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Tsung-Mei Cheng testifying before the Senate Health Subcommittee on Primary Health and Ageing on Universal Health Care Models, 11 March 2014. Source: C-Span

Transpacific Taiwanese Americans and the Global Fight against Covid-19

Transpacific Taiwanese Americans and the Global Fight against Covid-19

| Wayne Soon |

This essay explores the critical role of the Asian diaspora, specifically the Taiwanese, in the United States in shaping medical knowledge of the Covid-19 pandemic. Focusing on the acute phase of the pandemic from February 2020 to December 2020, before Covid-19 vaccines became available, I argue that some members of the Taiwanese/Taiwanese American (TTAM) community became critical in making visible the promises and perils of the fight against Covid-19 in both Taiwan and the United States. Through an analysis of three TTAM professionals who were key to this history—material scientist Peter Tsai (蔡秉燚), health analyst Tsung-mei Cheng (鄭宗美), and Taiwan’s representative to the United States, Bi-khim Hsiao (蕭美琴)—I show how members of the TTAM community constructed scientific and medical discourses that were crucial for the fight against Covid-19. These transpacific actors’ expertise and authenticity, however, were sometimes questioned by members of the mainstream media.

The essay draws on research by Erika Lee (2016 357–72), Shelly Chan (2018), and Madeline Yuan-yin Hsu (2000) on how East Asian, South Asian, Taishanese, and Hokkien immigrants in the United States drew on their transnational experiences in shaping their communities stateside as well as the specific communities with which they identify in Asia. It also draws on the emerging scholarship on the transpacific history of Taiwanese people in the United States, such as Pei-Chia Lan’s (2018) and Wendy Cheng’s (2017) work on transpacific parenting and political activism. Both scholars highlight the symbiotic relationship between politics and culture in Taiwan and the United States in the experiences of TTAM across borders.

Tsai, Cheng, and Hsiao came to prominence in the broader context of this transpacific history. The passing of the US Immigration and Nationality Act of 1965, as well as the creation of a separate immigration quota in the Taiwan Relations Act of 1979 after the derecognition of the Republic of China, saw many people from Taiwan emigrate to the United States. At that time, Chiang Kai-shek’s government allowed only certain businesspeople and students to leave for the United States, so many Taiwanese who stayed on were graduates of American colleges who found employment in the country (Cheng 2017). As a result, as Wendy Cheng, Pei-Chia Lan, and others have shown, many first-generation Taiwanese Americans were students or professionals, like Tsai and Cheng.

Drawing on analyses of newspaper articles, media reportage, scientific publications, and Covid-19 data across the Asia-Pacific, this essay will illustrate how these TTAM experts drew on their transpacific expertise to improve the United States’ pandemic responses. I show how Tsai drew on his engineering research and capabilities accrued in Taiwan and the United States to invent and popularise the use and reuse of N95 respirator masks. I reveal how Cheng drew on her longstanding comparative healthcare analyses to make policy suggestions to improve America’s pandemic response, and how Hsiao promoted Taiwan by highlighting the strength of its pandemic responses vis-a-vis the United States. A diasporic and transpacific approach thus challenges the United States’ and China’s pandemic exceptionalism by revealing the more moderate, measured, and practical approach taken by Taiwan and other Asia-Pacific countries.

Biographical Profiles

Born in Taichung, Taiwan, Peter Tsai moved to the United States in 1981 to pursue his doctoral degree in material science at Kansas State University. He later became a professor of material science at the University of Tennessee, where in 1992 he led a team that developed an electrostatic charging technology to filter out unwanted particles—an invention that eventually became the foundation of the N95 respiratory mask. Tsai came out of retirement in 2020 to share with healthcare workers his knowledge of how to sterilise and reuse N95 masks, which were scarce early in the pandemic.

Tsung-mei Cheng is a Taiwanese American health analyst at Princeton University and the author of numerous articles on healthcare systems and pandemic controls. She is most famous for being part of an international working group—which also included her late partner, Uwe Reinhardt, as well as William Hsiao, a Chinese-American health economist at Harvard University—that helped design Taiwan’s national health insurance (NHI) system in the early 1990s. Taiwan’s single-payer universal healthcare system kept costs low, allowed patients to choose their own doctors, imposed modest mandatory premiums, and provided an extensive range of coverage options, including for traditional Chinese medicine, gaining widespread praise (see, for instance, Rosenberg 2019; Scott 2020). During the Covid-19 pandemic, Cheng has been key in highlighting the role of Taiwan’s NHI system in fighting the virus.

Bi-khim Hsiao is Taiwan’s current representative to the United States, appointed to this de facto ambassadorial position by President Tsai Ing-wen in July 2020. Born in Japan in 1971, Hsiao attended high school in Montclair, New Jersey. She received her Bachelor of East Asian Studies from Ohio’s Oberlin College and earned a masters in political science at Columbia University. Because her mother was an American citizen, Hsiao held dual US and Taiwanese citizenship until 2000, when she gave up her US citizenship to serve as the main English interpreter to Taiwan’s president Chen Shui-bian. Hsiao also served as a member of the Taiwanese legislature between 2000 and 2008, representing the Democratic Progressive Party. In the early phase of the pandemic, Hsiao was instrumental in publicly sharing Taiwan’s experiences and geopolitical challenges in fighting Covid-19 with National Public Radio, the American Enterprise Institute, the Asia Society, the Hoover Institute, and many other organisations in the United States.

Transpacific Medicine and Technology

In the early days of the pandemic, masks, especially N95, were scarce, but were critical for healthcare workers in hospital settings to prevent infection from Covid-positive patients. Given these dire circumstances, Peter Tsai saw the need to reuse N95 masks to help healthcare workers make the best of scarce resources. In an interview with US Now This News in May 2020, he shared his research on how appropriate heat treatment could eliminate the virus from the N95 mask and keep it 98.5 per cent effective for healthcare workers (Carter 2020). Tsai had published his findings with another Asian-American physician, Dr Pascal S.C. Juang, a month earlier in The Journal of Emergency Medicine. The editor of the journal thanked Tsai and Juang for a ‘timely article’, commenting that the physicians had devised what ‘appear to be simple methods for conserving N95 masks’ (Juang and Tsai 2020).

Part of Tsai’s research on reusing N95 masks was done in a makeshift laboratory at his home as he did not have access to a research laboratory in his retirement. According to The Washington Post, Tsai found that N95 masks could be heated at 70ºC for 60 minutes using a dry-heat method without diminishing the filtration technology—a hypothesis that was later validated by US National Institutes of Health scientists (Page 2020). In the early months of the pandemic, Tsai was also answering phone calls and emails around the clock, acting as an informal consultant to health experts and authorities from across the world. He also worked with Tennessee-based Oak Ridge National Laboratory to scale up N95 mask production (Gabrielle 2021). His efforts were celebrated by many, culminating in a ceremony in May 2021 at the Chinese American Museum in Washington, DC, at which he was honoured, alongside the first Asian-American US ambassador, Julia Chang Bloch, and the first Asian-American astronaut, Taylor Gun-Jin Wang (Chinese American Museum 2021).

Representative Bi-khim Hsiao. Source: Taipei Economic and Cultural Representative Office in the United States

Like Tsai, Tsung-Mei Cheng sought to improve the management of Covid-19 in the United States in the broader context of Taiwan’s relative success in fighting the virus. Before the emergence of the Omicron variant, Taiwan had much lower rates of infection from the virus than the United States. Even in the post-Omicron period, Taiwan had far fewer Covid-19 deaths as a percentage of the population than the United States (Soon 2021, 2022). In an interview with the Council on Foreign Relations (2020), Cheng recounted how Taiwan fought the pandemic successfully early on through effective ‘prevention and control’ policies. She specifically emphasised ‘for American viewers’ that what the government was doing in Taiwan was ‘not arbitrary’ but ‘fully science and evidence-based’. Stressing the high rates of mask-wearing among Taiwanese, Cheng argued that US and European audiences should embrace masks, as an ‘ounce of prevention’ goes a long way. She laid out clearly how Taiwan’s central government took charge of fighting the virus from the beginning of the outbreak, unlike the US Government, which delegated the job to individual states—a decentralisation that caused a notable lack of coordination that impaired the United States’ pandemic response. In an opinion piece, Cheng (2020) summed up her project of borrowing from Taiwan’s experience to assist in the United States’ fight against the virus:

Covid-19 can be controlled and contained, as we have seen in Taiwan and many European and Asian nations. It is said that Americans will always do the right thing after exhausting all alternatives. Now is [the] time that we, as a nation, come together and start doing the right things to help save lives.

Bi-khim Hsiao similarly shared how Taiwan fought Covid-19 effectively, in a podcast interview with two scholars at the American Enterprise Institute (2020). Of particular interest was Hsiao’s emphasis on the fact that Taiwan did not conduct mass-testing or enforce isolation of all suspected Covid cases. Rather, she pointed out, Taiwan took a more targeted approach:

I know for many societies now, including where you are at [in] the United States, you’re talking about isolation for everyone. But we handled this in a very targeted way, that is, we isolated only those with a risk of exposure, those who have come into contact with patients or individual cases, those who have traveled from abroad, so that the rest of society can function normally.

Like Cheng, Hsiao explained Taiwan’s targeted approach within the context of its early success at containment and prevention of the virus. Because Taiwan was initially so successful, it could demand fewer personal sacrifices from its citizens in the fight against Covid-19. In an interview with the Asia Society Policy Institute in September 2020, Hsiao remarked that, apart from people being required to wear masks and undergo temperature checks when entering many buildings, life and business in Taiwan ‘carried on relatively normally throughout the pandemic so far’. She also said that ‘unlike the rest of the world’, including the United States, ‘Taiwan avoided a business lockdown and schools remained open’ (Asia Society 2020).

To Hsiao, the relative normalcy of life under this targeted approach resulted in the Taiwanese people’s support for the country’s anti-pandemic measures and its political leaders, which helped keep democracy intact and vibrant at a time when many other democracies became bitterly divided over pandemic measures. The Taiwanese people’s support of the country’s anti-Covid measures and its leaders remained high for the first year of the pandemic. While support for the government’s de facto zero-Covid policy did wane over time—culminating in the once-popular health minister losing his bid to become Taipei’s mayor in the midterm elections of 2022—the Taiwanese Government’s attentiveness to the populace’s desire to end the policy resulted in the gradual reopening of Taiwan in the second half of 2022, after much of the population had received two or more shots of the Covid-19 vaccine. It is also notable that Taiwan never locked down businesses or shut schools en masse between March 2020 and May 2021 (Minshi Xinwen 2020). Only in May 2021 did Taiwan shut schools for virtual learning as well as numerous public and entertainment facilities because of an extended Covid-19 outbreak on the island, but only for seven weeks until the beginning of summer holidays in early July (CNA 2021). When the school term resumed in the autumn, local governments resisted shutting these facilities en masse in an attempt to live with the virus, even before the de jure policy of living with the virus began in May 2022 (Davidson 2022).

Transpacificity and its Limitations

The effort of Tsai, Cheng, and Hsiao to disseminate Taiwan’s experience was a transpacific one. In addition to the North American media, Peter Tsai gave interviews to Hong Kong’s South China Morning Post (Han 2020) and India’s India Today (2020) and WION Online (2020). Tsung-mei Cheng also spoke on global pandemic preparedness with news presenters at China’s CGTN (2020) and Singapore’s Channel NewsAsia (CNA 2020). Hsiao’s activities were regularly reported in Taiwan’s and Hong Kong’s media.

Yet the media, especially in the United States, overly tied their expertise to immigrant narratives. For example, National Public Radio (NPR 2020) argued that Hsiao’s work for Taiwan in the United States was informed significantly by her familial connection to her American mother. The interviewer said to Hsiao that the relationship between the United States and Taiwan ‘for you isn’t just professional. It’s personal. Your mom is American.’ Hsiao’s professional credentials were tempered by her ‘personal’ details. Similarly, NBC News partly constructed the narrative of Peter Tsai’s work within the broader context of being an immigrant ‘role model’, overcoming racial discrimination and the Trump Administration’s immigration bans (Yam 2020). Finally, the reporter from the American Chamber of Commerce in Taiwan began her story with the fact that Tsung was ‘a native of Taiwan’, ‘living in the US for a long time’, and ‘working at Princeton’ University, thus making her migrant background central to her expertise (Mills 2020).

Even though newspaper reporting provided much needed health expertise and narratives of social mobility in the context of anti-Asian discrimination in the early phases of the Covid-19 pandemic, the coverage potentially drew on stereotypes of ‘model’ minorities and perpetual foreignism (Zhou 2012; Wu 2015; Fujitani 2013). In so doing, they often otherised Taiwanese and Taiwanese American experiences even when these experts’ brokerage of medical knowledge and experience sought to boost the United States’ fight against the virus. These individuals’ willingness to engage actively with mainstream American society revealed the tensions between their emphasis on the democratic and scientific nature of Taiwan’s fight against Covid-19 and the desire by many in the United States to dismiss Taiwan’s (and other East Asian countries’) experience as part of a ‘collectivist’ East Asia. In the words of scholars critical of this oft-repeated claim of collectivism, ‘grasping for explanations’ of the uptake of mask-wearing and other pandemic responses, ‘some Western journalists and politicians dug up and repeated longstanding tropes of Asian collectivism, submissiveness to government mandates, and techno-enthusiasm’ (Knowles et al. 2022: 117–23).

Taiwanese and Taiwanese Americans as Transpacific Method

This essay suggests that Taiwan as transpacific method can better reflect the lived experiences of many Taiwanese and Taiwanese Americans. My work augments Kuan-Hsing Chen’s (2010: xii) ‘Asia as a Method’, in which he revealed the urgent academic project to ‘decolonialize, deimperalize, and de-cold war’ Taiwan and broader East and Southeast Asian modernity. However, Chen’s project of seeing Taiwanese consciousness (which he calls a form of nationalism) as merely a mirror, and hence not necessarily an antidote, for the longstanding problem of Chinese chauvinism (Chen 2010: 49–60) should be modified by considering the complexity of historical actors over time and space. The project of creating Taiwanese consciousness was not merely a result of frivolous nationalism but was deeply intellectual, increasingly transpacific, and rooted in multiple levels of power relations. Beyond nation-based identities, centring Taiwanese consciousness in the context of the life histories of Taiwanese and Taiwanese American intellectuals reveals the latter’s international efforts at understanding, challenging, and augment the political, cultural, and medical status quo. These TTAM experts did so through explicit acts of comparison, lobbying, and reflection on Taiwan and the United States in ways beyond fostering parochial nationalism.

Many current and former Taiwanese leaders spent time abroad as political exiles, professionals, or students; others are descendants of early Taiwanese migrants in the United States. For example, former Taiwanese vice-president Annette Lu’s autobiography, My Fight for a New Taiwan (Lu and Esarey 2016), reveals how her graduate education and political activism in the United States shaped her political career in Taiwan. Her release from incarceration as a political prisoner in 1985, for example, was due in part to her advisor and allies in the United States placing pressure on the ruling Chinese Nationalist Party (Kuomintang) administration. New Yorker columnist and Bard College Professor Hua Hsu’s 2022 memoir, Stay True, reveals how his life in the United States was profoundly shaped by his frequent travels with his family to Taiwan as well as his communication with his father in Taiwan via fax machine. Similarly, a more complete historical presentation of the professional lives of Tsai, Cheng, and Hsiao, including their pandemic advocacy, can only be accomplished by considering their transpacific experiences in Taiwan, the United States, and the broader Asia-Pacific region.

Taiwan as transpacific method can help us think more historically, comparatively, and globally about the range of pandemic responses. So much of the history of the pandemic as discussed in the mainstream media has revolved around a temporal US–China axis, which posits that the United States’ early haphazard, divided, and politicised responses to the pandemic gradually gave way to a consensual societal desire to abandon most public health measures or restrictions even as Covid-19 death and hospitalisation rates plateaued at significant levels. China’s border and social controls as part of its zero-Covid policy saved lives early in the pandemic but authorities held on to increasingly draconian policies until they had to abandon them under intense global scrutiny and local protests. Even some of the most nuanced columnists critiquing this binary have used this framework of divergent US–Chinese world views of Covid-19 to unpack their analyses (Wallace-Wells 2023).

As I (Soon 2022) and others have articulated elsewhere (Davis 2023), neither the United States nor China represents the full range of global responses to the pandemic. Taiwan and many other Asia-Pacific countries—which I call ‘third way’ countries—adopted a zero-Covid or low-Covid policy early in the pandemic to save lives (Soon 2022). They also bought time to facilitate widespread vaccination before opening their borders and transitioning to coexisting with the virus. They saw the shift to living with Covid-19 as essential to reopening their borders and jumpstarting their economies, but until very recently they also retained commonsense policies such as indoor mask-wearing in many public places and healthcare facilities to prevent the overwhelming of health services. Their actions saved many lives, especially those of elderly and immunocompromised people. According to the Johns Hopkins University’s mortality tracker (JHU 2023, consulted on 21 March 2023), third-way countries recorded comparatively far fewer deaths per 100,000 of the population—such as Australia (76.88), Japan (57.72), New Zealand (52.88), Singapore (29.43), South Korea (66.50), and Taiwan (74.20)—compared with the United States (341.11), the United Kingdom (325.13), and France (254.68).

As Tsung-Mei Cheng demonstrated in her comments in a PBS (2021) documentary as well as in an interview with the Bush China Foundation (2023), scholars can be critical of both the United States’ and China’s broader responses to Covid-19, while unpacking how Taiwan and other successful countries fought the pandemic.

In contrast, South Korea—another country that had a measured and successful pandemic response—saw its story mostly shared by its politicians and experts who gave presentations in the United States or by journalists on the ground in the country. Former South Korean prime minister Chung Sye-kyun (in office 2020–21), for example, visited the University of Pennsylvania in October 2022 to share how South Korea’s ‘successful’ Covid-19 response could provide lessons for the next pandemic (de Groot  2022). Chung, however, was neither a member of the Korean diaspora nor identified as Korean American, and in this he was different from transpacific TTAM actors engaged in pandemic response measures.

Comparison of Covid Mortality per 100,000 of population between “Third Way” developed and
highly developing countries and United States, United Kingdom, and France (Johns Hopkins University’s Mortality Analyses Tracker, March 21, 2023)

Transpacific Communities of Care

Ultimately, in this essay, I have shown how the diverse TTAM community became central to representing, analysing, and transmitting Taiwan’s pandemic responses to American audiences. They are part of a larger Taiwanese American transpacific community, which includes medical experts such as Dr C. Jason Wang (2023; BBC News 2022), Dr Catherine Chou (Wu 2021), Clarissa Wei (2022), and many others, who brought their expertise and communitarian assistance during the pandemic to wider Anglophone and Sinophone Asia-Pacific audiences. Their expertise, even if sometimes diminished in media representations, allowed many Americans to imagine a more robust response to Covid-19. It also allowed their descendants, like Peter Tsai’s daughters, to write about the humorous, overworked, and down-to-earth father whose invention of N95 masks undoubtedly saved millions of lives in the United States, Taiwan, and around the world (Tsai and Tsai 2020).

I thank Jennifer Gunn and Erika Lee for inviting me to present an earlier version of this research in a virtual Institute of Advanced Studies panel on ‘Emerging Immigration Histories of the Pandemic’ at the University of Minnesota on 26 April 2021. I appreciate the advice and suggestions given by the editors of the Global China Pulse.

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Yam, Kimmy. 2020. ‘Taiwanese Immigrant Who Invented N95 Mask on Working Amid COVID-19 Racism.’ NBC News, [New York], 15 July. www.nbcnews.com/news/asian-america/taiwanese-immigrant-who-invented-n95-mask-working-amid-covid-19-n1233777.

Zhou, Min. 2012. ‘Asians in America: The Paradox of “the Model Minority” and “the Perpetual Foreigner”.’ 43rd Annual Sorokin Lecture, 9 February. Saskatoon: University of Saskatchewan. artsandscience.usask.ca/sociology/documents/43rd Annual Sorokin Lecture.pdf.


Wayne Soon is an Associate Professor in the Program of the History of Medicine in the Department of Surgery and the Program of History of Science, Medicine, and Technology at the University of Minnesota. He is the author of Global Medicine in China: A Diasporic History (Stanford University Press, 2020). Soon has published articles on the history of medicine in China and Taiwan in academic journals and news magazines. His current research projects are centred on the history of health insurance and medical practices in postwar China and Taiwan and the transpacific history of Severe Acute Respiratory Syndrome (SARS) and Covid-19.
University of Minnesota
Volume 2, Issue 1, 2023

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