Diseases like influenza and tuberculosis are transmitted through droplet viruses and have grave impacts upon Taiwan as we have cities with high population densities. Based on statistics from Taiwan Centers for Disease Control (CDC), 18,533 people were killed by tuberculosis in 1947, 89 children died because of poliomyelitis in 1982, 78 children died from enterovirus 71 in 1998 and 81 lives taken away by SARS in 2003. Even up until recently, influenza killed 55 people from 2018 October to 2019 February. These terrible numbers tell us that we need to confront the diseases head-on, linking up our medicine knowledge and research techniques with the world.
Taiwan Tuberculosis (TB) Control was Rewarded Recognition Complying with WHO Guidelines
Our earliest tuberculosis (TB) control program started in 1914 during Japanese-occupied period. As deaths from TB started to increase in 1947, with foreign aids from the U.S. and WHO, Taiwan launched community-based TB control programs to fight against TB. In 1951, BCG vaccination plan officially initialized. In 1954, X-ray examination services started to make tour around Taiwan communities. In 1957, the very first TB prevalence national survey was conducted. Also in 1957, free medication program launched and BCG vaccination for infants were introduced in 1965.
After years of efforts, Taiwan has gradually transformed herself from an assistance receiver to a self-supporter. TB control program includes three principles, which are BCG vaccination and TuberculinSkin Test (TST), patience detection (with chest X-ray and sputum smear microscopy) and chemical medication (patience care and free treatment). Directly Observed Treatment Short-Course (DOTS) made its pilot run in 1997, which entailed “delivering medicine to patient, taking medicine and swallowing before leaving” from the trained care staff and the reception should be at least 5 times a week. Such medication adherence has effectively reduced the risk of TB transmission and difficulty of treatment.
Complying with WHO guidelines published in 2006, the DOTS was comprehensively implemented in 2007. In 2012, Taiwan CDC invited Edwin Antonio Paz, who was the project leader for tuberculosis control program in San Francisco Department of Public Health, to run field research around Taiwan and evaluate the effectiveness of DOTS teamwork. Dr. Paz noted that during his visit in 10 cities and 45 towns, DOTS implementation and disease control effectiveness have made remarkable progress, and both central and local governments should keep going in this right direction.
According to CDC, in the 10-year DOTS implementation 2007-2017, cases of tuberculosis have been significantly reduced from 440 to 152, cure rate has been improved to 82.4% and rates of lost to follow-up and failed have both been limited below 3%. Success story of our DOTS has been published in leading journal Clinical Infectious Diseases, making Taiwan a model for other countries.
Vaccine Research is Our Answer to Dealing with Pain and Grief
Enterovirus has ravaged Taiwan in 1998, but Taiwan turned her grief of loss into drives for vaccine research. Enterovirus belongs to a group of small RNA viruses and CDC stated that 1998-2006, among 1560 confirmed cases, 40.2% were enterovirus71, and among 244 deaths, 45.5% were enterovirus71. Droplet transmitted viruses cause outbreaks every 3 to 5 year. According to Professor Jen-Ren Wang from National Cheng Kung University (NCKU) Hospital, based on the fact of recombinant coxsackievirus and varied virus genotypes, cross protection is vital.
Taiwan public acknowledges that health is a fundamental human right. Our national health insurance indeed faces challenges, but the government strives to work it out. When confronting the grief imposed by illnesses, the best way is to take actions to improve the health. In 2011, Taiwan National Health Research Institutes (NHRI) released the phase I clinic trial for EV 71 vaccine. Both safety and immunogenicity were evaluated; the cells and viruses used in clinic trial were also international accredited. The very first EV 71 vaccine was therefore successfully launched, freeing children from the threats posed by enterovirus.
NHRI established “Asia-Pacific Network for Enterovirus Surveillance (APNES)” in 2017 to tackle enterovirus threats to our children. They worked together with Vietnam, Cambodia and Malaysia on disease prevention and vaccine research, by which the epidemiologic data were collected and analyzed. NHRI chairman Lin, Tzou-Yien noted that there are more than 100 human enterovirus (HEV) serotypes, in which poliovirus, EV 71, EV 68 and few coxsackievirus can easily cause severe complications. Based on international reviews, EV71 sweeps countries like Vietnam, Cambodia and Malaysia where they have more infants. The establishment of APNES can support governments monitoring the progress of the disease and virus evolution, making the newborn protection become possible.
Taiwan Launched Human Vaccine Self-manufacturing Plan to Tackle Influenza
Global epidemiology of influenza has always been the principal focus. There were 3 influenza pandemics in the 20th century, which were H1N1 in 1918, H2N2 in 1957 and H3N2 in 1968. According to researches on epidemiology, influenza occurs in specific regions like communities, cities or within a country. Shared characteristic for regional influenza is acute infections which can be progressively increased within 2 or 3 weeks. To understand flu viruses subtyping and antigenic variation, CDC established in 1999 “Virology Contract Laboratory”, entrusting 8 medical centers to integrate and set up their virological surveillance mechanisms.
Under the threats posed by influenza all over the world, vaccine development becomes the leading approach against it. While international vaccine manufacturers were overburdened, Taiwan government had no choice but to kick start the vaccine self-production plan. Prevention measures and experiences learned from SARS in 2004 have built up a foundation for us to cope with the H1N1 outbreak in 2009. Adimmune Corporation, though quite new in the market, has been Taiwan’s first manufacturer who has successfully produced international certificated H1N1 vaccine.
A disease outbreak can cause great panic and economic impacts. Vaccination cannot provide 100% protection. We need to, on the one hand build a talent pool, monitor all agents of disease and reinforce our medicine development and vaccine efficacy, on the other hand work with other countries, involve more international exchanges on prevention plans sharing, pathogen variation data exchange, etc. Only by doing so, we can block an outbreak from further spreading and provide instant prevention care.
Disease Control Shall Not be Limited within Borders
Due to frequent international contacts, national borders no longer stand as protective barriers against disease transmission. Based on previous experiences, we need to implement vaccination and improve surveillance efficacy so that we shall strengthen our immune system and prevent illness spreading. All these years, both advanced countries and private sectors have continuously invested money and men into global eradication initiative and assisted in set up surveillance mechanisms in epidemic areas.
As the viruses keep changing, as well as variations on regulations, environments, economic conditions, faith and politics, it can cause problems to disease prevention. Taiwan expects to emphasize the importance that health is a fundamental human right. Let’s turn goals into actions. Join international seminars and utilize foreign experiences, strengths and resources. Together let’s make disease prevention more effective and provide a better future for our people.