by Enbion Micah Aan

Photo Credit: Lisa Fernando/CC

IN RECENT DAYS, COVID-19 vaccines have been all the rage in Taiwan. During a historically unprecedented pandemic, it would be not unusual for any nation to debate and discuss vaccines. Unfortunately, in Taiwan, such discussions morphed into post-factual political attacks and sensational commentaries that sow unnecessary distrust in its population at the time when public trust of our institutions is of paramount importance.

To stress public trust does not mean that Taiwan’s Central Epidemic Command Center (CECC) should not be beyond reproach. These institutions should still be under scrutiny even in the face of an emergency, but there is a clear difference between being critical and being manipulative or simply wrong. I would argue that one should look closely and apply critical pressure to the government’s actions while being mindful that one’s comments have the capacity to eradicate public trust in these institutions at the time of crisis. For example, criticisms around migrant workers and lack of testing are legitimate issues, and one can raise these serious concerns without undermining the government’s legitimate efforts in curbing the pandemic.

Photo credit: Lisa Fernando/CC

In other words, the common sense criticism during a time of crisis is not to sound the alarm where there is no fire, and one should be careful not to overreach on issues to create unnecessary public panic. Unfortunately, creating fire out of nowhere just to manufacture unjustified public outcry is precisely what has been happening in Taiwan’s political landscape around the issue of COVID-19 vaccines.

The government in Taiwan has made spreading “fake news” about COVID-19 illegal, with a fine of up to three million NT and a sentence of up to three years. “Fake news” has always been a major issue during elections in Taiwan, and this legislation is intended to curb false information that might have public health implications. To date, there have been no reported cases with jail time. However, it is perhaps precisely because of this requirement that one can not spread false information about COVID-19 that politicians and commentators found a way to gain politically or sensationalize with phantom vaccines and false equivalents. What I mean by phantom vaccines are vaccines that do not actually exist in reality, or more accurately, imagined or self-constructed vaccines.

Since it is perfectly legal, and in fact, impossible to be inaccurate in talking about fictitious vaccines, phantom vaccines are a good tool for politicians to take cheap shots, construct narratives they deem useful politically, and for commentators who need to sensationalize everything on tv. These narratives, on the surface might look absurd and even comical, but yet, the real result is that many people will no longer trust the institutions at the very moment that they should adhere to public health policies.

Claims of vaccine donations first started by KMT politician Lin Ming-Chen, then followed by Billionaire and Foxconn President Terry Gou and Fo Guan Shan, widely known as a pan-blue buddhist organization in Taiwan. On Guo’s Facebook page, he publicly stated that he will purchase five million doses of Pfizer/BNT German-made vaccines for Taiwan. Donating vaccines that one simply can’t purchase may seem absurd, but such is the political reality people of Taiwan face on a daily basis. Any claims, however absurd, are enough to justify political power, as the politicians can blame the central government for its perceived, however ridiculously wrongly, for the vaccines they themselves are not able to purchase. It matters little that there is a global shortage, and there are 3 established and well known channels to purchase vaccines, all need to be through the government. This has been talked about in length in another New Bloom article with a detailed account.

Vaccine imports as spoken of by commentators and politicians are phantom vaccines because the parties claiming to be able to purchase vaccines do not actually have the vaccines, nor do they have the capacity to purchase them. Commentators, then, in turn talk endlessly about these non-existent vaccine imports to make an impression that the government is incompetent if not outright useless. The purpose of vaccine import narrative is not about vaccine imports—the real purpose is to establish the narrative amongst pan-blue supporters that the government is utterly incompetent. Once this narrative takes hold, all sorts of post-factual commentaries will continue to spring up.

What is particularly disturbing is not that pan-blue supporters are simply prone to politicians’ manipulation, but rather, that these pan-blue politicians have no qualms about the fact that by seeding distrust with the CECC, they are making it more likely for their older supporters not to follow government policies and increasing the likeliness of infections and vaccine hesitancy. At this time, most COVID-19 deaths in Taiwan are the elderly. The CECC is by no means perfect, but by the numbers, it has handled the pandemic quite well, with Taiwan enjoying a practically COVID-19 free year in 2020. Even with the recent outbreaks, one notes that the infection rate is still among the lowest in the world. For example, currently, in a two-week span, the per 100,000 rate is 1.4, roughly the same as Japan (1.7) , and mucher lower than 4.2 of the US—Japan and the US are the two countries that have donated vaccines to Taiwan. This is not to mention, the government has quickly fixed the aforementioned testing shortage issues, and there’s no talk of shortage of facemasks. Given the public health implication, seeding the unjustifiable distrust amongst its mostly older and at the same time, the most vulnerable, supporters is quite morally dubious.

Now, let us first talk about the “normal process” in vaccine approval in the US. It typically takes 10-15 years to develop a vaccine. The fastest time frame that a vaccine was developed was the mumps vaccine in the 1960s, and that took four years. All current COVID-19 vaccines were developed in unprecedented speed and have smashed the record. In a normal, non-emergency scenario, a vaccine would go through four phases of trials.

Phase zero consists of cellular and animal testing. Phase one consists of safety trials, but they are tested only in a small number of humans. Phase two consists of expanded safety trials with hundreds of human test subjects. Phase three requires tens of thousands of human test subjects to test for efficacy and other long term and side effects. Phase four is when the vaccines are allowed to be used by the general public, with the FDA’s monitoring. The FDA can stop a vaccine at any stage.

What is different is that Emergency Use Authorization (EUA) occurs at Phase three, where only a few thousand human test subjects are required, as opposed to tens of thousands. Currently, all available COVID-19 vaccines are still in Phase three and under EUA. EUA would not stop Phase three trials, as pharmaceutical companies would still want to have the “normal” FDA Approval after Emergency Use.

In lengthy vaccine trials, a common tactic to speed up the process is to have a Phase two and Phase three combination design, and this is why it is quite often that one would see “Phase II/III” in reports, and this design is the basis for Taiwan’s Phase two requirement under Taiwan’s EUA rules, according to Taiwan’s FDA. The combining of these two phases has been done and is not novel.

The false equivalent of the Taiwanese “Phase two” vaccines here is more widespread and not restricted to only pan-blue politicians, but also government bureaucrats, highly educated professionals and NPP politicians. Here, the false equivalent is the notion that Taiwan’s vaccines would only go through the equivalent of US FDA’s Phase two trials. Commentators and politicians alike conflate US and Taiwan’s EUA standards and make it seem like Taiwan’s vaccines would only require the equivalent of the US FDA’s Phase two trials.

Here, to be fair to commentators and politicians alike, Taiwan’s government does claim Phase II trials alone is enough for EUA, and it was the government that started the false equivalency in claiming that vaccines in other nations were also authorized during Phase two. The government here is saying that Taiwan’s Phase two is similar to or the same as, for example, Phase three of the US FDA requires in cases of Emergency Use.

Therefore, the contention here lies, where commentators correctly point out the FDA of the US requires Phase three trials, and the government’s claim that US FDA approved EUA after Phase two (of the Taiwanese equivalent). Here, a great meta-debate around semantics ensures public confusion—Taiwan’s government’s claim is not 100% correct, and the commentators’ conflation of the US’s FDA standards with Taiwan’s FDA standards only furthers the confusion. [1] The end result is, without any evidence, ordinary Taiwanese people believe Taiwan’s vaccines will not be safe, or at least inferior to that of other vaccines.

Taiwan’s EUA process is actually based on the US’s FDA’s EUA, but whereas the US’s FDA requires Phase two and partial Phase three trials with the minimum of 3,000 test subjects, Taiwan’s FDA categorizes the partial Phase three trials under Phase two, or one could say Taiwan’s Phase two requirement is a more expansive version of traditional Phase two with partial Phase three trials. For example, Taiwan’s vaccine Phase two trials have about 3,800 test subjects. Moderna had 600 Phase two test subjects and was required to have at least completed 3,000 Phase three subjects before they could apply for EUA. By the time Moderna vaccines were rolled out with EUA, the number of test subjects was over 30,000. Moderna has also recently applied for “normal” FDA approval.

So, if we were to use FDA as the standard at the time of EUA application, it appears the number of Taiwan vaccines’ test subjects is about the same as that of the US, but what is different is that the US FDA requires two months of follow up, whereas Taiwan’s FDA only requires one month. As such, Taiwanese government’s claim about Phase two (Taiwanese equivalent) falls short of at least one month of the US version of phase three. If we were to apply to the 30,000 test subjects that Moderna had when it received its official EUA as a standard, Taiwan’s vaccines will probably fall way short of this number when they are officially approved and released.

At the time, the Taiwanese government had not published EUA guidelines. And this is where the lack of information and confusion was seized upon by the opinion class, who then made or strongly implied this false equivalent, that Taiwan’s vaccines only require the equivalent of US Phase two vaccine trials—making it seem like Taiwan’s EUA requirement is radically different from that of the US. Though the persistent myth that Taiwan’s vaccines would only have the equivalent of the US’s FDA Phase two trial is false, and in a sense, ridiculous since one can’t establish efficacy with only US Phase two trials, this is what most people seem to believe at the moment.

The government is obviously also at fault here in the area of perception management, as it lacks transparency and is prone to unclear communication in regards to these trials. In not explaining the complex process of vaccine trials and the differences in different nations, the government, perhaps unknowingly, created a meta-narrative that is confusingly frustrating for its citizens.

One also notes that the lack of information around Taiwanese vaccines might simply be because the vaccines have not been approved—there is no point in releasing information about a vaccine that might be rejected in the end. If so, the government should not have brought up the issue to begin with—it should have known that Taiwan’s opinion class and politicians would seize any opportunity to exaggerate, as rumors and speculations play an outsized role in Taiwanese culture. Hopefully, upon Taiwanese vaccines’ actual approval, much of this confusion can be cleared up.

When and if Taiwanese vaccines are approved for EUA, citizens are most likely to be understanding of the emergency situation, so fully disclosing the risks and being completely transparent is of the utmost importance. Attempts at dodging risks associated with vaccines will only create more distrust and meta-narratives that will do nothing but confuse people. In other words, the government needs to have faith in its own procedures and risk assessment—it does not need to be lockstep with the American FDA, and understand that the citizens will make decisions on their own, and, ultimately, the accuracy and the trustworthiness of the information released by the government will determine how well the pandemic can be managed.

When commentators go on TV or when politicians, doctors, and lawyers go on and on about American EUA requiring Phase three but Taiwan’s does not, the opinion class has not only failed to inform the public of a very complex process, but also scared the public into possible vaccine hesitancy. Vaccine hesitancy is not necessarily bad, as the decision to get jabbed is a personal choice, but vaccine hesitancy based on a narrative of false equivalency and false assumptions could have easily been avoided by a more thoughtful leadership—both the government and the opinion class are responsible in this regard. This is not to mention that the public in Taiwan is prone to fear vaccines. For example, there is a persistent and common fear with vaccines already in Taiwan, with people worrying about rare instances of blood clotting of AstraZeneca vaccines— the chance of blood clot after the first shot of AstraZeneca is more common with young people, but at the low rate of 12.3 per million doses. The public obviously misunderstand the implication of blood clotting, and often refer to it as “blood acid”—something that reporters ask about at times at daily briefings. With a population that is already prone to fear and an opinion class that enjoys fear mongering, the government could have been more careful in disclosing information, and the opinion class should understand its influence to the public and could have just toned down the rhetoric and provided context for a very complex process.

Photo credit: Pixabay/CC

Under EUA, vaccines would not go through full Phase three trials, the relative risk, especially long term risk would naturally be higher, but this is true of all COVID-19 vaccines that are available at the moment. Instead of explaining the inherent risk of such a process, the opinion class decided to dismiss context and insistently make false equivalents. The responsibility of people who understand this complex process, the politicians and the highly educated opinion class, is to explain to their supporters and viewers how complex the vaccine trial and making process is. Instead, it is quite disappointing to see that they resorted to making false equivalents, making it seem as if Taiwan’s vaccines would be released after US FDA’s equivalent Phase two trials, even when it is clear that such a scenario would actually not conform to Taiwan’s legal requirement for EUA.

It is, of course, entirely possible that the opinion class simply never understood the trial process, but in that case, it is still wrong to assert a position on Taiwanese vaccines that they know little about. Furthermore, politicians’ and commentators’ dramatized commentaries end up having the real effect of fear mongering.

One thing that all these cases of false equivalency have in common is the loss of context. The pan-blue camp, as well as the opinion class, does not bother telling their constituents that there is a global shortage when they speak of purchase of vaccines, nor do they give an overview of the trial process. One notes that none of them appreciate the fact that the current situation with COVID-19 is unprecedented, and rushing out vaccines in this manner is actually the first time in Taiwan’s history, not to mention, in every country’s history.

The loss of context is important for these individuals, as it allows them to cherry pick for manipulation—all propaganda, after all, requires a kernel of truth. Phantom vaccines and false equivalents not only require the loss of context—it is infantile politics, as it renders the public helpless and goading them into magic thinking. This allows politicians and public figures to assert and justify their positions of power. Politicians, commentators, government bureaucrats, and the techno-bureaucratic and corporate-influenced system alike, after intentionally or unintentionally seeding unnecessary fear in the public, are also unlikely to be held to account. Such are the politics of today’s Taiwan.

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