Having implemented a Hepatitis B (HBC) vaccination program for newborns in 1986, Taiwan was once a pioneer in vaccination efforts.  However, Taiwan’s exclusion from participation in the World Health Organization (WHO), a tight budget, and a lack of coordination between immunization policy and healthy insurance policy have taken their toll. As a result, the development and advancement of immunization practices in Taiwan has fallen behind other countries.

In the newly published 2018 Taiwan White Paper, the Public Health Committee of the American Chamber of Commerce in Taipei urges the Ministry of Health and Welfare (MOHW) to continue to enhance Taiwan’s vaccination policies.

Specifically, the Committee suggests allocating sufficient funding to expand general immunization availability and accelerating the introduction of new vaccines. These measures would help Taiwan catch up with other countries that have adopted more extensive national immunization programs and ultimately restore Taiwan’s leading position in the Asia Pacific region for vaccination policy.

The government has increased the Vaccine Fund budget from NT$2.2 billion in 2017 to NT$3.1 billion in 2018. Still, the 2018 budget is more than NT$500 million short of what is needed, so the government will withhold the introduction of several new vaccines.

The Vaccine Fund budget comes primarily from two sources: the National Treasury and the tobacco health and welfare surcharge on cigarette sales. The latter, which comprises 73% of the Vaccine budget in 2018, has fluctuated historically, making it an unstable and unreliable source for vaccine funding.

“It doesn’t make sense to know what you want to do and how much budget you need to do it but not get enough budget to do it. That’s what’s happened for the past five years,” said GlaxoSmithKline Senior Government Affairs and Healthcare Policy Manager Angela Wen-Chi Lo.

In the previous five-year-plan for national vaccination, there were six vaccines that should have been introduced between 2014 and 2018. Of those, only three where implemented – the pneumococcal conjugate vaccine, the Japanese encephalitis vaccine upgrade, and the Hepatitis A vaccine. The funding for the Hepatitis A vaccine came from a charity foundation.

Three others – the pneumococcal vaccine for the elderly, the Rotavirus vaccine, and the quadrivalent flu vaccine – are still waiting to be integrated.

The Public Health Committee urges the government to come up with a robust financial plan to implement these policies. It has offered to introduce financial models to help maximize healthcare objectives while respecting budgetary constraints.

The Committee believes that adding new vaccines will allow Taiwan to further showcase its healthcare practices to regional partners. Doing so aligns with the Taiwanese government’s New Southbound Policy, a 2016 initiative to enhance cooperation and exchanges between Taiwan and 18 countries in Asia.

Investing in vaccination also brings social and economic benefits. A severe influenza pandemic, for instance, could result in a decrease in Gross Domestic Product (GDP) of 0.5% to 4.3%. Flu vaccines, on the other hand, reduce the amount of lost work and lowered productivity.

In a report published by the Taiwan Immunization Vision and Strategy (TVIS), experts noted that the value of lost work and productivity due to seasonal influenza came to around NT$30 billion in 2010-2011, far more than the procurement cost of flu vaccine. “Vaccination should therefore be seen as an investment, not a cost,” the Committee writes.

Funding for a more advanced flu shot might have prevented Taiwan’s influenza B outbreak this year. There was no budget in the 2018 Vaccine Fund to upgrade the flu shot from trivalent to quadrivalent, which would have provided protection against all four different flu viruses – two influenza A viruses and two influenza B viruses. The trivalent vaccine administered in Taiwan this year only protected against one of the two B strands. It was the other strand that caused the outbreak this year.

“Without sufficient budget, important items will continue to be pending on the list. That is the main challenge for vaccination policy right now,” says Lo.

For the full White Paper on public health in Taiwan, click here.