Scholars have noted the Taiwanese state’s ability to recognize and swiftly respond to the early signs of the COVID-19 pandemic, manage the crisis with intra-government and state-profession coordination, and communicate related information with transparency. As early as January 20, 2020, with only sporadic cases reported from China, the Taiwan National Health Command Center (NHCC) activated its Central Epidemic Command Center (CECC), which then coordinated with other government agencies in fighting the pandemic. The CECC rapidly designed and implemented a list of 124 action items (Wang et al. 2020), including measures for border control, case identification and contact tracing, as well as quarantine requirements and other related guidelines, such as mask-wearing and social distancing measures. Upon the CECC’s request, the National Health Insurance Administration (NHIA) and the National Immigration Agency worked together to supplement the NHIA’s centralized cloud-based health records with patient travel histories, serving to alert hospitals to high-risk patients and allow the CECC to trace paths of infection (Wang et al. 2020; Lin et al. 2020). The CECC held daily briefings, which were rescheduled as weekly press conferences in early June, after the pandemic appeared sufficiently contained in Taiwan.
As we will illustrate below, the health administration’s remarkable precaution, coordination, and transparency during this pandemic represents institutional legacies co-produced by the civil society, the state, and the medical profession, through a long-term process of societalizing pandemic unpreparedness. This societalization process started after the SARS crisis and resumed in the early stage of the COVID-19 pandemic, with some challenges remaining unaddressed.
Systemic and civil repairs of the public health administration and the medical profession
In sharp contrast to its image during the COVID-19 outbreak, the Taiwanese state, along with the medical profession, performed miserably during the 2003 SARS crisis. When the public decried these institutional failures, it triggered the societalization of pandemic unpreparedness, which in turn resulted in systemic repair of the public health administration and, to a lesser extent, civil repair of the medical profession.
The Taiwanese public health officials repeatedly missed the early signs of the SARS epidemic. When they finally responded, their actions were haphazard, uncoordinated, and resembling “afterthoughts rather than well-planned strategies” (Fan and Chen 2007, p. 151). As the SARS outbreak intensified, failures of the public health administration came to be viewed as a societal disaster by the public (Fan and Chen 2007). From a CST perspective, the institutional dysfunction was being societalized as a national crisis. For the most part, the civil sphere attempted a systemic repair, focusing on how the health authorities failed to live up to state bureaucracy’s core values, including preparedness and coordination. In particular, the Ministry of Health faced heavy criticisms in the media for not declaring SARS an infectious disease early enough, not providing hospitals with adequate personal protective equipment (PPE), and not coordinating with the Taipei mayor in shutting down the Hoping Hospital (Fan and Chen 2007; Kuhn 2003).
These criticisms eventually forced the Minister of Health and the Chief of the Taipei Municipal Health Bureau to resign. Under mounting pressure from the public, more reforms unfolded, including the establishment of the National Health Command Center (NHCC) in 2004, which was designed to coordinate future pandemic interventions (and did so in the 2020 outbreak). The new Minister of Health (later the vice president of Taiwan during the COVID-19 pandemic) implemented other reforms, including building isolation wards, increasing the national stockpile of PPE, and expanding virus research laboratories (Hernández and Horton 2020; Chuang et al. 2015; CDC (Taiwan) 2013). In short, responding to widespread civil society criticisms of its failed performance and demands for its systemic repair, the public health administration was pressured to establish mechanisms for facilitating better intra-government coordination and enacting precautionary principles for future outbreaks.
The medical profession also failed to adhere to its professional ethics during the SARS crisis. In the context of the state failures described above, many “gave up their battle in the name of individual or worker’s rights” (Ku and Wang 2004, p. 135). Some were caught on camera as they climbed out of windows to escape from the Hoping Hospital after the Taipei government placed it under lockdown—a government decision later condemned as ill-conceived and poorly executed. Many frontline medical workers resigned from their posts, and Taipei Mayor Ma Ying-Jeou accused them of being “traitors in a time of war” (Hanson 2020). Nurses and doctors organized many protests to demand respect for their lives and human rights. Protesting healthcare workers contended that requiring them to return to duty under ill-conceived government orders and without access to appropriate protective gears was tantamount to sending them to their deathbeds. These protests and interviews were widely reported in the media, intensifying the public’s distrust of the medical profession and its professional ethics (Ku and Wang 2004; Fan and Chen 2007).
After the SARS crisis, nurses and other medical groups took the initiative to engage in a civil repair of their profession. Many argued that uncivil values, specifically the outsized influence of market incentives in the hospital system, had led to unsafe working conditions and, accordingly, compromised their ability to perform their professional duty (Fan and Chen 2007; Tzeng 2003). Some medical professionals formed their own civic associations as a path toward institutional reform. For example, in the aftermath of SARS, the Association of Nurses Rights was organized to facilitate collective discussions about improving nurses’ working conditions so that demoralized nurses could renew their commitment to professionalism (Fan and Chen 2007). Other medical professionals launched discussions and workshops in the civil sphere, inviting both public intellectuals and social science scholars to discuss issues of medical ethics (Tsai and Jiang 2012; SARS Mental Health League 2003). On some occasions, medical workers explicitly invited “the people,” who “we are serving,” to help shape the approach for addressing the tensions between medical workers’ risk exposure and duty to care (Lin 2009, p. 189). As frontline medical workers attempted the civil repair of their profession by importing civil sphere values (e.g., individual rights) to reform the polluted qualities of the medical sphere (e.g., market incentives), they highlighted that the tension between medical ethics and unsafe working conditions should concern not only medical workers but the general public.
To some extent, medical workers’ attempts at civil repair in the sphere of healthcare dovetailed with some of the systemic repair conducted in the sphere of public health administration. In particular, the government’s efforts at expanding the stockpile of PPE and the number of isolation wards and negative pressure rooms addressed some of the concerns about occupational hazards during outbreaks. Along similar lines, medical professionals advocated for proposals to counter-balance the profit-driven logic of hospital administration with greater consideration for community well-being and healthcare workers’ chronic overwork. Concrete post-SARS reforms included the establishment of a patient-referral system to distribute patients across a hierarchical medical network (Cheng et al. 2014, p. 11), the allocation of greater resources to community and family medicine (Khu 2014, p. 2), and the expansion of targeted efforts within departments of infectious diseases (Hsu 2003). Tangible outcomes regarding professional ethics are more difficult to document, but as Taiwanese medical professionals received high praise during the COVID-19 outbreak, their professionalism seems to have been revitalized to some extent.
In short, with the state and professional dysfunctions during the SARS outbreak being societalized, widespread discussions in the civil sphere eventually led to relatively effective systemic repair of the public health administration and, to a lesser extent, attempts at civil repair of the medical profession. Many of these reforms became the foundation upon which the Taiwanese state was able to adopt a precautionary, coordinated, and transparent approach toward pandemic intervention during the COVID-19 outbreak, with the support of a committed and high-performing medical force. Indeed, throughout the COVID-19 pandemic, newspapers in Taiwan repeatedly praised the health authorities and medical professionals for reactivating and expanding their post-SARS reforms.
Civil repair of the civil society
Taiwan’s extensive post-SARS reforms notwithstanding, its societalization of pandemic unpreparedness was incomplete. It was not until the COVID-19 outbreak that the Taiwanese civil sphere undertook an additional step for the necessary civil repair of another sphere—the civil society itself.
Back in the 2003 SARS outbreak, Taiwanese citizens’ initial complacency was superseded by panic and selfishness. Many hoarded masks; others lied about their SARS-related symptoms and defied self-quarantine guidelines. Still others mobilized for NIMBY (not-in-my-backyard) protests, attempting to block SARS patients seeking medical care, return travelers from high-infected areas, or prevent SARS-related “public bad,” such as medical waste, from entering their communities (Ku and Wang 2004; Fan and Chen 2007).
However, in contrast to the aforementioned reforms in the state and the medical profession, there was only sporadic reflection upon ordinary citizens’ uncivil acts (Fan and Chen 2007; Chang 2005, pp. 6, 12–13). While a few news commentaries complained about the “ugliness of Taiwanese people” during the crisis, once the WHO removed Taiwan from the affected area list, most journalists, newspaper readers, and civic organizations dropped even the few projects and discussions on community-rebuilding or solidarity-revitalizing initiated during the SARS outbreak (Ku and Wang 2004).
In 2020, with the COVID-19 pandemic raging, journalists in Taiwan across the political spectrum united in their emphasis on societal collaboration. Commentators posited that even the most precautionary and well-coordinated state-led intervention efforts can only yield results with the collaboration of citizens. Indeed, newspapers from both sides urged the Taiwanese to exercise the civic virtues of responsibility and compassion by protecting one another through adhering to state-issued guidelines. From a CST perspective, we argue that agents of the civil sphere engaged in civil repair upon the civil sphere itself, reinterpreting the boundaries between personal choices and civic duties within a framework of community interdependence during the pandemic. In this instance, the contentious Taiwanese civil society departed from its “against the state” mode (Cohen and Arato 1992), in which civic solidarity is fostered through struggles against state surveillance, to mobilize for a “self-limiting” purpose (ibid.), in which civic solidarity is negotiated through bottom-up collaborations among diverse groups and sometimes with the state.Footnote 2
Examining the editorials and columns during the COVID-19 outbreak in the two major newspapers across the political divide, the pro-independence Liberty Times (LT) and the pro-unification United Daily (UD), we found both newspapers filled with reflections on the SARS experience. The similarity in these discussions across LT and UD was uncanny, considering their sharply polarized political stands and contrasting positions on almost every topic. Articles in both LT and UD revisited collective memories of SARS-related suffering caused by political incompetence and professional dysfunction and shared a sigh of relief as they recounted the lessons learned from Taiwan’s SARS trauma. Journalists often discussed post-SARS reforms as the foundation for Taiwan’s efforts to keep COVID-19 at bay, with both newspapers highlighting similar details of these institutional legacies, e.g., reformed public health infrastructure, experienced medical professionals and public health officials, and SARS-originated legal frameworks for pandemic management measures.Footnote 3 Drawing on collective memories shared across the political divide, journalists from both LT and UD not only accepted state guidelines as science-based measures but also accordingly framed citizens’ adherence to these guidelines as a form of civic virtue and an expression of civic solidarity.
Both LT and UD journalists praised Taiwanese citizens for the civic spirit they displayed with nearly universal mask-wearing in public transportation and other crowded public spaces and adherence to other inconvenient COVID-related regulations. These articles frequently characterized this civic spirit as indicating that citizens had learned from their “SARS mistakes.” A LT editorial from January 30, 2020 observed that “after experiencing the SARS storm… ordinary citizens must have learned [our lessons]. We don’t expect Taiwanese to repeat our society-wide panic state during the SARS crisis.”Footnote 4 Another LT column wrote: “Because of what Taiwan learned from the 2003 SARS outbreak,…Taiwanese people displayed a high degree of civic spirit this time, allowing for state-society co-mobilization to contain the spread of COVID-19” (emphasis ours).Footnote 5 Similarly, a UD editorial on January 23 urged citizens to adhere to the government’s travel restriction “even though such restrictions will cause individual inconvenience and displeasure.”Footnote 6 A LT column on April 24, 2020 reiterated that “the key [to containing the pandemic] lies in civic obligations and interdependence.”Footnote 7
Conversely, several articles alerted readers that not everyone had learned these lessons from history, citing examples of people lying about their symptoms, gathering in large crowds, or traveling overseas, and condemning these behaviors as a “gap in our line of defense” (LT, March 17, 2020).Footnote 8 A few journalists warned that there were new challenges that the Taiwanese civil society had not experienced during the SARS crisis. For instance, a LT editorial (February 18, 2020) argued that the misinformation campaigns on the internet could dismantle the civic solidarity fostered through and required for state-society collaboration in fighting the pandemic.Footnote 9 Responding to these worries, some commentaries demanded stricter government regulations, whereas others urged citizens to nurture greater civic awareness. The point is that in contrast to the NIMBY mentality and frantic searches for individual solutions during the SARS outbreak, Taiwanese citizens in the COVID-19 crisis displayed great moral conviction regarding mutual protection, for which journalists across the political divide vocally advocated.
Drawing on the theme of learning lessons from history, several commentaries pointed out that, because of the SARS experience, mask-wearing was seen as a civic duty during the pandemic in Taiwan, whereas the same mandate was resisted in the name of individual freedom in the U.S. (e.g., LT, April 14, 2020; UD, March 22, 2020).Footnote 10 These articles conveyed Taiwanese civil society’s understandings of and capacities for civic virtues that had been shaped by its past, and in particular, the SARS crisis. By extension, some commentators contemplated how the current efforts at containing COVID-19 would shape the future of Taiwanese civil society, accordingly urging citizens to consider investing in the public good for the long term. A few columns called for the civil sphere to consider possibilities for an even more extensive state-society network of pandemic management and a deeper reexamination of its citizens’ civic virtues from the perspective of one’s obligations to future generations. “In the spirit of civic duties,” the LT suggested, “…we should take this opportunity to reconsider how to build a more sustainable society, in terms of food security, medical resources, and so forth” (LT, April 24, 2020; see also UD, February 29, 2020).Footnote 11 While these discussions did not constitute a dominant theme in the civil sphere discourse about the connections between SARS memories and the COVID-19 crisis, we view them as forming a significant subplot in this civil sphere discourse, which began to situate civic virtues in the context of historical continuity and citizens’ interdependence across generations.
Threats of populism
As with other cases of societalization, disruptions to civil repair were unavoidable. In the example of the mask-rationing system discussed below, political polarizations prompted the United Daily to advocate for populist demands, threatening to stall the “self-limiting” mobilization in the civil repair of an uncivil public.
Early in the epidemic, the Taiwanese government implemented the mask-rationing system as a mechanism to ensure the availability of facial masks. Over time, public health administrators adapted relevant regulations in response to a fluid and rapidly evolving environment of supply and demand. As the local supply for masks gradually increased, the quota for each individual became more generous. Taiwan even began to donate millions of masks to the international community as an act of compassion and a tool for diplomacy.
Commenting on these changes, most editorials and columns in the Liberty Times praised the government for its responsiveness. In contrast, the United Daily repeatedly complained that these policy adaptations exemplified incoherent, self-contradictory state actions and criticized the government for not producing enough masks for everyone to purchase at will. In a sense, the contrasting stands reflected the positions of the two papers in a polarized Taiwanese society, with LT and UD generally publishing along the pro-independence versus pro-unification fault-line. While, as discussed above, their shared collective memories of SARS marked a rare exception, their divergent stands on the mask-rationing system might appear as an unremarkable example of their general publishing patterns. But closer examinations of UD’s criticisms of the mask-rationing system suggest that UD’s commentaries represented a populist attempt at civil repair. The United Daily spun a discourse of “making the people happy,” which reified “the people” as possessing a singular will (demanding more masks regardless of its social costs), ignored competing voices (from masks producers, healthcare professionals, diplomats, and others), and over-moralized policy stability in the rapidly changing context of the pandemic.
For example, on February 1, 2020, a UD column complained that the masks sold through the rationing system, priced at NT$6 (about $0.20) apiece, were “too expensive, and the people still cannot find all the masks they need” (emphasis ours).Footnote 12 A UD editorial criticized that “although our nation has really lowered the transmission rate,…the people still need to stand in long lines for masks” (April 11, 2020; emphasis ours).Footnote 13 “The people never enjoyed the feeling that there are plenty of masks” (April 10, 2020; emphasis ours).Footnote 14 Considering that the rationing system was implemented amidst a global shortage of masks, these complaints, constructed solely on the foundation that some “people” were unhappy, were hardly reasonable.
Similarly, many UD commentaries criticized the government for being inconsistent with its mask policies, as these policies contained different components or were adapted to changing contexts. Some UD articles accused the government of causing confusion because “the government advocated for mask-wearing as a general principle…but the Ministry of Health and Welfare also explained that this principle mainly applies to those with underlying conditions, entering crowded or poorly ventilated spaces, or going into hospitals and other public buildings” (February 2, 2020).Footnote 15 “At first we went to the supermarket to buy masks, then, under the name-based rationing system, we had to go to the pharmacies to buy them. The people cursed these changes” (February 4, 2020; emphasis ours).Footnote 16 Over time, as the supply for masks became more stable, increasing each individual’s quota was no longer the top concern in the civil sphere. Medical and lay groups advocated for disinfecting masks for multiple usages to minimize the impact on the environment and to increase the supply for high-risk populations. The Tsai administration also proceeded to donate masks to the U.S., Canada, the EU, and other allies, as a diplomatic strategy to facilitate Taiwan’s international participation as Taiwan is excluded from most international forums, including the WHO. These civic voices and diplomatic strategies were condemned in most UD commentaries because “some people in Taiwan still cannot get all the masks they want.” By elevating the interest of a segment of the public in the name of “the people” at the expense of competing priorities, these demands promoted populist rhetoric and accordingly threatened to disrupt the emergence of a “self-limiting” civic solidarity based on tolerance and interdependence.
The Liberty Times editorials and columns offered an almost completely opposite appraisal of the same policies and practices related to the mask-rationing system. Most importantly, LT explicitly criticized UD’s writings on this topic for being populist. Many LT articles engaged in criticizing the criticisms published in UD (and other similar media), cautioning that the latter was using the values of liberty (e.g., individual rights) and bureaucracy (e.g., efficiency) in highly illiberal and uncaring ways (e.g., insincerely, ignorantly, or selfishly). Similar to their discussions of the SARS legacies, many LT articles about the mask-rationing system emphasized the theme of civic virtues, arguing that, during a pandemic, individual rights and bureaucratic efficiency should be situated in the framework of the interdependence and mutual protection of the community. In contrast, the theme of civic virtues was completely absent in the UD comments on the mask-rationing system.
At the end, with the mask-rationing system receiving high approval ratings domestically and significant praise overseas, the United Daily abandoned this conversation and their comments on the topic tapered off. Still, the UD’s populist imaginations for pandemic interventions threatened to push the state–society collaboration unproductively toward an overly narrow set of considerations. These populist demands seemed to give way when countered by the LT’s alternative civil discourse envisioning pandemic management mechanisms as addressing diverse and evolving social needs. But the danger of populism persisted. If the high level of public support for the mask-rationing system had not materialized, it is not clear that LT’s counter-arguments alone would have been sufficient to redirect UD’s populist discourse.
Missed conversations about scientific uncertainty
The civil repair for negotiating a “self-limiting” civic solidarity faced other limits due to the polarization of the Taiwanese civil sphere. While with their shared SARS memories, the two sides temporarily consolidated a moral discourse of the interdependence of the community, the Taiwanese civil society remained deeply divided over the boundaries of this community, specifically in terms of its relationship with China. When it became front and center in the conversation, the issue about community boundaries caused a gridlock for the civil repair of the civil sphere’s own pandemic unpreparedness, as illustrated in the debate over how to evacuate the Taiwanese in Wuhan.
Most LT editorials and columns on this topic coalesce around the theme of prioritizing the health of the residents in Taiwan. These commentators argued that the Taiwanese government must strictly control the procedures of the chartered flights, prioritizing those with medical and other needs while holding off on less urgent cases. Several authors referenced a petition drafted by groups of medical professionals that favored strict controls for the chartered flights to prevent Taiwan’s medical system from collapsing. This petition was described in the LT as an expression of civic solidarity that served to reinforce the boundaries of the community.
Defining this community against China’s aggression, LT authors were highly critical of China’s delays in the chartered flight negotiations, last-minute changes to the list of evacuees, and deviations from the safety requirements specified by the Taiwanese public health officials. These authors argued that China prioritized its political agenda of asserting dominance over Taiwan at the expense of public health concerns. Several authors further charged that the evacuees that later tested positive for COVID-19 (and who were not on the original agreed-upon list) were smuggled onto the plane by the Chinese authorities deliberately, to function as a Trojan horse that would sabotage Taiwan’s pandemic containment. Authors further questioned the political agenda behind the Taiwanese journalists who minimized the threat of this “Trojan horse” (e.g., LT, February 7, 2020; LT, February 21, 2020).Footnote 17
Editorials and columns in the United Daily countered this position by arguing that the “Trojan horse” could be safely contained by government efficiency and precaution, such as testing, quarantine, and contact tracing. As this debate became increasingly polarized, UD authors became more defensive. They argued that the “Trojan horse” was not so deadly after all (e.g., UD, February 23, 2020),Footnote 18 that compassion should outweigh any such concerns (e.g., UD, February 6, 2020),Footnote 19 and that discussions of limited medical resources were merely a politicized discourse to further the Tsai Administration’s anti-China agenda. UD commentaries labeled the civic groups advocating for stricter control over the chartered flights callous and hateful, condemning their sense of community as exclusionary and discriminatory toward the Taiwanese in China and their Chinese families (e.g., UD, February 12, 2020, February 22, 2020, February 26, 2020).Footnote 20
These themes in UD and LT were almost entirely oppositional to each other, reflecting their unresolvable tensions regarding the boundaries of the Taiwanese community. LT defined this community primarily as consisting of the 23 million residents in Taiwan. UD regarded how the government and the Taiwanese civil society handled the chartered flights as a litmus test for whether they accepted the Taiwanese in China as equal members of the community. Without a doubt, chartered flights from the epicenter of the pandemic carried considerable risks for spreading the virus in Taiwan. The efforts to manage such risks, in turn, would impose certain social costs, with different options implying different costs on different stakeholders. Balancing the concerns of risk management and social cost would accentuate the scientific uncertainties in all available options, thereby inviting different groups to engage in the evaluations of alternatives. But with the over-politicization of the issue, the two sides never had a full-fledged conversation about the scientific uncertainties that they were facing.
Granted, discussions of risk management and social cost are necessarily political to the extent that civil society discourses are always hegemonic. But cast in the polarized pro-Taiwan versus pro-China framework, the position of the Taiwanese in China became hyper-politicized. Instead of proceeding from an acknowledgement of the scientific ambiguity involved, each side viewed the other side’s proposal as purely a politically motivated agenda. In the end, scientific uncertainty was eclipsed by ideological certainty, resulting in the largely missed opportunity for in-depth conversations about different approaches to balance risk management and social cost.