Over a period of more than 40 years, Taiwan has built up a strong environment for immunization, drastically decreasing once-prevalent diseases and generating widespread trust in Taiwan’s public health system. However, while Taiwanese citizens currently enjoy almost universal access to a wide range of publicly funded vaccines, insufficiencies in that funding threatens to reduce the effectiveness of its immunization regime. Funding issues also constrain the public’s ability to receive new, innovative vaccines.
In 1974, the Taiwan government began developing a nationwide program of neonatal Hepatitis B vaccinations, in part to stem the high rate of liver cancer on the island. By 1986, all newborn babies in Taiwan were receiving the Hepatitis B inoculations, an extraordinary achievement that garnered international recognition and praise.
Over the following three decades, Taiwan’s vaccine program expanded to include over a dozen new vaccines, all fully subsidized by the central and local governments. Given Taiwan’s reliance on immunizations to maintain health and prevent infectious diseases, the adoption of a co-payment mechanism raised some objections from the public, notes Dr. Chen Hsiu-hsi, the Cambridge-trained associate dean of National Taiwan University’s College of Public Health.
Immunization in Taiwan is supported by the National Vaccine Fund, the budget for which comes primarily from the national treasury and the tobacco health and welfare surcharge on cigarette sales. Treasury funds should account for 60% of the NVF’s finances, but over the past four years, they have only provided 30-40%, and the fund has experienced a budget deficit since 2016.
“If we want to continue to have a well-regarded, comprehensive vaccination program in Taiwan – one that doesn’t overburden our citizens – we really need to expand the vaccine budget,” says Chen. In addition to increased funding for vaccines, he notes, the source of funding should be sustainable so that the program is able to continuously accommodate everyone.
He adds that it is important to raise awareness among government, healthcare professionals, and civil society about the importance of vaccination beyond childhood – also known as life-course vaccination. This approach to immunization not only positively impacts overall public health, it has indirect effects on economic activity and growth, as well as on national security. A healthy population is a prosperous one and a safe one.
One of the major aims of a new and improved immunization program should be to respond to the World Health Organization’s call to eliminate cervical cancer – often caused by the human papilloma virus, or HPV – by 2030. To do this, Taiwan should organize an HPV-related cancer prevention effort that includes screening, a gender-neutral HPV vaccine policy, and treatment for the virus.
Taiwan already has a model it can emulate to realize this goal: its impressive achievements in treating Hepatitis C under the Ministry of Health and Welfare. In 2018, the MOHW vowed to eradicate the disease in Taiwan by 2025, exceeding the WHO’s target by five years. In order to realize this goal, the government increased funding and considered drifting restrictions on accelerating treatment for Hepatitis C in 2019.
Efforts to make the HPV vaccine universal in Taiwan are already underway, says NTU’s Chen, who has been lobbying the government for years on the importance of an HPV- and cervical cancer-prevention program. “The government has lifted the normal budget constraint for the HPV vaccine,” he says. In addition, MOHW’s Health Promotion Administration (HPA), the competent authority for vaccine administration, has provided government-subsidized 2-Valent HPV vaccines to 7th-grade girls since 2018.
Yet the aim to rid the island of cervical cancer by the 2030 deadline will require the removal of ongoing budget constraints. “We currently have around a 60% vaccination rate for teenagers, which is not bad, but we’d like to see that bumped up to 80% or more in the next few years,” says Chen.
Chen posits that considering Taiwan’s excellent approach to containing COVID-19, now is the time for the government to start making a sustained push to develop a more robust immunization program. Doing so will ensure that Taiwan is realizing the WHO’s goals on eradicating infectious diseases and that new vaccines are accessible to all.
[ The information source is MSD ]