supported India’s healthcare response as COVID-19 cases surged in mid-2021. In May 2021, Taiwan sent a shipment of 150 oxygen concentrators and 500 oxygen cylinders[3]. The Taipei Economic and Cultural Center (TECC), Taiwan’s representative office in New Delhi, stated this as an expression of “strong friendship with India in its fight against a new wave” of the pandemic[4].
On April 27, Taiwan’s President Tsai Ing-wen conveyed solidarity with India’s fight, tweeting, “On behalf of all Taiwanese people, I would like to express my serious concern over the rapid spread of COVID-19 in India. Taiwan stands with India in this difficult time, & we are ready to provide help”.[5]
Taiwan also shared its best practices of dealing with the disease with India, training over 10,000 Indian medical personnel.[6] The sessions covered important aspects of COVID-19 response including analysis of cases and treatment of positive cases.[7]
Similarly, India also sent medical supplies for combating COVID-19 to multiple countries during 2020.[8] This was followed by extensive deployment of COVID-19 vaccine doses under the Vaccine Maitri (Vaccine Friendship) initiative, though this had to be halted as India grappled with a devastating COVID-19 wave in 2021.[9]
Though there is no overt evidence, it appears that India helped Paraguay, Taiwan’s diplomatic ally, obtain critical vaccine doses at Taiwan’s request[10]. While India has denied that the aid to Paraguay was at the behest of Taiwan[11], this action may have contributed to stymieing China’s influence on disassociating Paraguay from Taiwan.[12] This kind of indirect diplomatic assistance may also contribute to establishing support mechanisms between India and Taiwan.
There are various additional avenues for India and Taiwan to cooperate over COVID-19 pandemic. For example, India can learn from Taiwan’s experience of using technology to underpin COVID-19 communications.[13] Given India’s population and variety of languages in use, the innovative use of technology will be key to deliver communications swiftly and respond to further outbreaks. Communication will be important in breaking vaccine hesitancy, redirecting resources if required in future waves and conveying resource availability to the needy population. India can use the current time to build these systems to ensure smooth communication during any subsequent waves.
Another important area for health cooperation is governance of emerging outbreaks. Taiwan established the National Health Command Center (NHCC) in 2004, unifying a central command system including the Central Epidemic Command Center (CECC), the Biological Pathogen Disaster Command Center, the Counter-Bioterrorism Command Center, and the Central Medical Emergency Operations Center.[14] A unified inter-ministerial response is key to responding to outbreaks such as COVID-19 that impact all aspects of public life. Shared knowledge on this governance mechanism would be useful for India to create a similar one tailored for the Indian context.
Conversely India has tremendous vaccine expertise– from indigenous research, manufacture and deployment that can be shared with Taiwan. This exchange of expertise can form the basis for long-term partnerships that can go beyond the COVID-19 vaccines. India-Taiwan collaboration can help in creating better vaccines for existing neglected diseases and a long-term partnership can be leveraged to rapidly create vaccines against emerging diseases.
COVID-19 has thus shown the potential for collaboration between Taiwan and India, but the scope for this partnership can be extended to other areas of healthcare as well.
Avenues beyond COVID-19
The two countries have been attempting to advance cooperation in traditional medicine. India took a first step to concretising healthcare ties with Taiwan by donating US$ 20,500(NTD 570,000; INR 1.5 million) to the National Research Institute of Chinese Medicine for work on traditional medicine.[15] India, through its own Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homeopathy (AYUSH) ministry is encouraging research on traditional medical systems being practised in India. Cooperation in this domain, particularly on the understanding of traditional medicines and the development of analytical tools to test their utility can help in their adoption and use across the world. Key areas of collaboration are identifying ways of standardising traditional medicines, testing their utility and standardising manufacture. Further, training in traditional medicine can also be a focus area of cooperation.
India can also extend its concept of regulatory sandboxes in healthcare to Taiwan to trial their emerging healthcare technologies. This will expose India to the latest in medical technology, while utilising its vast diversity effectively. The presence of a strong health regulator is key to achieve this goal, while protecting the rights and health of any vulnerable populations. Particular areas of collaboration can be point of care diagnostics, wearables, assistive devices – these can be developed and tested across Taiwan and India and then deployed across the world.
For example, an exciting new avenue for collaboration for scientists in India and Taiwan are prosthetics and biomechanical suits. With applications from military to rehabilitation, prosthetics made using biomaterials can revolutionise the healthcare industry, particularly as the world faces an ageing population.
Taiwan’s increased thrust on precision medicine can also be a potential area of collaboration with India. Precision medicine is based on the application of technological tools to the analysis of massive genetic data. Taiwan’s technology strength coupled with India’s data strength can be used to harness this important emerging technology, transforming Taiwan and India into world leaders in this field. Further, the targeted use of precision medicine on relevant diseases can help health outcomes and increase productivity in India and Taiwan.
Finally, India can learn from Taiwan’s impressive healthcare system that includes digitised patient records, universal healthcare access and affordable insurance models. Working with India, Taiwan can solve challenges on tailoring this system to a high population, heterogeneous country in a resource-starved environment. Such a system can then for a template for improving health outcomes in other countries as well.
Way Forward
Both India and Taiwan are geopolitically positioned to cooperate in the health sector. India is one of Taiwan’s 18 target countries under its New Southbound policy[16]. This policy explicitly names public health and medicine as a potential area of cooperation for Taiwan. Two approaches proposed in the policy include creation of training programmes for medical staff and building of medical supply chains.
Similarly, Taiwan could be a collaboration partner for India under its Look East Policy. However, direct recognition of Taiwan through setting up of diplomatic connections may be in conflict with India’s hesitance to explicitly support or negate China’s One China policy.[17] Hence, it is important to devise creative channels for India and Taiwan to work together while balancing any geopolitical concerns. One approach would be to consider cooperation in health to be beyond geopolitical issues: COVID-19 has made it apparent that public health threats do not recognise political boundaries and will not pay heed to diplomatic understandings. Thus, public health security is one sector where collaboration may need to trump international order.
One way to boost collaboration between Taiwan and India is to set up more offices that can facilitate exchange of ideas and resources. For example, Taiwan has established the Taipei Economic and Cultural Centre (TECC) in India and India has a diplomatic mission, India-Taipei Association (ITA) in Taipei. The TECC and ITA represent the respective country’s interests and act as-defacto embassies. Through these offices, centres for cooperation in traditional medicine systems from both countries could be established.
Similar offices or centres built to aid exchange can help identify areas of collaboration between the two countries and facilitate mobility of people and resources. For example, if sharing vaccine knowledge is identified as a key area of collaboration, these centres can facilitate in the identification, travel and necessary documentation to ease connections between manufacturers and researchers in India and those in Taiwan. Similarly, programmes with specific outcomes can be devised for Indian medical personnel or policy makers who want to study Taiwan’s advanced medical systems and governance structures.
Building on these lines, individual institutions – academic, private companies and think tanks – can work with each other to achieve mutually beneficial outcomes. The two governments can work together to reduce barriers for this collaboration, without any overt role to play themselves. This can be done in the form of specific visa programmes for health personnel, language training, creation of scholarships, amongst other measures. Centres such as the Taiwan External Trade Development Council can aid in making these connections[18]; however, individual institutions should take the lead in identifying collaborators.
A low-hanging fruit in resource development is setting up student exchange programmes – such programmes can lead to cultural exchanges, increased travel and trade and increased awareness about opportunities in both countries. Two important factors that can underscore student exchange are easy availability of language training programmes and the availability of work opportunities, including work visas post course completion, for the visiting students.
Further, even if the Indian Union government does not establish overt diplomatic ties with Taiwan, Indian state governments can take the lead in technology and resource exchange. Individual states can set up collaborative projects with Taiwanese entities by facilitating availability of land, finance, labour and other required resources.
Finally, India can work with Taiwan through smaller multilateral platforms. The Quad has already shown interest in supporting Taiwan. The United States, Australia and Japan have promised aid to Taiwan in multiple ways. The United States has recently set up interactions with Taiwan diplomats, has included support for Taiwan in its Interim National Security Strategic Guidance and provided military support[19]. Australia has also demonstrated support to Taiwan in case of attacks from China[20]. Similarly Japan has also recognised the Taiwan’s importance for “Japan’s security and the stability of the international community”, and begun diplomatic talks addressing security co-operation[21]. India can utilise platforms such as the Quad to further its own collaborative efforts with Taiwan – such as sending vaccines. India can also offer indirect aid by partnering with countries that have diplomatic connections with Taiwan. Further, India can also use its diplomatic position to support the recognition of a wider role for Taiwan in multilateral organizations such as the WHO.
Conclusion
The COVID-19 pandemic has demonstrated the need for establishing health cooperation across the world. Public health security cannot be established by any one country alone and India needs to explore partners that can help build capacity and expertise in protecting its citizens. Taiwan with its technological and healthcare expertise can be one such partner. Conversely, India can offer its strength in research, abundance of resources and diplomatic connections to Taiwan. Together, India and Taiwan can strengthen each other’s healthcare programmes to improve health outcomes and innovate new solutions for existing and emerging health issues.
[1] Chen SC., “Taiwan’s Experience in Fighting COVID-19”, Nature Immunology , vol. 22, 2021, p. 393-394.
[2] “Taiwan Donates Over 51 Million Masks to Countries Worldwide”, Business Wire, July 2020, https://www.businesswire.com/news/home/20200722005405/en/Taiwan-Donates-Over-51-Million-Masks-to-Countries-Worldwide.
[3]“Taiwan’s First Batch of COVID-19 Aid Leaves for India”, The Hindu, May 20, 2021, https://www.thehindu.com/news/national/taiwans-first-batch-of-covid-19-aid-leaves-for-india/article34462658.ece.
[4] Rezual H. Lasker, “Taiwan, Uzbekistan Send Support for India’s Covid-19 Response”, The Hindustan Times, May 2, 2021, https://www.hindustantimes.com/india-news/taiwan-uzbekistan-send-support-for-india-s-covid-19-response-101619945937995.html.
[5] Twitter account of Taiwan’s President Tsai Ing-wen , https://twitter.com/iingwen/status/1386938260362915842?s=20.
[6] Sidhant Sibal, “COVID-19: Taiwan Shares Coronavirus Response Strategy with 14,000 Indian Medical Staff”, DNA, April 12, 2020, https://www.dnaindia.com/india/report-covid-19-taiwan-shares-coronavirus-response-strategy-with-14000-indian-medical-staff-2820631.
[7] Supriya Modi, “Taiwan lends a hand to India in the fight against Covid-19”, Invet India, April 24, 2020, https://www.investindia.gov.in/team-india-blogs/taiwan-lends-hand-india-fight-against-covid-19.
[8] Nayanima Basu, “India to Export Critical Drugs Like Hydroxychloroquine to More Than 20 Countries for Covid-19”,The Print, April 11, 2020, https://theprint.in/diplomacy/india-sends-drugs-medical-supplies-to-13-nations-as-govt-shifts-covid-aid-focus-to-africa/413757/.
[9] “Vaccine Supply”, Ministry of External Affairs, Government of India, https://mea.gov.in/vaccine-supply.htm.
[10] “Taiwan Says India Helped Paraguay Get Vaccines after China Pressure”, Reuters, April 7, 2021, https://www.reuters.com/article/us-health-coronavirus-taiwan/taiwan-says-india-helped-paraguay-get-vaccines-after-china-pressure-idUSKBN2BU0NH.
[11] “India Rejects Report of Taiwan’s Role in Arranging Vaccine Supplies to Paraguay”, The Hindustan Times, April 8, 2021, https://www.hindustantimes.com/india-news/india-rejects-report-of-taiwan-s-role-in-arranging-vaccine-supplies-to-paraguay-101617900647486.html.
[12] Harsh V. Pant and Premesha Saha, “India’s Vaccine Diplomacy Reaches Taiwan”, Observer Researhc Foundation, April 21, 2021, https://www.orfonline.org/research/indias-vaccine-diplomacy-reaches-taiwan/.
[13]Heidi Tworek, “Lessons learned from Taiwan and South Korea’s Tech-Enabled COVID-19 Communications”, The Brookings, October 6, 2020, https://www.brookings.edu/techstream/lessons-learned-from-taiwan-and-south-koreas-tech-enabled-covid-19-communications/.
[14] C. Jason Wang, Chun Y. Ng, Robert H. Brook, MD, “Response to COVID-19 in Taiwan
Big Data Analytics, New Technology, and Proactive Testing”, Jama Network, March 3, 2020, https://jamanetwork.com/journals/jama/fullarticle/2762689.
[15] “India Sends Funds to Taiwan to Boost Cooperation on Traditional Medicine: Report”, The Hindustan Times, February 28, 2021, https://www.hindustantimes.com/india-news/india-sends-funds-to-taiwan-to-boost-cooperation-on-traditional-medicine-report-101614475503085.html.
[16]New Southbound Policy Portal, Minsitry of Foreign Affairs, Republic of China (Taiwan), https://nspp.mofa.gov.tw/nsppe/.
[17] Tanvi Madan, “The India Opportunity for Taiwan”, Brookings, April 15, 2019, https://www.brookings.edu/articles/the-india-opportunity-for-taiwan/.
[18] TAITRA New Delhi, https://newdelhi.taiwantrade.com/aboutTaitra.
[19] Derek Grossman, “Biden Administration Shows Unwavering Support for Taiwan”, TheRandBlog, October 20, 2021, https://www.rand.org/blog/2021/10/biden-administration-shows-unwavering-support-for-taiwan.html
[20] “Australia vows to help US defend Taiwan from Chinese attacks”, Financial Times, November 13, 2021, https://www.ft.com/content/231df882-6667-4145-bc92-d1a54bccf333
[21] Ryan Ashley, “Japan’s Revolution on Taiwan Affairs”, War on The Rocks, November 23, 2021, https://warontherocks.com/2021/11/japans-revolution-on-taiwan-affairs/
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