Taiwan has had great success with its public health programs, and AmCham’s Public Health Committee stands ready to continue working with the government to help it achieve its goals, such as joining the World Health Organization (WHO).
The Committee’s members will also continue to promote Taiwan’s achievements by encouraging visits by senior corporate executives, sharing news of positive developments in Taiwan with our head offices, and advocating for closer U.S.-Taiwan cooperation on health affairs during AmCham’s annual CEO Mission to Washington.
Taiwan’s history in 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 also applauds the Ministry of Health and Welfare (MOHW) for its outstanding achievements with hepatitis C (HCV) treatment. Last year, MOHW set a goal of eliminating the disease by 2025. To achieve this ambitious objective, the government increased funding and removed restrictions to enable accelerated treatment to start from 2019. The HCV budget has reached a record high of NT$8.2 billion for a single therapeutic area.
The Committee commends the National Health Insurance Administration (NHIA) for including hepatic carcinoma cancer (HCC) in the reimbursement for immuno-oncology drugs. We urge NHIA to continue the good practice, as providing innovative and effective HCC treatment is an important step toward becoming the Liver Health Center of Excellence in Asia. In addition, it will bolster Taiwan’s position in seeking membership in the WHO.
Besides liver health management, the Committee would like to partner with MOHW in improving the national vaccination policy. We applaud the government’s intent to keep abreast of international trends and scientific assessments, and we understand that a phasing strategy helps address the difficulty brought about by insufficient vaccine funding over the short term. However, it is 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. In line with President Tsai’s policy of promoting “cooperation between the government and civil society for a better nation,” the Committee would like to build on the 2019 Aging Society Forum we sponsored to help develop a pilot public-private partnership program with MOHW to help prevent bone fractures through screening and health intervention as well as to increase public education and enhance prevention and treatment for ailments afflicting the elderly in Taiwan.
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 12,000 people died in 2018 due to chronic liver disease, cirrhosis, and liver cancer, also known as hepatocellular carcinoma (HCC), according to the MOHW.
Cirrhosis/chronic liver disease continued to rank as the 10th leading cause of death in Taiwan in 2018. Liver cancer remains 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.
Taiwan’s goal is to eliminate HCV by 2025 – an even more ambitious target than the WHO goal that aims for 2030. The increase in HCV reimbursement in 2017 and relaxation of the reimbursement guideline in January 2019 were critical milestones toward achieving the 2025 goal. Reflecting the government continued commitment, the HCV budget reached a record high of NT$8.2 billion for 2020. The Committee is eager 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.
With regard to Hepatitis B, Taiwan has implemented a vaccination program for all newborn babies since 1986. This extraordinary achievement has received worldwide recognition for substantially decreased the prevalence of hepatitis B virus (HBV) infection. The next goal will rely heavily on the government’s continuous efforts in comprehensive chronic hepatitis B (CHB) management to stop disease progression and improve long-term clinical outcomes, such as the prevention of fibrosis, cirrhosis, liver cancer, and mortality. The relaxation of reimbursement guidelines in treatment criteria and continuity of treatment will be key factors in achieving this goal.
For HCC, there is an urgent need to introduce more innovative treatment options for all patients. Current reimbursement guidelines are highly restrictive, and therefore priority from a public health perspective should be given to accelerating the entry of innovative HCC drugs to benefit patients.
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. We also wish to help maximize and accelerate patients’ access to innovative medicine in order to 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 continue to put effort into identifying effective screening strategies to support therapy and comprehensive links 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. The Committee also recommends that the government accelerate the reimbursement process with a sensible guideline for new drugs in order to provide better treatments to HCC patients.
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.
Include more treatment options under the National Health Insurance program – for example, TKIs and IO (immuno-oncology) drugs – and relax reimbursement guidelines in line with TFDA’s approved label indications in order to help more HCC patients and their families. Essential to success will be accelerating the entry of new drugs by encouraging clinical trials invested in Taiwan.
Suggestion 2: Relax regulations governing vaccine advertising and public communication for disease awareness.
The Taiwan government has repeatedly emphasized that vaccination is the most effective measure against infectious diseases, and the outstanding results of Taiwan’s vaccination programs were seen as a benchmark internationally.
Worldwide, many severe infectious diseases such as smallpox, pertussis, and measles have been effectively managed or are close to eradication through vaccination. At the same time, the global panic that COVID-19 has caused shows the impact that a disease can have on the health of citizens and the economy when a vaccine is unavailable.
In recent years, the WHO has highlighted cervical cancer prevention as a key public health issue, calling for vaccination – along with early diagnosis and treatment – as critical components of an effective policy against the disease. Taiwan has implemented a cervical cancer vaccination policy since 2018, and last year the MOHW increased the vaccine fund in order to introduce quadrivalent flu vaccines. Both policies demonstrate a strengthened vaccination strategy in Taiwan.
Aside from the increased budget for flu vaccines last year, the size of the vaccine fund has been unstable. In recent years, the government has frequently delayed implementation of recommendations from the Taiwan Advisory Committee on Immunization Practices (ACIP) for public immunization programs. With an unsustainable vaccine fund, Taiwan is no longer a benchmark for good practices in vaccination policy. Instead, the maintenance of high public health standards and individual health relies heavily on public awareness of the effectiveness of vaccination as a method of disease prevention – and on a willingness to pay privately for vaccination.
The Pharmaceutical Affairs Act restricts the ability to communicate in-depth disease awareness information to the public and prohibits manufacturers from conveying the differences between products. The result is to limit public appreciation of the effectiveness of vaccinations in disease prevention.
We understand the government’s commitment to ensuring drug safety for patients. Yet as we face the resurgence of various infectious diseases, vaccines remain the most effective method of prevention. The government should adopt a “shared responsibility” approach to the situation, engaging in more public education on the value and benefits of vaccination.
The Committee again urges the government to relax the current regulations around vaccine promotion. This change would enable patients to choose vaccines that suit their own needs, reduce the burden on the National Health Insurance system, and in turn reduce the financial pressures on the government budget.
Establish a comprehensive vaccine administration plan, increase the budget allocation, and ensure that the allocation is sustainable. Globally vaccination strategy has moved from targeting newborns to a more holistic approach – from young children to adolescents, adults, and then the elderly. To strengthen Taiwan’s vaccination fund, government appropriations should cover at least 60% of the fund’s finances. After all, vaccination is not just a matter of public and personal heath, but also one of national security.
Relax regulations governing advertising and disease-awareness communication related to vaccine products. Article 67 of the Pharmaceutical Affairs Act limits the advertising of prescription drugs to publication in academic medical journals. As vaccines are considering prescription drugs, it is not possible to advertise directly to members of the general public to educate them about the value of vaccines. As a result, it becomes more difficult to provide the public with accurate and targeted information. Patients are deprived of guidance in selecting the most suitable vaccines for their prevention needs. Worse, misconceptions often arise in the absence of good information. An approval and review mechanism could be established to ensure the accuracy of the information in terms of TFDA indications and scientific evidence. The result would be higher vaccination rates while reducing the burden on government- sponsored vaccination programs.
Suggestion 3. Increase the awareness, prevention, and treatment of osteoporosis and initiate primary and secondary osteoporosis-prevention policies.
Due to extremely low birth rates, Taiwan’s population is aging rapidly. Our 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 aging of society is bringing an enormous increase in the incidence of fragility fractures, often caused by osteoporosis. The fractures consume a great deal of healthcare and long-term-care resources, and they also create a huge burden for caregivers in families.
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 NHIA. Up to 80% of patients with hip fractures become disabled, and 20% of the patients will die within a year. Hip fractures not only increase overall medical expenditures, but also impose heavy burdens on those patient’s family and the public healthcare system. The impact on the overall social economy is hard to even estimate.
Leverage the power of civil society and private industry to raise public awareness about osteoporosis detection and fracture prevention. Fragility fractures can be effectively prevented through screening and health intervention. Early detection and prevention are the key. The Committee urges MOHW’s Health Promotion Administration (HPA) to work with civil society and industry to engage in largescale public education to raise awareness regarding bone health and osteoporosis prevention. We also recommend that HPA list osteoporosis screening as a national health screening item for people 65 years old or older to encourage early diagnosis and necessary preventative intervention to reduce disability and death from osteoporosis.
Initiate primary prevention of osteoporosis (prior to a first fracture) and improve secondary prevention of fragility fractures. Currently osteoporosis treatment is reimbursed under National Health Insurance only for patients who have experienced a fracture. Broadening the coverage will promote bone health, while greatly reducing osteoporosis-induced fractures, enabling Taiwan’s healthcare system and social economy to enjoy long-term sustainability.