The Taiwan Example: Community Pharmacists Helped Keep COVID-19 Deaths, Cases Way Down

In contrast to the United States, Italy, Spain, and many other countries, Taiwan has been largely spared the ravages of the COVID-19 morbidity and mortality. An opinion piece published today in theAnnals of Internal Medicine says that community pharmacists deserve a great deal of the credit.

“Often serving as the first point of contact between individuals and the health care system, community pharmacists offered education and consultation on proper hygiene strategies, disseminated accurate information to counter myths and misinformation, and provided emotional support to alleviate public concerns arising from the COVID-19 crisis,” write Huang-Tz Ou, Ph.D., of National Cheng Kung University, and Yea-Huei Kao Yang, B.S. ,at the university’s School of Pharmacy.

The John Hopkins COVID-19 tracker says that as of today Taiwan has had a total of six deaths from COVID-19 and just 393 confirmed cases. That death total works out to about 0.025 deaths per 100,000 people. By contrast, the U.S., as of today, has had 22,109 deaths from COVID-19, according to Johns Hopkins, and that works out to about 6.7 deaths per 100,000 population. So on population basis, the COVID-19 death rate in the U.S. is 240 times higher than of Taiwan's. 

Taiwan’s COVID-19 exceptionalism has not gone unnoticed. Anders Fogh Rasmussen, the former prime minister of Denmark, wrote about it in Time magazine last month. Others have also chimed in. Rasmussen and Ou and Kao Yang point to the country’s experience with 2003 SARS outbreak as leaving it far better prepared to deal with COVID-19 than most other countries.

By no means did all of the steps that Taiwan take to fend off COVID-19 involve community pharmacists, but Ou and Kao Yang highlight them along some others. Here are some of their key points:  

• In late January 2020 the government imposed a ban on the export of surgical masks because of a shortage, and it requisitioned all domestically produced masks. In early February, the government implemented a rationing system for distributing surgical masks to prevent panic buying.
• Community pharmacists were given the responsibility of distributing and rationing surgical masks. The pharmacists were supported by chatbots and voice assistants. Notably, community pharmacies in Taiwan have information systems that are tied into the country’s National Health Insurance, the single-payer system that the Taiwan adopted in 1995. That integration enabled a real-time tracking system for masks.
• However, some small independent pharmacies had difficulties dealing mask distribution. Pharmacy organizations and pharmacy schools helped them out by deploying student volunteers.
• Dispensing by community pharmacies have minimized the potential for an influx of patients seeking prescriptions at hospitals.
• As result of COVID-19, the Taiwan government has set up a website where people can buy masks. The notion is to prevent overcrowding at the pharmacies and reduce viral transmission.
• Drug shortages are looming as a potential problem because of the lockdown of some manufacturers. Ou and Kao Yang say identifying alternative medications and minimizing no-substitution requests could help with any shortfall.

But Taiwanese offiicials also took many steps that weren't related to community pharmacies or pharmacists. As described by Ou and Kao Yang, they included referring suspected cases to government-designated hospitals, outdoor quarantine stations for anyone showing any sign or symptoms of COVID-19, and obtaining travel histories.

“In this unprecedented global public health emergency, a reliable network of health care professionals in communities near where people live is vital for providing services and products for self-care and reducing anxiety and panic,” they concluded. “This COVID-19 crisis is the moment for community health care workers to step up to the plate and show their value in public health.”