Can you share the transcript with me at the end, or should I take notes also?
I’ll, of course, share with you both the recording and the transcript.
Wonderful. Great. How are you doing?
Very well.
Are you exhausted? Has this been a depleting time?
Not really. We’re very calm and collected. I just gave a talk at The Web Conference about the three ingredients of the Taiwan counter coronavirus strategy which is, and as you probably know now, fast, fair, and fun . We’re keeping things fun.
Nice. Thank you for taking the time to talk to me. I’m sorry that our earlier plans were disrupted. Who knows, maybe sometime in the future, we can resume that idea.
I suppose some general questions I have for you today are about the relationship between technology and social trust, which obviously is a big part of what you guys have been working on, especially because I think that this isn’t obviously true across the board.
There have been a number of smart and nuanced representations of Taiwan’s response in the American media. More broadly, I think there’s been a fairly consistent mischaracterization of a number of the responses in small Asian countries here that either rely on a stereotypical orientalist notion of an obedient population, or on the other hand, they rely on notions of magic bullet technologies.
All we have to do…
Yeah, techno-optimism.
Yeah, exactly. Especially in the way that, for example, the conversation about Bluetooth proximity, contact tracing has been taken up here that…
We’ve not deployed any Bluetooth technology here. I don’t know how that get there.
First of all, there’s so much confusion about what is done in one place. You have these articles that say, “In places like South Korea, Taiwan, Hong Kong, and Singapore, they have use automatic…” but if you even take two minutes to look into what those countries have done, they’ve all done completely different things.
[laughs] That’s exactly right. Not to mention, we’ve never entered community spread. A lot of characterizations doesn’t apply simply because there’s nothing to apply to.
Even in the way that the conversation about, for example, Bluetooth has moved from Singapore to the States that…I spent some time talking to the product lead on the GovTech side in Singapore.
He said, “We, from the very beginning, had only ever looked at this as one additional tool to help our manual contact tracing efforts, that we didn’t think that this was ever going to completely supplant manual contact tracing. We thought that this was just going to be one additional tool for the Health Ministry to use.”
Whereas here, of course, there’s a fantasy of something that’s completely decentralized, completely distributed will just function magically on its own.
We’ve heard of this before. It’s called distributed ledger technology. [laughs]
I think, especially in some of the conversations about the technology here, there’s an overemphasis on what can be done via a purely distributed system. I’m curious about how you see the relationship of the centralized, coordinated efforts with the decentralized?
First of all, I would say that decentralized social technology really works. It’s like proper hand sanitation, washing your hands with soap. That’s a decentralized social technology that really works. It’s reliable. It’s robust. It’s very inexpensive.
It’s social innovation, because people keep reminding each other, like in Taiwan, we have even nursery rhymes like [non-English speech] that reminds you how to wash your hands properly. That’s social technology for you. That really works well and is thoroughly decentralized. There’s no penalty. There’s no top-down regulations that regulate hand sanitation, but you’ll do it anyway. It’s magic.
I wonder about the element of coordination on the other side of it.
I think, because I assume you’ve watched my six minutes film, a lot of it boils down to just norms. People expecting that anyone who have some symptoms will take a medical mask, go to a local clinic, and report whatever they have done in the past 14 days.
They do so not because there’s a strict penalty, there’s a top-down way, or they’re being Bluetooth traced. No, none of the above. They do it because we have a single-payer health system, and it’s a logical thing to do.
The coordination may look like very compliant. I’ve even seen things like this is a Confucious thought or something like that, which is…I’ve read Confucious “Analects.” I understand that it’s a useful metaphor, but this looks far more Taoist than Confucian to me.
(laughter)
The people really said that it’s they who’ve done it. People criticize the government usually not for that we’re not top-down enough. They usually criticize us for not responding fast enough.
Which means that the people think most of the coordination is the people’s own merit, is the people’s own mobilization. That’s a very Taoist thing.
What I think is interesting about what you just said, I think that there’s, when people write about such things as a high degree of social trust or a high degree of social cohesion, to me often, it’s treated as that’s the explanan, so to speak, when it should be the explanandum.
Which is to say that that’s not something that explains the success, it is something that has to actually be explained. Whereas so often this attitude toward social trust is that it’s either something that magically exists in a society, or it’s something that doesn’t.
That it thus, that it’s not something that then could be cultivated or that could come out of institutional relationships. Instead, it’s just, “You either have it or you don’t.” Unfortunately, we in America are a low-trust society.
It just seems to me, one of the things I’d like to hear you expand upon a little bit is that, even in just now, when you talked about this relatively high degree of social trust, that other people are being compliant, is not some magical property of the Taiwanese society, but because of existing institutional social safety nets like single-payer, for example.
Exactly. It’s all rational choice. It’s all participatory mechanism design. There is no magic about it. If you know that you will incur a large financial or social burden for reporting your symptoms, you don’t. If you know that there is no social and financial burden, you do. It’s that simple.
Do people worry about, because it seems…One of the other things is in the political science literature about how one develops a relatively high degree of social trust a voluntary compliance with things is that people are confident that free riders will be punished.
That part of voluntary compliance is being able to proceed with the expectation that there won’t be free ridership elsewhere.
I think that’s one of the advantage of being an island is that you don’t have accidental people crossing the borders. That just don’t happen.
Because of that, [laughs] our single-payer universal health system, which covers more than 99.99 percent of the population, including residents, migrant workers, and foreigners staying in Taiwan, there is no free rider, period.
It was more that, I suppose the free rider problem here was about other people not complying with things like wearing a face mask or panic buying, for example.
That’s the interesting thing. It’s that the mask, while it actually protect others, is billed in Taiwan as something that protects you. We say that with some scientific backup, because our masks are medical masks.
They are properly PFE-certified masks, and so they do protect you, to a degree, but they mostly protect others.
This is a selfish incentive with a far more positive than to the user to the social externality, positively speaking. That encourages prosocial behavior, whereas people who do not wear a mask and do not keep a social distance gets shamed, basically.
Everybody is wearing the medical mask as a signal. They get shamed not for threatening others, but for not protecting themselves. Other people can say, “Why don’t you take good care of yourself?”
It’s a very interesting incentive design in that it encourages people to adopt prosocial behavior, but the justification is of self-interest.
I’m just getting that down. What does that social shaming look like? That’s just people on the street saying to you, “Why don’t you take good care of yourself?”
That’s right, exactly, yeah. For example, I was filming myself. There was a photo of me in a convenience store trying out the mask collection system. I was helping a friend of my grandma.
My grandma’s 87. Her friend is 77. I’m just working on the experience of preordering masks using a convenience store kiosk. The 77 years old friend of my grandma was just trying it out in a kiosk. I was filming, like a user research program, behind her.
I’m facing her, and she’s facing the kiosk. There’s zero chance of she infecting me, because she’s in front of me, and she’s facing the front. Whereas there is non-negligible chance of me infecting her, because I’m not wearing a mask when I’m doing this user research.
We’re roughly 1 meter and 20 centimeters apart, 1.2m, but the convenience store is an indoor place. Our social distancing is 1.5 meters. Strictly speaking, I’m violating the social distancing protocols.
I didn’t take that picture. I didn’t know that the head of the convenience store was taking a picture, but they posted it on social media. I get a flood of comments saying that Audrey is not protecting herself.
(laughter)
Like, “Audrey is very important to us. We need to remind her.” I have to reply to each and every comment, saying, “I do have the mask. It was on my hand. I am just taking it down for the photo. Once I’m done with the photo, I’m putting it right back on.”
That’s the social pressure. Nobody said, “Oh, you’re potentially infecting vulnerable people.” That’s harder to say. But it’s easier to say, “Hey, you’re not protecting yourself.”
That’s a good point. I have a question about this article that Glen Weyl and Jaron Lanier had written for Foreign Affairs. This might seem like a fairly specific question, but I think it does get to…
I felt like it was unexplained here, and I wanted a little bit more background, which was when…Now, I’m trying to find it. Oh, in the stuff about the maps that were available for distribution after the Diamond Princess docked.
Glen and Jaron write, “Individuals use the platform to show reports voluntarily in real time about symptoms using a variety of media, such as a call on Line and smartphones. This information was quickly verified and collated.”
Collated, yes.
It seems to me that verified and collated is a pretty big step that they just jump over. I’m curious about what that verified and collated means.
There is a single phone number, 1922, that anyone can call and tell the CECC, the Central Epidemic Command Center whatever. In my video, I use the example of people calling in and saying that, “Hey, you should all wear the pink medical masks to support the boy.”
Right, which was a very cute…
[laughs] It’s social innovation right there, right? After the Diamond Princess, and actually, after each incident, the 1922 gets a spike of calls, like up to 30k a day or something. People just speak whatever they want, like the tips they really want the CECC to know.
Like they’ve spotted certain breach of protocols, like whistleblowing. They pretty much say anything they want to say. They’re verified by the CECC after a significant number of people who reported the same thing to 1922.
Then the contract tracers, the medical officers, would then be deployed to investigate. It’s all manual work. This is just your standard epidemiology at work. There’s nothing magical about it. It’s just a single line that’s guaranteed to have 80% – I think we are at 90% now – pickup rate.
Percent, you mean?
Yeah, per day. At spikes, of course.
In this case, what was being verified here when individuals were sharing reports at symptoms? What there was being verified?
A few things. One is that there was a case with a cab driver, and there was no obvious link, like where did the cab driver get the infection. When the CECC, because there was a daily press conference, said that they don’t quite know why that there was an infection chain.
People called into 1922 with plausible hypotheses, basically crowdsourcing detective work.
I had read that the case with the cab driver was basically the only time that they had used the merged databases of the immigration…
For proximity. Yeah, the immigration integration. There’s a reason for that, because after a while, only citizens can return home, and foreigners are banned. by default [laughs] It’s not as useful after that point in time.
The immigration integration was only useful if there are certain high-risk areas in the world and certain areas deemed as low-risk, so that you would want to share the information to the clinics whether they’ve visited high-risk areas in the past 14 days.
That was the value of the immigration database link. Then after a while, the CDC declared the entire world to be high-risk, except for Taiwan, and banned foreign travel altogether, unless you were a citizen returning home.
If you’re returning home, you’re sent to quarantine, anyway. Then at that point, the link doesn’t quite contribute as much anymore.
It was used in the case of that cab driver and the businessman from Wuhan?
That’s right, yeah. What I mean is, because we quickly switched to a centralized quarantine if you are from a high-risk place, or at least home quarantine, if you don’t show any symptom, and you come from a milder place, and only if your home have sufficient self-isolation rooms, and that you don’t live with vulnerable people. Otherwise, you are sent to a hotel.
Do you have to pay for that yourself, or does the healthcare pay for that?
The healthcare pay for that, and they also pay for your time. You get $33 USD per day. If you breach the quarantine, you pay 1,000 times that.
Has Taiwan used digital ankle bracelets in the way, for example, Hong Kong has with…
We use the mobile phone. People are addicted to their phone anyway.
Then it’s just, if the phone leaves the geofenced area, there’s an automatic notification to the police, and then they call?
To the household managers or the police, and it’s an automatic trigger of the SMS system. Then they visit or call back.
Are there random calls, then, to make sure that people aren’t leaving their phones home?
Of course, and especially if the phones don’t move for a while.
(pause)
I’m curious if there are other examples where, because it seems to me the view from here, as I mentioned, is that a much greater emphasis on things that resemble automation that then, that there’s always some mechanical trick behind it, or there’s always some human labor behind it.
I’m curious about other things that might look from the outside to be automated, but are in fact, or do in fact, represent social…
They are automated in the sense that there are time-savers. Using a chat bot to ask for self-reported temperature and symptom and taking a photo or something, of course, that saves time compared to manual health visits, obviously.
These are just automating away the chores. It’s not magic. It’s just basic time-saving stuff. The digital fence, the triangulation, is not based on an app or Bluetooth, it’s just triangulation. The five telecoms that volunteer to run this proximity algorithm, it’s only for the 14 days for the home quarantine.
On the 15th day, you are no longer tracked that way.
Did you have to pass a law to use that telco data, or was there already a…
Oh, we did. That was SARS. That was with SARS.
Oh, with SARS?
Yeah. During SARS, there was a barricade of an entire hospital, the Hoping Hospital. It was traumatic. Everybody above 30 years old remembers that.
A barricade of the entire, what happened?
The hospital. SARS was spreading in the hospital, so everybody in the hospital, including patients, their families, all the nurses, and so on, was barred, literally, from leaving the hospital.
It was April 24th, that day, which is today, actually. [laughs] Exactly 17 years ago, it was very chaotic. Also, there was a case that went all the way to the Constitutional Court that whether…
Wait, but before you go on, explain. How long was the hospital barricaded for?
The Hoping Hospital, which was the name of the hospital, there was a spreading of SARS within that hospital. The hospital, they didn’t know that it was SARS back at the time. Then people realized that it was SARS.
It was barricaded by, I think, Mayor Ma Ying-jeou at the time. As I mentioned, that was exactly 17 years ago. I think how long was that? That was a really good question. I know that it started that day, and I know that it ended with 24 people dead, with 97 people infected with SARS.
That was civilians. The hospital staff, 57 infected and 7 died. I didn’t remember for how long. Of course, I can look it up right afterward.
It’s fine. I can also look it up. You were saying that memory is so strong with people that that was part of…
Yeah, that was part of the reason why, right after SARS, there was a…Because the barricade was without any announcement, so there’s a constitutional dispute of whether that was a good idea or not, or whether it was constitutional or not.
It went all the way to the Constitutional Court. The Constitutional Court, I think it was until May the 8th. Anyway, the Constitutional Court said that it’s not unconstitutional, although it’s severely lacking in due process.
There was no strict time limit, and the legislator did not find alternatives that are less intrusive than a physical barricade as a measure, and that it need to be clearly specified in the CDA, in the Disease Control Act, and so on.
There was a specific Constitutional Court ruling. Then the legislators went and implemented those legal underpinnings, which is why the digital fence – which is strictly better than physical barricade, I think everybody agrees – there’s less constitutional disputes this time, because we had that discussion during SARS and after.
Then you were going to mention something else about SARS before I asked you to explain.
Also, back in SARS, there was panic buying of N95 mask. There was a shortage of N95 mask, which was, I think, invented in Taiwan in the first place. People attach special magic property to it, but it’s really unnecessary. Also, it caused a lot of chaos and panic.
We’re no stranger to panic buying, is what I’m trying to say. Also, that is why soon as the Dr. Li Wenliang whistleblowing gets known by the CDC, was the last day of last year, there’s a very quick escalation of priorities.
So that they, in the CECC, working with the Ministry of Economic Affairs, coordinated by our vice premier, Chen Chi-mai, who studied public health with his professor, Chen Chien-Jen, who wrote the textbook, now our vice president… that’s our unfair advantage.
They quickly decided that they really need to procure the necessary machinery to produce masks this time. Instead of stocking mask, stocking mask machinery is certainly the only way, really, to fight panic buying of masks.
That happened in SARS, and they anticipate that this will happen one way or another, anyway. That proved to be very prescient.
Were there people then saying that this was too early to be making administrative decisions like that, or did people think, “Oh, that’s very prudent of them to be invoking these kinds of production powers now”?
Two things. Yes, there were people, mayors at that, that says, “We probably shouldn’t blindly expand our production.” There was people saying that. Also, there’s no legal challenge of the mobilization power, because it’s well within the administrative power to work with existing production lines to expand the production lines.
That is, I think, the main difference, because as of now, Taiwan has not entered an emergency state, nor an all-out mobilization act which imbues an extra, like a constitutionally defined emergency phase of the administration do whatever, and then the legislation reaffirm it afterwards.
Many other jurisdictions have entered that part of the law. Taiwan, for what we know, is operating under normal law system. We’ve not, the president have not, declared an emergency order.
That means that all these mobilization is well within our continental law system, what the administration can do anyway in normal time.
(pause)
There’s a special budget, of course. We eventually get the legislation to give us special budget to expand on these, but that’s still well within the special budget power.
What are the other basic mechanical, preventive measures that were taken in addition to ramping up masks early that, again, are just simple, basic failures of competence elsewhere in the world?
I didn’t say that. I really didn’t say that.
(laughter)
I can say that. I can say that.
Really, if you look at the jurisdictions that responded well, because they were inoculated one way or another through SARS, through MERS, or through Ebola, or so on. Mobilization don’t happen unless the citizens know how traumatic it is if you don’t mobilize well.
I think it’s unfair to compare a jurisdiction that’s not being inoculated with a jurisdiction that has been inoculated, just for the record.
In any case, there are other things that I think are important from mechanism design point of view. For example, the fact that we the publish the pharmacy stock level every three minutes, and not every one day.
That, I think, is really symbolic of many things. That if you call 1922, you get a response immediately in the next day’s press conference. That builds trust in an unprecedented way. People expect, almost, the daily press conferences.
People expect if they hear a rumor that the government pushes out a funny meme in the next two hours, usually one hour now, and so on.
Pushes out what in an hour?
A funny meme.
Oh, a funny meme?
That clarifies it. People are just anticipating, what’s the next funny meme to come out of the ministry and what the DOGA CEO has to say this time. [laughs] This is mechanism design. This is communication mechanism.
I think that is what other jurisdictions really need to look into. This is really a way to rebuild social trust.
Did you guys look into anything like the Bluetooth stuff? I asked about this, just because it’s become such a big topic of conversation here, and so much energy has been put into it. One of the things that I really appreciated about this guy in Singapore, the product lead who said to me, “In so many places, this is being treated as some kind of cryptographic problem.”
This is not a cryptographic problem. This is a public health problem.
We just launched a co-hack initiative today. Part of it is six Polis forums, back to our original topic, [laughs] that ask people if there are ideas, including Bluetooth, but I don’t think Bluetooth features prominently for managing community resources, making a smooth transition to the new world after the pandemic.
Protecting vulnerable groups, predicting future pandemic outbreaks, supporting frontline staff and essential workers, and establishing proper data-driven risk communication, ACA, DOGA, CEO.
If you go to the web page which I just pasted you, at the end of that page, there is six Polis conversations. Who knows? Maybe Bluetooth will appear as part of it, but people are certainly not fixating on a specific technology, but rather on the six end goals, on the six core values that you need to uphold concurrently during a pandemic.
That is the important thing.
(pause)
It even says Polis in the header, so part of our story.
Hopefully, we can return to it when this is all over.
In the few minutes we have left, because I don’t want to take up more of your time…
No, it’s fine. I don’t have anything afterward. I can chat for another hour.
Are there other basic important elements of this constitution of social trust that you think get lost, get missing, or aren’t paid sufficient enough attention to?
I think the importance of making sure that people learn about epidemiology is somehow…In many jurisdictions around here – East Asia, I mean – there’s a technocratic culture, like the people in the command center knows best culture.
Everybody I meet in the CECC is working to ameliorate that culture. This includes, for example, the Minister of Health and Welfare and commander of the CECC offering to teach all the journalists epidemiology.
So that they can communicate like their fellow detectives. It only makes sense if they speak the same jargon. Our VP, Chen Chien-Jen, actually delivered on that. There is a new course of his bestseller textbook, “Epidemiology,” but translated into funny MOOC online.
It’s real well-done. There’s even English subtitles, so if people in the US want to learn from our VP about epidemiology, [laughs] you can follow on that. It’s just been posted. It’s just 48 short minutes, but there’s already 15k people who completed the course.
I don’t think they get examinations by hand by the VP. I think he has other things to work on. [laughs] Not like a normal professor-student relationship. Nevertheless, people do take it seriously.
Like instead of following orders, people are really curious about epidemiology, about R0, about herd immunity, or nerd immunity. Well, maybe not nerd immunity. [laughs] About also the importance of knowledge sharing.
How the communicate the epidemiologic knowledge in a way that the entirety of your family can easily understand is an art in itself. He also talks about mental health, which is also very important. Emotional support and things like that.
Treating fellow citizens as participatory citizens, and potentially fellow epidemiologists, I think that is very important. That is hugely important. It is not part of this Confucianism thing. Confucianism was never about [laughs] enabling all your citizens to be fellow scholars. [laughs]
It is really this empowerment. It is empowerment. If there is only one single thing I would say, get your top epidemiologists, VP or not, to speak in plain language in an anime, comical, funny way, and make sure that the entire citizens have easy access to materials that people can learn together epidemiology.
Have there been worries about disinformation or misinformation campaigns?
Sure. Panic buying, the one about tissue paper was promulgated by a tissue paper reseller. That’s disinformation. [laughs] For private profit, at that. The DOGA thing really helps to counter the disinformation, the spokesdog.
If the spokesdog isn’t powerful enough, there is always our premiere, his head, and his buttons. [laughs] That’s really, really effective. So far, we’ve never found any disinformation that we cannot dispel by the strategic use of our premiere’s image.
I don’t know if you saw the news from last night here, but apparently, our president thinks that you should be drinking or injecting yourself with bleach and other cleaning products.
Mm-hmm.
Unbelievable. Well, this is all really wonderful for now. I’ll look at those links that you’ve sent. I really appreciate it, Audrey. Thank you so, so much for your time, especially right now.
I’ll be back in touch if I have other questions. In the meantime, again, I really appreciate this. Congratulations on all of your successes there.
Yeah, and let’s hope that after a week or so, we can look at the Polis results and see how Polis contributes to the COVID prevention.
Actually, you know what? That would be great. I have to turn this in in about a week, but then there’ll be two or three weeks of editing, so there would be time to incorporate that. I’ll make a note to follow up with you, but also, if you remember, when Polis results start to come in, please don’t hesitate to let me know.
OK, awesome.
Audrey, thank you so, so much. Best of luck, and stay safe.
You, too. Stay safe. Cheers.
Take care. Cheers. Bye.