Taiwanese President Tsai Ing-wen attending the 2020 Global Health Forum in Taiwan
Cover Photo: Overseas Community Affairs Council, 2020
By SALINA KUO,
2nd-year Student in the Middle East-Mediterranean Campus of MENTON
The fact of being an underdog changes people in ways that we often fail to appreciate. It opens doors and creates opportunities and enlightens and permits things that might otherwise have seemed unthinkable.”David And Goliath: Underdogs, Misfits And The Art Of Battling Giants by Malcolm Gladwell
Malcolm Gladwell roots for the underdogs, but not for the reason you may think. In his obsessive inquiry to unpack the biblical story of David and Goliath, he finds himself befuddled about the odds of David’s victory against Goliath. How did the shepherd boy of Bethlehem, David, triumph against the Philistine champion, Goliath? A boy, equipped with only a sling and a shepherd staff, cannot realistically defeat an armored giant several times greater than himself. How did the improbable—impossible, even—come to pass? Gladwell came to realize that his calculations were erroneous: David’s victory was not an impossibility. He was not armed with what is often presumed to be a toy, but rather, a devastating weapon that had the ballistics, the stopping power, roughly equivalent to that of a .45 caliber handgun.
Gladwell’s interpretation of David and Goliath provides invaluable insight that challenges preconceived notions about power, and with this newfound understanding, he roots for the underdogs—people that are seemingly weaker than the formidable adversary. This perceptive calculation may hold true when we look at the capacity of countries as well. What are the odds of a tiny island-state in weathering the storm of the COVID-19 pandemic?
At first glance, the chances of avoiding an outbreak in Taiwan were incredibly slim. The island is 130 km (81 mi) off the coast of mainland China, and given the number of flights and people-to-people exchanges between the two countries, Taiwan was predicted to have the second most cases of COVID-19. Likewise, being denied membership in both the United Nations and the World Health Organization—the largest collective effort for advancing international public health—should have put the country at a significant disadvantage in terms of coordinating a rapid response. It turns out that none of these factors served to challenge the island in fending itself from the threat of a pandemic. To the surprise of many, the spread of the virus was swiftly contained without a lockdown and an epidemic entirely averted. The David of our contemporary narrative here is Taiwan.
Indeed, even with our very own David and Goliath-eqsue scenario in the twenty-first century, Gladwell was right: perceptions only go so far in reflecting the true capacity of David’s strengths and weaknesses. Taiwan had its own set of sling and staff, though instead of equipping it against the backdrop of the Shephelah in the ancient Kingdom of Israel, it did so with the advantages of a democratic landscape—leadership under competent authority, instructions carried through highly transparent pathways, and the helping hand of a vibrant civil society.
Setting the Stage: The Shepherd Boy Takes His (Sling) Shot
To date, Taiwan has had 611 confirmed cases, 546 recoveries, and a total of 7 deaths, with the vast majority being imported cases—and no, these numbers do not reflect a matter of underreporting, but rather, the efficacy of policy pathways rooted in democratic norms. Taiwan has returned to a state of near normal in the past few months, with frequent gatherings at concerts, baseball games and cinemas—though never without masks or social distancing.
To put the numbers into perspective, consider the following chart:
In another visualization, the following graph released by the Brookings Institution demonstrates that Taiwan is one of the only countries in the world to have avoided both significant GDP loss and mass casualties:
Despite the country’s wildly successful response to the virus, Taiwan is not listed in the WHO COVID-19 dashboard— an omission that is not by accident, but very much intentional. The absence of Taiwan from the WHO dashboard (and indeed, the WHO itself) is rooted in a deeper political dynamic that has had, arguably, far-reaching implications on a global level.
Taiwan’s Center for Disease Control (CDC) was first alerted about the virus on December 31, 2019, when the staff encountered posts on an online forum about the circulation of a particular disease in Wuhan, China. The discussion online speculated on the similarities between the symptoms of the new virus and the Severe Acute Respiratory Syndrome (SARS), which alarmed the CDC and prompted the department to investigate. The CDC emailed the WHO requesting additional information about the novel virus, and they pointed to concerns about the isolated patients in China; isolation, of course, suggested the possibility of human-to-human transmission of the disease. This request was “forwarded to expert colleagues” without a direct follow-up. Weeks later, the WHO responded by echoing Chinese officials, insisting that there was “no clear evidence” of the virus being transmittable between individuals. On the same day of this discovery in late December, passengers flying from Wuhan to Taiwan were required to go through health screenings before they disembarked the planes. Taiwan effectively became one of the earliest countries to activate prevention measures against COVID-19.
On January 8, 2020, the virus was listed as a Category 5 communicable disease, an alert that vested the government with legislative powers to enact new measures—including the enforcement of mandatory quarantine. As the threat of the disease became increasingly evident, the Central Epidemic Command Center (CECC) was activated to centralize coordination and risk management between government agencies and important stakeholders. This all occurred before the appearance of the first COVID-19 case in Taiwan on January 21.
Border controls were put in place on January 21 as incoming Chinese nationals were barred from entering the country. On March 19th, the travel restriction to Taiwan was extended to all foreign nationals without special permission to enter, and on the same day, the mandatory home quarantine was put in place for returning Taiwanese nationals or residents.
The 14-day quarantine period for those who enter Taiwan is enforced through GPS cell tracking, and daily calls are made by local civil officials to inquire about symptoms. Should a confirmed case arise, mechanisms to streamline contact-tracing will identify and locate those who had close contact with confirmed cases. Those identified will be required to remain in Home Isolation for 14-day days. Extensive contact tracing is enforced, with the need for participants of public gatherings and events to register their ID or phone number. In certain contexts, the fear of identity disclosure encouraged innovative solutions, with certain nightclubs running on systems that collect single-use emails, code names and burner phone numbers without the need to keep track of real names.
Associating the new virus with SARS triggered a collective trauma, hauntingly evocative of the time when the island was confronted with one of the highest SARS mortality rates in the world. It was this quiet, cautious and home-grown fear that compelled the government to react as assiduously as they did. Taiwan’s experience with the SARS outbreak in 2003 drove the government to enhance the functions of the CDC under the Ministry of Health; this entailed expanding the medical workforce and raising the standards for expertise in information technology and epidemic investigation. Since the SARS epidemic, periodic drills in hospitals have also been held across Taiwan, and it was this elevated “combat readiness” that attuned the medical setting for rapid response, should another outbreak emerge. Taiwan’s epidemic prevention mechanism, health care system and government bodies were all indispensable, mutually-reinforcing components to a well-oiled machine by the time the coronavirus came around. This machine was no literal sling, but it was just as devastating given its comparable “stopping power.”
Off with the Goliath’s Head: Trust-building, Shiba Inu Memes and Dismantling Stereotypes
A single shot hadn’t been sufficient for David. The giant may have perished, but a final act was to follow for Goliath’s Philistine army to witness. He didn’t assume that the fatal shot to the giant would force the army to retreat — he made sure of it. David’s beheading of Goliath was a visceral moment for the Philistines, and it was only then that David truly claimed victory. While the government’s containment response was key to Taiwan’s success, it does not comprise the full picture of what unfolded across the island state. The final “blow” to the threat of an outbreak came from a series of consistent measures and principles that sought to tackle the public’s sense of fear, uncertainty, and isolation. Rather than reduce the Taiwanese people to atomic, submissive units of central policy-making and spectators of an impending ‘coronavirus terror,’ the spirit of democracy was very much kept alive and, most crucially, channeled into the government’s epidemic response.
Transparency and trust have been the cornerstone of the country’s prevention strategy. The timely flow of information to the public was ensured through daily press conferences held by the CECC; the briefings are broadcasted to disclose new confirmed cases and new measures, should they arise. Health Minister Chen Shih-chung, the key spokesperson at the briefings, has become a heroic figure of sorts, and a national symbol of trust and compassion. When he announced Taiwan’s 11th confirmed case of the coronavirus, Minister Chen made headlines by breaking down in tears at the CECC press conference in early February. The 11th patient in question had been stranded in Wuhan for weeks, and the Minister made a public plea for the health officials to save the man’s life. This rare moment of vulnerability does not reveal weakness on the part of policymakers and health officials. On the contrary, it humanizes them; it stresses a universal truth of our most primitive responses, and in Chen’s case, it was the truth of uncertainty. There is a certain allure to vulnerability, and surely enough, Minister Chen’s tearful reaction drew over 100,000 heart-warming messages and consoling remarks from sympathetic online users.
In another remarkable display of solidarity, Minister Chen, along with his staff, donned pink masks during one of their press conferences, and this public move came in response to the report of a boy having been bullied at school for wearing a pink mask. Complaints were brought by the parents about their son being unwilling to wear the government-administered masks in fear of being mocked as “girly” at school. It was a tactful and persuasive approach to move past gender stereotypes that undermined basic, public health precautions amid the epidemic.
As the WHO remained months away from declaring a global pandemic in January, wearing a mask became mandatory in Taiwan. The government deployed measures to build mask production lines, and by the end of May, over 19 millions masks were being produced a day. Indeed, wearing a mask is common practice for the sick in Taiwan, but to have achieved it at such a large scale can be partly attributed to the collective alert among citizens and their fear of history repeating itself with another SARS outbreak; this created conditions for self-discipline in the rigorous practice of simple health precautions and social distancing.
Lest someone forgets to practice standard prevention measures, the health ministry introduced the Shiba Inu “Zongcai” (總柴) as their mascot, or some would say, their COVID-19 communications ambassador. The Shiba Inu now makes a regular appearance on Facebook posts and posters to communicate reminders about public health.
According to Digital Minister Audrey Tang, the introduction of Zongchai is part of Taiwan’s wider “humor over rumor” strategy to use comedic relief as a way to combat stress and outrage during these challenging times, as well as to prevent the spread of misinformation surrounding the virus.
While Taiwan has long been a target for disinformation from China (and has continued to be during the pandemic), an unlikely culprit emerged to take advantage of an increasingly anxious public: a local toilet paper retailer. As a marketing tactic, false allegations were released about the competition for raw materials between toilet paper producers and mask manufacturers. To address and further prevent the panic-buying of toilet paper, Minister Tang’s team released a meme that featured the Taiwanese premier sticking out his rear-end with the caption “we only have one pair of buttocks!”
Harnessing the Wind: Civic Hacking in Taiwanese Democracy
A sling—when handled with precision and agility—can be a lethal instrument, though it is the favorable external conditions, say, the wind or elevation of the sling-bearer, which facilitates the speed and trajectory of the ammo, intensifying the impact several-fold. In Taiwan, it was the innovative spirit of the civic tech community and the freedom of the digital space, afforded by the trust between government and the people, which provided the much-needed strength to keep an outbreak at bay. This potential was harnessed for the purpose of mask distribution.
Vaccines can engender herd immunity if enough people receive the shot. Following the same line of reasoning, Minister Tang and the Taiwanese government believed that theoretically, a majority of people—specifically three-quarters—in masks could lead to a similar effect. The goal was to get three-fourths of the population into the habit of using hand-sanitizers and masks.
The government rolled-out plans to manufacture masks on an extensive scale, but ultimately, it was the public release of supply-chain data which maintained the effective, fair and timely distribution of masks. The government-run National Health Insurance (NHI) System maintains a database of all the masks available at pharmacies across the nation, and the database is periodically updated in real-time. Audrey Tang describes how, instead of a top-down mechanism of distribution, they relied on pharmacists to administer the masks. In addition to this, Tang introduced the idea of creating a mask-rationing system. With the swipe of your NHI card, you are then allowed to purchase an allocated quota of masks dispensed by vending machines. They’ve also implemented a pre-order and 24-hour pick-up system at convenience stores.
From the outset, the government recognized that their methods at the time were flawed. Once pharmacies ran out of masks, the staff had to dismiss long queues outside their stores, leaving a number of people without the masks they came for. To address this predicament, Tang called for the release of data on mask availability to the general public through an API. As the new project was launched, a group of “civic hackers” were invited to contribute to and refine the system, leading to the creation of over 140 applications to facilitate mask distribution. Civic hackers are average citizens, specialized in a range of fields, that work to solve issues that affect public life through the digital space; oftentimes, civic hacking involves using government data to enhance government accountability.
Most notable of the apps include maps that display the supply of masks at pharmacies, visualizations of the number of masks distributed in various locations and of the fairness of distribution across the island, and a voice-command function for the visually impaired. Instead of daily or weekly updates on mask supply numbers, an open API allows for updates every 30 seconds. Those queuing in line at the pharmacy can refresh their mobile app to look at the numbers of masks purchased by the people before them. Likewise, the hotline “1922” was made available for reporting suspicious behavior at distribution sites.
For such a system to work, a system of co-creation and public use of government data, the government must have a tremendous amount of trust in the people. The trust is reciprocal: if data is not released in a “radically transparent or real-time fashion,” the reliability of the system would break down. In Audrey Tang’s words, “reliable data is the foundation of trust.” In an interview with WIRED, Tang relates this system to the “Pygmalion effect,” where the greater the trust a government has for the people, the more trustworthy the people become. This creates a system of mutual accountability with participatory auditing, as opposed to relying on a central database to do the auditing. Again, the digital system was initially flawed. There were discrepancies between the actual number of masks with the number indicated on the app. The issue was only resolved after the civic programmers stepped in, streamlining the automated process.
Tang believes that it was the harnessing of anxiety into co-creation and humor which reduced fear to an obsolete emotion. Her characterization of democracy as a “set of technologies” is sensible: providing the everyday programmer with these “democratic tools” serves to enhance democratic participation. She mentions how uploading “three-bits per person” every four years, or in other words simply “voting,” is unsatisfactory for democracy. In digitizing democracy, it is, instead, more useful to “bring technology to the people” rather than ask the people to conform to technology, which is more disruptive.
Appreciating the Underdog
David went down in history as the boy who achieved the improbable, and this herculean accomplishment paved the way for his eventual ascension as King of Israel. In hindsight, his victory was not such a far-fetched outcome after all. The presence of ideal conditions reinforced existing tools and strategies that were intended to be deployed against an opponent. In the same way, while policy foundations undergird an effective COVID response, further steps should be taken to facilitate its implementation. Most crucially, an effective policy response considers the reaction, needs and realities of the people it will directly affect. No policy is fail-proof.
Concerns have been raised about Taiwan’s expanded surveillance power under the pandemic, with specific reference to GPS-tracking under the quarantine policy as an intrusion to privacy. Various legal grounds have been cited to justify the extreme measures, though the issue remains an ongoing discussion. For the most part, public opinion has been relatively supportive of government measures; those under active monitoring in their two-week quarantine period will also receive financial compensation of up to NT$14,000 (roughly equivalent to 490 USD). If the state were to, for some reason, retain such powers after the pandemic, they will likely be contested by a dynamic civil society that has sought to keep the government accountable for the past three decades.
To the extent that David’s glory can be compared to Taiwan’s success in containing the epidemic, there are still questions to be raised about the island’s political future. The opening quote by Malcolm Gladwell considers the opportunities for the underdog that has risen from the unthinkable. Will Taiwan’s efforts in fighting the pandemic bring to light the values and policy models it could offer to the international community?
Indeed, Taiwan has been applauded and globally recognized for effectively responding to the pandemic, but it doesn’t make the geopolitical threat across the strait any less real, and it remains that only 14 countries formally recognize Taiwan’s sovereignty. In spite of backing from the United States and the European Union, Taiwan was blocked by China from attending the WHO discussions on the pandemic earlier this year. Despite its continued exclusion, Taiwan has proceeded with donating over 50 million masks and other medical equipment to more than 80 countries falling short of supply, including the U.S. and several European states. This reversed their initial policy of banning mask exports at the peak of the pandemic, given the island’s limited supply and manufacturing capacity.
Perhaps Taiwan’s ostracization from the international stage was a blessing in disguise, but at the end of the day, it remains a bitter-sweet ordeal. Taiwan’s implicit warning of the coronavirus back in December went unheeded, and to consider the possibilities if it had been taken seriously draws attention to an international system rife with information asymmetry, a lack of transparency and a dangerous power imbalance.
With division across party lines and the occasional corruption scandal, Taiwan is not a country without its own set of domestic troubles. Even so, its capacity to evade the “unassailable” pandemic is an incredible achievement, telling of a young and resilient democracy that has flourished on its own. ▣