from lab bench to public office and back

Chen Chien-jen, Taiwan’s pandemic vice-president — from lab bench to public office and back, Nature 603, 203 (2022)

Two years on from the World Health Organization’s official declaration of the pandemic, I’ve been thinking about lessons I’ve learnt toggling between science and public service. I think all researchers — from bench scientists to physicists to computational social scientists — might find this exercise useful. Government advisers, too.

The first lesson: scientific training teaches us to seek out all the variables that might affect a system. My work as a minister taught me to expand that list of variables far beyond what is typical. Budgets, laws, staffing levels and more enter the picture. So do values and priorities.

Consider: as health minister, I set up how and when to pay for antiviral therapy for people with chronic viral hepatitis. As a researcher, disease severity and treatment efficacy were top of mind. As a minister, I had to take more into account: accessibility, equity (especially reaching marginalized groups), feasibility and financial resources. People in rural and mountainous regions could not afford to travel to medical centres, so we set up outreach units. I argued that fixed, separate budgets for distinct categories of disease hindered smart decisions: antiviral therapy is expensive, but liver transplants and cancer treatments are more so. I also adapted governing structures to decision-making needs. To build in sustained focus for other tricky, crucial issues, for example, I created units to focus on international cooperation and long-term care. (*)

The second lesson: science is never enough to bring about a thriving society. That takes trust, robust institutions and social cohesion. Solidarity is essential to inspire the public to comply with epidemic-prevention guidelines. Without solidarity, there cannot be effective border control, quarantine, contact tracing and isolation. The government must do its part to encourage compliance, such as paying for low-income people to get to vaccination centres and sending them free face masks and hand sanitizer. We targeted economic support where it was needed most, such as restaurants, vendors, grocery stores and taxi drivers.

The third lesson: infectious and toxic agents have impacts that last for decades, so long-range investments in scientific infrastructure pay off. But action must be quick. When SARS happened so long ago, neither the public-health nor the hospital system in Taiwan was prepared. Ineffective quarantine and shut-down procedures led to infections and deaths. The ministry trained staff at major medical centres, then dispatched them to hundreds of regional hospitals, which launched training at local hospitals — establishing an island-wide protocol in just two weeks. Steps to track down sources of infection with a standard set of questions were important, as was a computerized system to find out who had travelled to hotspots. This existing infrastructure has served Taiwan well through subsequent epidemics. 

(*) Operations research and decision theory are useful for these kinds of problems.