In Taiwan, the cost of Covid-19 vaccination is too high.
I’m not talking about the financial cost. The government-paid vaccine is available to people in the prioritized groups. And even the self-paid vaccine is capped at a reasonable NT$600 (US$21).
I’m talking about the transaction cost of getting vaccinated.
Currently, if you want to get a Covid-19 vaccine in Taiwan, whether it’s government-paid or self-paid, you would need to take the following steps.
To start, you need to pre-register by checking each hospital’s vaccination appointment web page to see if there is an open spot. If appointment availability is scarce, as it is right now, then you need to check every hospital one by one, each with its own system to navigate. In addition, if you’re a first-time visitor to the hospital where you find an open spot, you also have to fill out a registration form with basic health information, whether online or on paper.
On the day of the appointment, despite the pre-registration, you still have to check in upon arrival at the hospital. Then, you go to a waiting area to receive and complete an assessment form and the vaccination record card. To fill out the assessment form, you have to go to a self-serve station to measure your blood pressure and heart rate. After that, you would go to another waiting room to check in for the doctor consultation. Only after the doctor’s consultation can you go to the injection room, where you receive the Covid-19 vaccine. But that’s not the end: you then stay thirty more minutes at the hospital for observation, before being allowed to leave. From start to finish, you can expect to spend one to two hours at the hospital.
That’s a lot of steps and a lot of time.
In contrast, nowadays far fewer steps are required for receiving a Covid-19 vaccine in the United States. Americans can simply walk into a pharmacy to be vaccinated. There is no blood pressure check. There is no doctor consultation. And the observation time is shorter, too. From start to finish, those in the U.S. can expect to be done in less than thirty minutes.
Taiwan’s government has done well to make vaccination available at a low financial cost. But availability is not the same as accessibility. To make vaccination accessible, the government must do more to reduce its transaction cost, too.
The issue is not only a matter of efficiency, but a matter of equality. Judging by anecdotal evidence, the people who have been vaccinated — especially via self-paid vaccines — tend to be economically advantaged, such that they can afford to take a couple hours out of their day to go through the many required steps. They also tend to be socially advantaged in other ways, like being able to navigate the online pre-registration step with ease, and being able to communicate in a locally dominant language with fluency. Others have friends who are fluent and familiar with Taiwan’s medical bureaucracy and are happy to assist them. Conversely, other people — even those who are eligible for government-paid vaccines — have not been able to get vaccinated due to their socioeconomic disadvantages. They cannot afford to take the time out of their work day, they cannot easily find an open spot online, and they cannot easily fill out the numerous forms. While the recent local transmission cases have increased overall vaccine uptake, in all likelihood they have also increased the inequality with who gets vaccinated and who doesn’t.
Taiwan’s government was rightly concerned with justice in vaccine distribution when it made government-paid vaccines available to certain groups before others. But as philosopher Matthew Noah Smith argues, social policies are not sufficient to realize justice. Material infrastructures matter, too. Smith gives the example of political enfranchisement. To guarantee the right to vote for all citizens, it’s not enough for the state to enshrine the right in the law; the state also needs to provide the requisite polling places and ballot boxes that are made accessible to all citizens.
As I argue elsewhere, material infrastructures can perpetuate and exacerbate existing social inequalities. To achieve justice in vaccine distribution, it’s not enough for Taiwan’s government to prioritize vulnerable groups on the eligibility list for government-paid vaccines; the government also needs to provide the requisite material infrastructures to make vaccination accessible. And that starts with reducing the transaction cost of Covid-19 vaccination.
To be clear, I understand the motivation for including, say, blood pressure check and doctor consultation in the current procedure. Many people in Taiwan were admittedly hesitant about receiving the AstraZeneca vaccine given the risk of its serious side effect of blood clots, which is very rare in reality but also constantly reported in the news. So these “extra” steps may have functioned to bolster the public’s confidence in the safety of the vaccine. However, the recent local transmission cases have also made salient another risk — the risk of not vaccinating people as quickly as possible. Now seems to be an especially good time to reassess whether the current procedure really achieves the most optimal balance between the two types of risks, or whether there are different tradeoffs to be made.
Even before the recent uptick in overall vaccination rate, people are beginning to recognize the transaction cost of Covid-19 vaccination. Taiwan’s government deserves credit for entitling vaccine takers to up to two days of unpaid leave in its policy. But once again, that’s availability, not accessibility. Material support, in the form of paid leave, can both increase overall vaccine uptake and decrease vaccine distribution inequality. In addition, the civic hackers of g0v can be commended for building vaxx.tw, which collects hospital appointment availability in one place so that one no longer needs to manually check each pre-registration system — though those most likely to find such a tool useful are likely to be already tech-savvy.
Although economically developed nations in the West still have not done nearly enough to vaccinate the rest of the world, Taiwan’s own vaccines — potentially available as early as July — will make Covid-19 vaccination more locally available. And it’s already quite affordable. However, to achieve justice in vaccine distribution, it’s necessary to simplify the steps and reduce the time. So what remains to be done is to make sure that it’s accessible, to all.
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TNL Editor: Nicholas Haggerty, Bryan Chou (@thenewslensintl)
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