Asia Report #56 | December 9, 2021
As an unprepared world reeled under the onslaught of the pandemic, Taiwan stood out for its early success in managing the spread of the virus. Taiwan continues to outperform other states in handling Covid-19, and a big reason is the way in which digital technology is being skillfully deployed for public health purposes within a demanding, vibrant democracy. How was Taiwan able to “hack” the pandemic and what does it suggest for the broader international community?
To take up this question, the Sigur Center for Asian Studies convened a Roundtable featuring Taiwan’s Digital Minister Audrey Tang, and two leading experts, Chelsea Chou, Associate Professor in the Graduate Institute of National Development at National Taiwan University and Lorien Abroms, Professor at the Milken Institute School of Public Health, The George Washington University. The event was moderated by Deepa Ollapally, Associate Director of the Sigur Center.
“Fast, Fair and Fun” Strategy
Audrey Tang, the trailblazing, youngest ever Taiwanese Digital Minister shared her insider account of how Taiwan “hacked” the pandemic. Tang introduced Taiwan’s three pronged Fast, Fair and Fun strategy, that has allowed Taiwan to counter the pandemic without complete and prolonged lockdowns. The first prong and the most important of the three, is a Fast response. Authorities began to screen people entering Taiwan from Wuhan on January 1, 2020, within 24 hours of news of the pandemic. The experience of MERS and SARS has not only fine-tuned Taiwan’s responses to epidemics but also found ways to quickly identify them. Taiwan’s reddit- the PTT, a purely academic forum with no shareholders or advertisers, was extremely useful for early detection according to the Minister. This type of collective and crowd sourced intelligence is the underpinning of all policies and action by the ministry. Digital social innovation by working with the people rather than just for the people enabled social innovators to see not just the ‘what’ of the policy but also the ‘how’ and the ‘why’.
The second prong is Fairness of the response, especially in the initial stages of the pandemic when masks were in short supply. Minister Tang explained how social technology and open API- gøv.tw, allowed for real time information. Throughout, privacy remained a salient feature of the responses even in the interest of contact tracing. This transparency encouraged the citizens and different ministries of the Taiwanese government to be more participatory in the whole process. The third and final prong- Fun was the most interesting of all and likely the most immediately adaptable in different countries, noted the discussants. This strategy promoted ‘Humor over Rumor’ and quickly dissipated conspiracy theories and misinformation in Taiwan. The mascot – a Shiba Inu (a once almost extinct dog that now thrives in Taiwan), was particularly effective in relaying messaging on handwashing, mask wearing and social distancing.
What Do Public Surveys Show?
Chelsea Chou introduced her academic statistical models that identified significance between these strategies of the Taiwanese government in quickly inculcating pandemic specific health habits in the population. She too observed that the government was not only able to control the number of infections in Taiwan, but was also able to maintain democratic principles throughout. She noted that the border controls, use of domestic travel QR codes and SMS to ensure that individuals do not break quarantine rules, significantly helped contain the spread. Moreover, she stressed the fact that the digitization of the Taiwanese National Health Insurance (NHI) database proved to be very useful to first responders.
In Taiwan every citizen has a health insurance card which stores an individual’s medical history. Additionally, travel history information is now also integrated into this system. During the pandemic, this has served as a foundation for frontline workers to identify, trace and reach those who have Covid. Another important facet of the response as identified by Chou was the frequent press conferences held by the Central Epidemic Command Centre (CECC). Survey data collected by Chou reveals that there was highly significant positive relationship between those who watched the press conferences and those who practiced healthy habits such as regular hand washing, mask wearing and social distancing.
Her data analysis also pointed to some challenges that the government may face such as maintaining the timelines of planning and evaluation of policies, as well as keeping the rate of infections low when Taiwan reopens its borders. As for the question of whether citizen support for strict Covid Zero policies is sustainable indefinitely, Chou acknowledges it is a potential challenge should there be more cases and Covid restrictions impact daily life in a way they have not so far.
Lessons from Taiwan
Lorien Abroms relayed her takeaways from several years of research on digital communication technologies for health. She identified from her work on preventing diabetes, smoking and cervical cancer that WHO’s “Be Healthy, Be Mobile” initiative was successful because of certain key communication characteristics. She noted that messages must come to the user, communicate the threat, be engaging and consist of a few simple messages repeated often by a variety of trusted sources. She commended the Taiwanese government for adhering to these principles in their communication strategies that ultimately avoided loss of life in Taiwan. She noted in particular that the Shiba Inu campaign, use of influencers and celebrities in messaging, and the 222 campaign (responses within 20 minutes in 200 words with 2 images) were strategies that were highly successful, and possible models for the United States.
The moderated Roundtable discussion that ensued laid emphasis on questions of privacy and use of health data in Taiwan’s pandemic responses. Minister Tang explained that the NHI has digitalized it’s health care system since 2003 and has a stellar record with respect to maintaining patient privacy. The data is accessed only by health care professionals, who leave a digital footprint when accessing whatever NHI data they access, making the system mutually accountable. These security networks have been vetted so that people do not have to suddenly depend and trust something new during a pandemic. The Minister noted that similarly, other successful warning systems previously used for flash floods and earthquakes have been repurposed.
Abroms pointed out that in the case of the U.S., privacy barriers make it difficult to replicate this model, despite success of some university trials at the University of California of the same. She stressed that the foremost barrier is the absence of a national health system in the U.S. On the engagement strategies and communications front she noted the need for the Centers for Disease Control and Prevention (CDC) to build the same trust with the American public as authorities in Taiwan have done.
Prospects
The government of Taiwan has crowd sourced innovation, maintained transparency and has had high success in preventing the spread of Covid-19. By being accessible and in touch with the people’s needs and modifying responses accordingly, it has built a track record of trust. In the process, it also demonstrated the usefulness of technology in promoting democratic values. It remains to be seen now with increasing vaccinations, emerging variants and the opening up of borders, how innovative digital oversight mechanisms will continue to succeed.
By Medha Prasanna, M.A. Candidate in International Affairs, Elliott School of International Affairs, and RPI Affiliate.
