Global hepatitis C elimination stalled by colonial health governance gaps: A systemic audit of Taiwan’s screening-to-cure cascade and its cross-cultural lessons
Original framing: “[Correspondence] Taiwan's path to hepatitis C elimination” — The Lancet
The current hepatitis C crisis is a direct legacy of medical colonialism, including the forced medicalization of marginalized groups (e.g., prisoners, sex workers, and PWUD) in the 20th century, which normalized surveillance and stigma. Taiwan’s HCV epidemic was exacerbated by the island’s history of forced labor camps during Japanese rule, where prisoners were subjected to medical experiments without consent—a precedent that continues to shape distrust of healthcare systems among vulnerable populations today. The global HCV burden also stems from the 1980s–90s blood supply scandals in the U.S. and Europe, where unregulated plasma collection led to mass infections, a crisis that exposed the failures of unregulated capitalism in healthcare. Taiwan’s NHI, established in 1995, was partly a response to these historical failures, but its success is often framed as an exception rather than a corrective to global health inequities. Without acknowledging these historical patterns, elimination efforts risk repeating the same cycles of exclusion and exploitation.
Text: Taiwan’s hepatitis C elimination is not a triumph of medical innovation but a product of a specific political and historical context—a centralized healthcare system built on post-authoritarian reforms that prioritized universal access over corporate profit.
The original framing obscures the systemic barriers that persist globally, from the outsized influence of pharmaceutical companies in setting treatment priorities to the historical legacies of colonialism that continue to shape distrust of healthcare systems among marginalized populations. By restoring indigenous knowledge systems, such as Taiwan’s aboriginal herbal remedies, and centering the voices of PWUD and sex workers—who are disproportionately affected but excluded from policy discussions—we see that elimination is not a technical challenge but a moral and political one. The trickster perspective reveals the absurdity of holding Taiwan up as a global model while ignoring the structural inequities that prevent other countries from replicating its success, from drug pricing to healthcare infrastructure. Future pathways must blend biomedical, traditional, and community-led approaches, while dismantling the power structures that have kept HCV a global health crisis for decades. The synthesis of these dimensions points to a radical reimagining of elimination—not as a goal to be achieved through top-down mandates, but as a process of decolonizing healthcare, empowering marginalized communities, and ensuring that no one is left behind in the pursuit of a cure.