Niall Ferguson: My first question relates to the early phase of the pandemic. In my book, “Doom”, I argue that Taiwan got this right in a number of different ways. The general argument is that Taiwan has to be quick in its response to any threat emanating from the Mainland.

Niall Ferguson: This is a broad feature of Taiwan’s situation. It has to be paranoid. You’ve made it a more technologically nimble government in a whole range of ways.

Niall Ferguson: How important was your work on technology and particularly the empowering of citizens when the pandemic struck? I’m just curious to look back on January of 2020, when an election was the main issue. When did you personally first realize that there might be a public health crisis, and what role did technology play in dealing with that crisis?

Audrey Tang: Personally, I become aware of it when the CDC, the Center for Disease Control, announced that there is not at a time called pandemic, of course, a possible epidemic. That was in early January.

Audrey Tang: I was talking with some international foreign journalists. I said, “Well, that pandemic is coming and so on. I can get you the exact date, but that’s before we set up a CDC, so early January on the first half of January.

Audrey Tang: Technology wise, because as I mentioned, we work on the counter infodemic infrastructure. A lot of that is actually repurposed for the counter pandemic infrastructure, and that includes humor over rumor strategy innocuous Bostock.

Audrey Tang: The participation officer, I’m just having a meeting before our call. [laughs] I had a team conversation with the person who live with that cute dog, [laughs] who is responsible for participation officer duties in the Ministry of Health and Welfare, and who was quite central in coordinating the strategy of humor over rumor, so I think that kick it in first and then came the mask rationing and other stuff.

Niall Ferguson: If you look back on the reasons for Taiwan’s successful containment of the virus last year, what other policies do you think were crucial? I’m thinking here of more straightforward things like travel restrictions from the Mainland or testing. How important were those different things, and to whom should we give the credit for the effectiveness of the response?

Audrey Tang: Definitely, the Taiwanese people, the citizens, and to be precise, the people who have understood the importance of these measures, especially anyone above 30 who would have had a memory of SARS in 2003.

Audrey Tang: By 2004, for example, we adopted the IC card based instead of paper based Universal National Healthcare card, and that become a new norm. The SARS in 2003 made many new norms possible. Those norms are instilled not just in the regulations.

Audrey Tang: For example, the act for control of spreadable, this communicable diseases, the CDCA, the spill out, this special carving of the Privacy Protection Act, which is otherwise very European style for the specific purpose of data collection during a pandemic and so on.

Audrey Tang: People understanding this and making sure that they ask the right questions because we never declared a state of emergency. Through interpolations, through the daily journalists, through calling 1922, I think 1922 is probably the most important piece, if you have single out one piece of technology, is this toll free number that we got more than two million calls last year.

Audrey Tang: Just today and this is actually exclusive because we’re just going to announce it tomorrow. We’re also using 1922 and SMS for check ins and so on. All these measures, make sure that people understand what’s going on is very transparent.

Audrey Tang: Also, if they make suggestions and they do, we take those suggestions into account implemented, usually within 24 hours, but at most, after just a week at most.

Niall Ferguson: Am I right in thinking that, in Taiwan, contact tracing was not done through an app, because there was never the need to scale it up that much, or did you have a contact-tracing app as well?

Audrey Tang: We did have a Bluetooth spaced Exposure Notification. That’s what we call non contact tracing. Exposure Notification System, the ENS, is called Taiwan Social Distance. The Taiwan Social Distance, we share the source code with other jurisdictions last year with at least India, and maybe also UK and so on.

Audrey Tang: At the time, we did not deploy it domestically, because there was no community transmission. This app really doesn’t make sense in a scenario with no community transmission. This app has been rolled out, of course.

Audrey Tang: This time, once we detect a community transmission within just a couple days — as of yesterday, there’s more than 4 million downloads and installations and counting in a population of 23 million — that means that we will soon reach the critical threshold for the Exposure Notification to work in the Bluetooth manner. It’s not that we didn’t develop it. It’s just we roll it out when the situation calls for it.

Niall Ferguson: When you look at the performance of Western countries last year, it’s strange to me how few were able to learn from what you were doing in Taiwan. Is that because people in the West just don’t pay enough attention to Taiwan and were busy learning lessons from the Mainland lockdown? Do you have another explanation for the seeming inability of Western governments to use these methods?

Audrey Tang: Very early, New Zealand said that they will just do whatever Taiwan is doing. They will play the Taiwan playbook. South Korea, for example, implemented mask rationing. We also work with the Tokyo Metropolitan Government on the dashboard and stuff.

Audrey Tang: It’s not that Taiwan model is known, but it requires a few things still because our system builds upon Universal Health Care, universal broadband. In a jurisdiction with NYDA, it’s actually not that easy to straightforwardly copy whatever we’re doing.

Niall Ferguson: If you take a step back and reflect on what you’ve achieved since you became a minister, you’ve said in other interviews I’ve read that it’s about empowering citizens, not the state. How do you think about the issue of data privacy?

Niall Ferguson: This is the stumbling block in the United States: arguments about using technology to deal with public health crises or other crises always seem to get bogged down in rather crude arguments about civil liberties.

Niall Ferguson: Do you have a good answer to those people who are just inherently suspicious of the kind of solutions that you’ve developed? How can we maybe change American minds on this question?

Audrey Tang: First of all, for example, we use a, what we call, real contact system rather than a real name system when it comes to the check ins.

Audrey Tang: If people don’t, for example, trust their own Bluetooth device for the Exposure Notification, there is an alternative. They can actually using pen and paper to write a number even prepaid SMS number or email, anything that could reach them if there is exposure and writes down like physically before entering a place.

Audrey Tang: That place doesn’t give this piece of paper to the contact tracers unless, of course, there’s a real outbreak in that area. If, after four weeks, nothing happens, then they just shred the paper. This has proven to be popular in, for example, the Nightlife District, among other things, because people would trust the venue owner to have an incentive, to not actually actively share this data.

Audrey Tang: When they do share it, they don’t have real identifiable information. They just sent this one way SMS saying that you should probably quarantine at home. If you develop symptom, go to the clinic, wearing mask, and things like that.

Audrey Tang: That’s sometimes described as participatory self surveillance, meaning that it’s devolved. We just spell out the kind of standard of what’s the minimum requirements for Exposure Notification to work, and each owner just innovates.

Audrey Tang: There’s easily more than 20 different — maybe one hundred now — implementation of the real contact system.

Audrey Tang: For the individuals, like small shops and so on, which does not have any computer technologies and so on, they can also handwrite such tables. The system that we’re developing based on SMS, again, even if they only have a feature phone or whatever, that will still work.

Audrey Tang: To maximize the inclusiveness and make sure that the data storage is on the social sector, that is to say is in the places that people trust, that is very important.

Niall Ferguson: Do you think it’s essential to have the identity card associated with the healthcare system to do what you’re doing? In the UK there’s a deep resistance to the idea of national identity cards. Could one nevertheless function and get a system like the one you’re describing to work without those identity cards?

Audrey Tang: It’s possible to replace that with a SMS sending phone, I was just explaining it. A SIM card is actually also a IC card. If you have no national identity card, usually, the SIM card is used in lieu of it, and that’s possible, it’s certainly fine.

Niall Ferguson: I wanted you to spell that out, because it’s often misunderstood that in effect we already have these identifiers in our devices, and therefore, you may not need a…

Audrey Tang: Yeah, your Telecom already know where you are, roughly, in a kind of 50 meter radius depending on the density, of course, of the Telecom towers. Each person, when you get that mobile phone number, you probably already had their photo ID identified, although of course you can buy prepaid.

Audrey Tang: Even with prepaid, if there’s still a unique number, that’s your phone number, [laughs] that’s associated with the SIM card on your phone…In a sense, yes, which is exactly how the SMS based real contact system works, in that if you have no ID with you, but you do have a SMS sending machine, then sending a SMS to 1022 is equivalent to a health card checking.

Niall Ferguson: Let me now turn in the remaining time to talk about the new outbreak that appears to have come in because of the pilots from abroad. How confident are you feeling about Taiwan’s ability to contain this outbreak, and what should I be watching out for as I try to assess how things are going in the coming days?

Audrey Tang: In the next four days, in addition to the previous three days, we’re actually looking at pre containment measures to nature our value. It looks like linear at a time, but then all exponentials look linear in its beginning. [laughs] That’s the first thing, or whether it goes sigmoid.

Audrey Tang: The next seven days, you get a feeling of the natural our values before Taiwan had any specific containment measures. Then, for the seven days afterward, you will see the containment measures and how that flattened the curve or not.

Audrey Tang: Within the next 11 days, we’ll probably have our values of the pre containment measure and post containment measure numbers. That’s what we should watch for, and for the past three days it looks like linear.

Niall Ferguson: As I understand it, the problem that’s come up is the shortage of testing capacity. This is based on talking to some people in Taiwan. Would it be fair to say that the government became overconfident about its COVID strategy and relaxed when it could have been doing more to prepare for this kind of outbreak? Is this being a victim of your own success?

Audrey Tang: One of the stories is about vaccination. That’s the point that most foreign observers are making, and I actually agree with them. I’m personally vaccinated, but when I vaccinate, the adoption rate of vaccines is really low, even up among health workers.

Audrey Tang: People share about, for example, the news that in July our domestic vaccines will be mass produced, and so let’s wait for July, because it’s domestic. It will be cheaper, less side effects, and so on.

Audrey Tang: They’re not actually wrong, but to me, of course, soon as I get AstraZeneca out, I got it on the first chance. I can’t actually get a job, because I understand that at any given time there may be a outbreak.

Audrey Tang: Even among the health staff at that time, which was early April, it was difficult to get this message through. That is if you describe it as “victim of our own success” applying to the lack of willingness to get early vaccination. That would be fair.

Niall Ferguson: I know how busy you are, so I won’t keep you much longer, but I want to ask a final and general question. I’ve tried to argue in this book and in interviews I’ve done that it’s better to be generally paranoid and quick in your response than to be specifically and meticulously prepared for the wrong contingency.

Niall Ferguson: It seems to me that you personify an approach to public policy problems that emphasizes speed of response and also crowdsourcing of information. Did Taiwan have a pandemic preparedness plan? I’m struck by the fact that the US had a very elaborate one, and so did the UK, and these plans did not work.

Niall Ferguson: In January, in February, in March, nothing much was done whereas you were very quick in your response. Am I right to characterize your approach as one of general paranoia and speed of response rather than meticulous preparation for a limited number of contingencies?

Audrey Tang: It’s both though. For example, right after SARS, we meticulously planned the Communicable Disease Control Act, the CDCA, the yearly drills, the stockpiling of PPEs among other things, so be meticulous and prepare between disasters [laughs] so that by the time that those meticulous planning comes, and there’s a playbook…

Audrey Tang: Early January — actually the first of January, we just said, “OK. Let’s play the SARS playbook. If this turns out to be nothing, well, no harm done. But if it turns out to be SARS 2.0, well, at least we know the SARS playbook.”

Niall Ferguson: That’s a brilliant note on which to end this interview. I’m extremely grateful to you for your time, particularly at a very fraught moment as Taiwan finally has to do lockdowns. I wish you every success in dealing with this and whatever the next problem is.

Niall Ferguson: I look forward at some point to inviting you to talk to a wider audience here at Stanford, virtually and perhaps later in the year in the flesh. Thanks again, Minister, for your time and also the inspiration that you give those of us who would like to see a somewhat similar approach to government in the United States.

Audrey Tang: We only go to lockdown if — as I mentioned, for 14 days — this curve continues with at least half transmitted from unknown sources.

Audrey Tang: We’re not yet in a lockdown. We’ll see whether in 10 days or so that Taiwan goes into a lockdown for the first time.

Niall Ferguson: As they say in the Western world, we’re keeping our fingers crossed. Thanks so much for your time, once again, Minister. It’s been a real pleasure.

Audrey Tang: Long live and prosper. Bye.