“Taiwan is a paradise bubble,” my dad told me in March, during my first few days back at my parents’ home. “This is probably one of the safest places in the world right now,” he said. Seeing the rush hour crush on the Taipei metro and children in school uniforms clustering at bus stops after school, all without exhibiting signs of fear or anxiety, I couldn’t agree more.
When the pandemic began, I had been in New York. Throughout February and early March, I checked in frequently with my parents in Taiwan. Things are fine here, they said. Meanwhile, the situation in New York was worsening. Cases were beginning to appear, but the government response was hesitant and nebulous. The virus is coming, warned the media. It may already be here.
If it’s already here, I wondered, why aren’t we doing anything about it? Why is everything continuing as normal? The situation felt out of control from the start. My parents urged me to come to Taiwan. On March 14th, 2020, I flew to Taipei on a direct flight.
My parents were right. From what I can tell, apart from masks on every face, life in Taiwan is uninterrupted by the pandemic. Schools, pharmacies, post offices, convenience stores, and parks are all open. Coffee shops, in abundance in Taipei, are full of people. Even the shopping malls are operating at regular capacity. Aside from a handful of attendants stationed at the front entrances, armed with temperature readers and hand sanitizer spray, every store remains open.
Early on, experts predicted that Taiwan, due to its close proximity to mainland China, would have the second-highest number of COVID-19 cases outside of the mainland. But the predicted wave of infections never materialized. As of late June 2020, Taiwan had reported only 447 known cases and 7 deaths. Compared with worldwide figures, these numbers are shockingly low; by comparison, more than 22,000 have died in New York City alone.
As countries around the world struggle to contain the virus, many observers are looking with great interest at Taiwan’s success. Rarely making international news and typically only in connection with mainland China, Taiwan has lately been held up by journalists and academics as a model for how to manage the pandemic. How did Taiwan, with a population of twenty-three million, eighty-one miles away from mainland China, with over 800,000 citizens working there and frequently traveling back and forth, manage to avoid the public health crisis that is now destabilizing the rest of the world? One part of the answer, I discovered, is a unique mix of technological interventions—some led by the government, others coming from the grassroots—that have helped coordinate the massive mobilization of people and resources required to fight the virus.
Fenced In
When I arrived in Taipei, I sailed through the airport. “Where are you coming from?” a health official asked. “New York,” I said. She took a health self-assessment form that I had completed, handed me a slip of paper with instructions for how to monitor my wellbeing, and waved me on. I had expected a more rigorous interrogation.
It turns out I had returned to Taiwan just in time. Had I landed two or three days later, when the authorities raised the United States’s travel advisory from Level 1 to Level 3, my experience would have been radically different. My friend Ting wasn’t so lucky. She arrived later than I did, also traveling from New York. And it was through her experiences that I first began to learn about the role of technology in Taiwan’s pandemic response.
By the time Ting left New York, the city had become a viral hot zone. Before she departed, Taiwanese authorities required that she fill out an online health screening form, providing her medical information and, most importantly, an address where she could quarantine in Taiwan. Upon landing, all passengers underwent testing, the results of which were given two days later. There was also a changing area where passengers could change out of their plane clothes. Alcohol was provided for full-body sterilization. Ting passed through immigration and was escorted to a special quarantine taxi, to take her and other travelers to their quarantine locations. She was required to spray herself down with alcohol again before entering the cab.
When she arrived at her apartment, she was called by a local healthcare official (衛生所) assigned to her. They exchanged contacts on LINE, a popular messaging app in Taiwan similar to WhatsApp, to stay in touch. She also had to join a special LINE group, where she was expected to report her temperature and wellbeing twice daily, at 9 a.m. and again at 3 p.m. Soon after, on that same day, a government worker arrived at her door with a bag of supplies. This included garbage bags, extra masks, and some food. She signed some paperwork that stated she would commit to the entire fourteen-day quarantine process without leaving her apartment. If she had not owned a cell phone, the government would have provided one for her.
How would the government know whether Ting kept her quarantine? The authorities use mobile phone location data and cell tower triangulation to draw a “digital fence” boundary around an individual’s home. If you step outside of this zone, or if you turn off your phone, an alert is sent to the police and local health officials. Ting tells me a story of a friend whose phone shut down suddenly while in quarantine. Within a minute, the police knocked on his door.
When I asked Audrey Tang, a former computer programmer and tech entrepreneur who now serves as Taiwan’s first Digital Minister, about the privacy concerns raised by the digital fence, she was quick to point out the ways in which the program differed from surveillance tools used in other countries, such as smartphone apps or physical bracelets. Tang believes the Taiwanese approach is far less harmful. “First, it’s not GPS,” she says. “We are not asking you to install an app that reports GPS.” The level of location specificity provided by such information would be unnecessary for enforcing home quarantines, she explained.
Moreover, telecommunication companies are already collecting the data being used to construct the digital fence. “This is not new information being collected,” Tang emphasized. The emergency warning broadcasting system, which sends texts about flash floods or earthquakes, relies on the same data. “Instead of collecting new data or requiring you to install a new app,” Tang said, “we repurpose existing data and existing notification mechanisms.” Most importantly, the program is sharply circumscribed: the data is only used to implement the home quarantines, Tang insisted, and nothing else.
Fork the Government
Technological solutions have not only come from the top down, however. They have also come from the bottom up. This is due in large part to Taiwan’s uniquely robust civic technology community, known locally as g0v (pronounced “gov zero”). In its current form, g0v grew out of the Sunflower Movement in 2014, a student-led protest sparked by concerns that a trade pact with mainland China would give Beijing more influence over Taiwan. But protesters also demanded more transparency and accountability from the Taiwanese government—demands that were taken up by the g0v movement.
Using the language of open-source programming communities, g0v claims that its goal is to “fork the government.” Digital Minister Audrey Tang, who is herself a veteran of the Sunflower Movement and a longtime contributor to g0v, explained the concept to me. Essentially, it means that g0v hackers produce alternative versions of government websites. “For each government website—which always ends in ‘gov.tw’—that they don’t like, they just change the ‘O’ to a ‘0’” in the domain name and create their own, Tang said. In the process, the g0v community has implemented a wide range of digital tools designed to increase popular participation in policymaking, from online platforms for circulating petitions to data visualization dashboards that help citizens understand how budgets are allocated.
When the pandemic began, g0v responded creatively, using its “fork the government” model to help the authorities contain the virus. Perhaps the best known example is the collection of digital tools—apps, maps, chatbots—that g0v hackers created to make it easier for the public to buy masks through the government’s mask-distribution system.
Due to its previous experience with SARS, also a coronavirus, the Taiwanese government recognized early on the importance of mask-wearing to reduce the spread of COVID-19. The speed with which the government reacted most likely prevented a more serious outbreak in Taiwan. Taiwan reported its first case on January 21st: a woman traveling back to Taiwan from Wuhan. The next day, the government banned all Wuhan residents from entering Taiwan, the day before Wuhan went into lockdown.
Although the government made assurances to the public later that week about a sufficient supply of surgical masks, fear of future shortages led the government to halt exports of masks on January 24th. To control the mask supply, the government also decided to implement a mask distribution system, while working with local mask manufacturers to ramp up production.
Masks were initially sold in convenience stores. With over 10,000 convenience stores on the island, Taiwan has one of the world’s highest ratio of convenience stores to population. Convenience stores in Taiwan provide services beyond what American convenience stores offer. You can pay your phone, electric, and utility bills; your taxes; and even your parking tickets there. You can buy everything from disposable underwear to towels to books to train and concert tickets. It even functions as a post office. Similar to Amazon Lockers, online packages can be delivered to any 7-Eleven or FamilyMart for pickup.
Convenience stores, then, were an obvious choice to serve as mask distribution hubs. However, it soon became apparent that the stores did not have a means of verifying people’s identity via their National Health Insurance (NHI) card to approve mask purchases, without violating personal privacy by collecting this data themselves. Eventually, a card scanning system was introduced to bypass data collection. But these challenges pushed the government to switch to selling masks from pharmacies, which are already connected to the NHI database. This allowed people to maintain their privacy and gave the government the ability to monitor the rationing of masks.
Mask rationing had been put into place on February 6th, within a week of the government launching the mask distribution system. To prevent hoarding, every Taiwanese adult with a NHI card was limited to purchasing two masks per week. To reduce congestion and long lines, the ability to purchase masks was also systematized. The last digit of your NHI card ID number indicated on which days you could purchase your masks. ID numbers ending with an odd number could purchase them on Mondays, Wednesdays, and Fridays; even numbers on Tuesdays and Saturdays. Sundays were open to everyone.
The government also worked to keep prices low, threatening to fine sellers that were inflating prices up to $50 million TWD (a little over $1.5 million USD). These moves were designed to ensure that every citizen would have the opportunity to purchase a sufficient number of masks for daily use at an affordable rate.
Despite these measures, however, the early days of the mask distribution system were plagued with problems. In February, when the system was still in its infancy, masks were selling out fast and the public was having a hard time finding them. There were frequent stories of people waiting in long lines to purchase masks, only to have the pharmacy run out when they got to the front. There was no immediate way of verifying whether the pharmacy you went to had enough masks until you physically arrived on location.
In response, g0v hackers came up with a solution. The idea first originated in the g0v Slack channel: a digital map that would visualize the quantities of masks available in different pharmacies. Howard Wu, a programmer and member of g0v, noticed that many of his family and friends were sharing information in LINE groups about which convenience stores still had masks in stock, back when convenience stores were the primary places to buy masks. He built a real-time “Mask Map” which relied on crowdsourced data to display mask stock levels in different stores. Users’ geolocation data would help them find nearby stores. Since there weren’t any existing comprehensive GIS datasets of convenience stores in Taiwan, Wu used Google Maps to obtain this data. Wu’s site had roughly 550,000 visits within the first six hours.
But relying on crowdsourced data wasn’t accurate enough. Digital Minister Audrey Tang showed Wu’s work to Taiwan’s Prime Minister, who immediately understood its usefulness. The government recognized that it could improve the accuracy of such civic digital tools by providing more up-to-date data. On February 4th, two days after Wu released his digital map, the government announced the switch to selling masks from pharmacies. In a coordinated effort with Tang, the Ministry of Health and Welfare released mask inventory data at pharmacies nationwide that was updated every thirty seconds.
Wu created another version of his site with the new data—and received 830,000 hits on the first day. Soon after, using the API that Wu had built for his map, g0v hackers created dozens more digital tools to help track mask availability, from more maps to smartphone apps to LINE chatbots. A government website now lists over 130 digital products for tracking mask inventories in Taiwan, all built by civic technologists.
The maps and apps have not only served as useful tools for people trying to purchase masks, however. The government has also relied on these tools to improve its own distribution supply chain. Officials have been able to track the fluctuating numbers in different cities and provinces, which they can use to adjust mask shipments in real time. This reciprocity between the government and the grassroots technologist community has greatly benefited both parties, and Taiwan as a whole. It also stands in sharp contrast to the top-down approach of mainland China, where technological interventions to contain the virus have taken a far more authoritarian form.
Care Works
There is no doubt that initiatives like the digital fence program and the g0v mask maps have contributed to Taiwan’s effective management of the pandemic. As mechanisms to help coordinate the allocation of people and resources, these digital tools have proven invaluable. But the more I read, observed, and talked to the people around me, the more persuaded I became that technology had more of a supporting role in Taiwan’s success.
When I ask my friends and family what Taiwan did right, they rarely mention technology. Instead, they talk about the soothing ritual of tuning in every afternoon to the Taiwanese CDC’s daily press conferences, which are led by doctors, epidemiologists, academics, and public health experts rather than politicians. They talk about the government’s decision to give journalists unlimited time to ask questions, and how this has resulted in more accurate media coverage, less disinformation, and greater public trust in the information being conveyed by the authorities. They also talk about the CDC’s toll-free hotline, where you can call and talk with a person about anything related to the virus. One friend of mine, worried she had contracted COVID-19, called the hotline multiple times. She described to me how comforted she felt being able to talk to someone who could ease her fears.
In part, the Taiwanese government’s multi-faceted communications strategy reflects an attempt to make up for past mistakes. The government’s mishandling of the SARS epidemic in 2003, which had a lower case count but a higher death rate than COVID-19, severely undermined public trust at the time. Unaware of the highly infectious nature of SARS, one woman’s visit to an emergency room set off a chain of transmission that spiraled out of control. In a desperate attempt to contain the virus, the government sealed off Hoping Hospital, with more than 1,000 people, infected and uninfected, locked inside. The inhumaneness of the approach shocked Taiwanese citizens. Twu Shiing-jer, Taiwan’s Minister of the Department of Health, resigned in the aftermath.
Post-SARS, Taiwan immediately began planning for the next health crisis. It could not afford to be caught off-guard again—especially since it had been clear during the SARS epidemic that Taiwan would have little to no direct communication with the World Health Organization, because it is not a member. Taiwan is isolated, and on its own. This realization may have proven decisive in its pandemic response, as Taiwan was one of the earliest countries to sound the alarm on COVID-19 and begin monitoring the virus.
Above all, when I talk to Taiwanese people about what Taiwan did right, they talk about healthcare. In particular, they praise Taiwan’s single-payer healthcare system. Almost 99 percent of Taiwanese citizens and residents are covered by Taiwan’s national health insurance program. (The 1 percent, the government believes, consists of Taiwanese citizens residing outside the country.) When coverage hovered around 96 percent, the government made a concerted effort to track down the remaining 4 percent—composed primarily of Indigenous Taiwanese, the unemployed, the homeless, and orphaned children—to get them enrolled. Households below the poverty line receive free coverage. Essentially, no one is denied healthcare in Taiwan.
With 99 percent of the population insured under one system, a centralized medical database made it possible for the government to rapidly implement its mask-rationing system. It also made performing contact tracing easier, as well as tracking community-based transmission. More importantly, universal health coverage means people aren’t afraid of being denied medical treatment or going bankrupt from medical bills. The government encourages citizens to report even mild symptoms, which enables the authorities to detect infection earlier.
Ultimately, Taiwan’s success in containing COVID-19 has less to do with technology than with well-functioning state institutions that acted quickly and collectively. As a Taiwanese friend described it, the government’s approach has resembled crossing a river. You inch forward step by step, feeling your way across and making decisions as you go. Along with this experimental, adaptable spirit, the government’s focus on transparency and building public trust, paired with an excellent universal healthcare system, are the real strengths of the Taiwan model. Technology, while useful, cannot make up for the absence of strong public structures of care. In the United States, where the fight for universal healthcare is still an uphill battle, care is a luxury good with multiple prerequisites—employment, wealth, geography. In Taiwan, care is a basic human right that everyone receives equally.