Furthering Taiwan’s public health by supporting initiatives such as the promotion of liver health, sufficient funding for vaccination policy, and sustainable long-term care focusing on osteoporosis management.
Taiwan has had great success with public health, and the Public Health Committee stands ready to continue working with the government to achieve its goals, such as joining the World Health Organization (WHO).
The Committee’s members will also continue to promote Taiwan’s achievements, hosting visits by senior executives, sharing news of positive developments with our corporate headquarters and advocating for Taiwan during AmCham’s annual CEO trip to Washington.
Taiwan’s history with managing liver health is especially impressive. The Committee believes that the country is well positioned to become the “Liver Health Center of Excellence in Asia.” Our members look forward to exploring new ways to work with the government to strengthen Taiwan’s position in this vital area.
The Committee applauds the Ministry of Health and Welfare (MOHW) for its impressive achievements with hepatitis C (HCV) treatment. Last year, MOHW set a goal to eliminate the disease by 2025. To achieve this ambitious goal, the government increased funding and removed the restriction to accelerate treatment starting from 2019.
The Committee commends the National Health Insurance Administration (NHIA) for including hepatic carcinoma cancer (HCC) into the immuno-oncology drugs’ reimbursement. Providing innovative and effective HCC treatment is an important step toward becoming the Liver Health Center of Excellence in Asia. More importantly, it will bolster Taiwan’s position to join the WHO.
In addition to liver health management, the Committee also would like to partner with MOHW in improving its vaccination policy. We applaud the government’s intent to keep abreast of international trends and scientific assessments. We understand that a phasing strategy helps address the difficulty brought about by insufficient vaccine funding over the short term. However, it’s important to note that only steady, long-term vaccination programs with sustainable funding can be successful.
Long-term care, especially osteoporosis management, is another major issue the Committee would like to work on with MOHW. Improving the health and mobility of senior citizens is critical for successful long-term care. The Committee would like to partner with MOHW to develop a policy and programs to prevent bone fractures – an extremely commonly problem for the elderly in Taiwan – through screening and health intervention.
Suggestion 1: Build Taiwan into a Liver Health Center of Excellence in Asia.
Liver health has long been one of the primary healthcare issues in Taiwan. About 13,000 people died in 2017 due to chronic liver disease, cirrhosis, and liver cancer, also known as hepatocellular carcinoma (HCC), according to the MOHW.
Cirrhosis/chronic liver disease ranks as the 10th leading cause of death in Taiwan. Liver cancer is the second leading cancer in terms of mortality. The Hepatitis B virus (HBV) and Hepatitis C virus (HCV) are the key risk factors for chronic liver disease, cirrhosis, and liver cancer.
Hepatitis B vaccination program was implemented in Taiwan for newborn babies as early as 1986. It not only substantially decreased the prevalence of hepatitis B virus (HBV) infection but was also an extraordinary achievement that has received worldwide recognition. The next goal will rely on the government’s continuous efforts in chronic hepatitis B (CHB) management to stop disease progression and improve long-term clinical outcomes, such as those leading to fibrosis, cirrhosis, liver cancer and mortality. Treatment continuity will be one of the key factors to achieve this goal.
Eliminating HCV by 2025 is Taiwan’s goal – a more ambitious target than the WHO’s goal that aims for 2030. HCV reimbursement in 2017 and the reimbursement guideline relaxation in January 2019 were critical milestones for achieving the 2025 goal. The Committee is keen to work with the government to come up with an executable plan of screening and linkage to care, which will be critical in the next few years.
There is a sense of urgency for introducing innovative treatment options to all HCC patients (currently NHIA reimburses immuno-oncology drugs for only a very limited number of HCC patients). Factors that will be essential to success include accelerating the entry of new drugs by encouraging clinical trials invested in Taiwan. Also crucial is increasing the new drug budget.
The Taiwan government rightly considers the biotechnology industry to be one of Taiwan’s strategic economic growth drivers. Based on the experience of advanced countries, the key success factors for the development of a bio-pharma industry are people, intellectual property rights, regulations, and markets. The Committee sincerely hopes to partner with the government to enhance international cooperation and increase liver disease-related new drug development and clinical trials. It also wants to help maximize and accelerate patients’ access to innovative medicine. This will improve Taiwan’s disease management and treatment of chronic liver disease, liver cirrhosis, and liver cancer.
Continue the great work on liver health management. The government has established an integrated office and has announced the national Hepatitis C policy guidelines aiming to eliminate HCV by 2025. The Committee suggests that the government have screening to support therapy and a comprehensive link to care systems, which are critical factors to accomplish the HCV goal.Since Taiwan has had tremendous success with HBV vaccination, we suggest that the government achieve alignment with international guidelines in HBV to continue to lower the HBV infection rate and disease progression. For HCC treatment, the Committee recommends that the government accelerate reimbursement with a sensible guideline.
Share the best practices of liver health management with countries included in the New Southbound Policy. The Committee’s member companies are willing to explore ways to support the government’s New Southbound Policy, which seeks to strengthen economic and cultural ties with 18 countries in South and Southeast Asia. One of the most impactful ways to promote the policy would be to share Taiwan’s success with liver health. The Committee would like to discuss how it can collaborate with the government in this area in which the industry can play a key role.
Suggestion 2: Provide sufficient vaccine funding to restore Taiwan’s position as a regional vaccination policy leader.
Taiwan has been a pioneer in vaccination, eradicating or managing several diseases – such as smallpox and measles – through immunization. With sufficient health education, it is also possible to protect Taiwanese children against the threat of pertussis, also known as whooping cough, through immunization. Vaccination continues to be one of the important issues in the field of public health. The government’s announcement to introduce the human papillomavirus (HPV) vaccine for girls in 2018 is part of ongoing efforts to enhance the standards of national immunization programs. This aligns with the WHO’s call to action on cervical cancer elimination through vaccination, early diagnostics, and treatment. Based on the MOHW’s “Phase III Project to Enrich National Vaccination Fund and to Boost National Immunity,” several new vaccines will be introduced into Taiwan’s national program in 2019. This is a positive development to strengthen vaccination policy in Taiwan.
To follow WHO recommendations, the MOHW plans to introduce new vaccines for different age cohorts and risk levels through public funding. We applaud the government’s intent to keep abreast of international trends and scientific assessments. We understand that a phasing strategy helps address the difficulty brought about by insufficient vaccine funding over the short term. However, from the perspective of continuity in public health policies, only steady and long-term vaccination programs can be successful.
Establish a solid vaccine funding plan that will support vaccination policies on a sustainable basis. In the 2018 White Paper, the Committee acknowledged that MOHW had a positive and proactive attitude about solving this issue. We would like to see the government further develop effective strategies and new funding sources to support the long-term vaccine policy.
We encourage the Taiwan government to more actively educate the public on the value and benefits of vaccination. It is also important for the authorities to consider how to compete with other nations for an appropriate share of the limited supply of vaccine in the global market. These steps will enable the people of Taiwan to benefit from a well-planned immunization program that enhances their health.Introducing new vaccination programs requires robust scientific evidence and applying best practices from other countries. The Committee will be happy to provide further information and support, as immunization is one of the most powerful and cost-effective investments that can be made in health and productivity. Expediting the introduction of new vaccines will provide the people of Taiwan with health protection comparable to the international level.
Suggestion 3. Work together to raise awareness of osteoporosis. Initiate primary and secondary osteoporosis prevention policies for an aging society.
Due to extremely low birth rates, Taiwan’s population is aging rapidly. The country officially became an aging society in 2018 with people over 65 years old accounting for 14% of the population. In 2025, it is projected to become a super-aged society, with at least 20% of the population 65 or older.
The most serious health-care problems for the elderly include disability and death from fragility fractures – often caused by osteoporosis. The fractures consume a great deal of health-care and long-term care resources. The injuries also create a huge burden for caregivers in families.
Fragility fractures indirectly affect social productivity, resulting in a great impact on the social economy, and thus pose a great challenge for an aging society. Because of the significant aging trend in Taiwan, the country’s rate of hip fractures is relatively high compared to other nations in the Asia-Pacific region.
Osteoporosis is often called the silent killer of the elderly. Without leaving any obvious signs, the disease gradually hollows out the bones so that a mild bump or fall can result in a fracture. Domestic studies have shown that one in three women, and one in five men, over the age of 50 suffer from osteoporosis.
Fractures due to osteoporosis result in severe pain, difficulty in movement, and even long-term disability. Of all the bone breaks, hip fractures are the most serious, leaving patients heavily reliant on the care of others. The injuries often result in serious complications or even death due to infection.
Taiwan has the highest incidence of hip fractures in Asia, with nearly 20,000 people diagnosed with the injury every year, according to the National Health Insurance Administration. Up to 80% of patients with hip fractures become disabled, and 20% of the patients will die within one year. Hip fractures not only increase overall medical expenditure, but also impose heavy burdens on the public health care system. The impact on the overall social economy is hard to even estimate.
Leverage the power of civil society and industry to raise public awareness about osteoporosis detection and prevention. Fragility fractures can be effectively prevented through screening and health intervention. Early detection and prevention are the key. It is imperative that the government combines the power of civil society and industry to initiate large-scale health education promotion and jointly raise public awareness of bone health and osteoporosis prevention. This will help people detect osteoporosis early and then seek health advice and take necessary preventative intervention to effectively reduce disability and death caused by osteoporosis.
Initiate primary and secondary prevention of osteoporosis. This will promote public bone health, while greatly reducing osteoporosis-induced fractures, enabling Taiwan’s health care system and social economy to enjoy long-term sustainability.
The Committee supports President Tsai’s policy of promoting “cooperation between the government and the civil society for a better nation.” The Committee will continue to work with the government to raise public awareness of osteoporosis and promote a healthy society.