Public Health Answers: Digital Technology and the COVID-19 Pandemic
Dear friends, dear colleagues, good morning, good afternoon, good evening. In our series, Public Health Answers, we have tried to cover a series of aspects of the current pandemic. We are now in the second year of COVID-19 and we start to see the differences between ways of managing the crisis.
The inter-dependence of aspects such as communication strategies, what kind of utilisation of digital technology, and in particular, the rights of the individual and the protection of the whole population. This fine balance and how this whole thing fits into democracy are questions. I had the possibility and honour to discuss some of these questions with an outstanding personality. She is from Taiwan, and she is Minister for Digital Affairs, but she is so much more you will see. Please let me introduce you to Audrey Tang. Hello Audrey, if I may say so. You are an iconic person,
you’re an entrepreneur, you’re a hacker, an activist, a politician and as I have learned you've even become the text for a Japanese song writer or let’s say rapper. Very few people have this portfolio if I may say so. I, myself, am Bettina Borisch, CEO of the World Federation of Public Health Associations and I am deeply into public health and global health. You know that in public health, we have this fine balance to protect individual’s freedoms, personal freedom and population health on the other side. So, I come with a question. You have been praised in Taiwan, and you personally, for being instrumental and getting through the pandemic crisis.
How do you manage this basic public health balance while managing a crisis? Thank you, this is a great question. In Taiwan, we managed to counter COVID-19 with no lockdown and an associated infodemic with no takedown. Indeed, in both public health and also, I guess, public mental health it is essential that people are guarded against either viral biological virus or viral conspiracy theories as it were.
What we have found that works reliably is what we call “humour over rumour”. Indeed, rapping is a really good way to deliver a lot of information in an entertaining form in a short time-span. We also work with professional communicators who, for example, work out this very cute Shiba Inu. It’s a spokesdog for the Central Epidemic Command Centre because when the Minister tells someone to wear a mask to protect against their own and wash hands, it’s difficult for other people to share this message.
But, if it’s a very cute dog putting its foot to its mouth and saying during the pandemic it’s very important to not do what a dog does here because the dog is so cute people share that in what we call a “viral meme”. That is to say, people understand social distancing like when we’re indoors, keep three Shiba Inus away or wear a mask. Outdoors, keep two Shiba Inus away from one another or wear a mask. Again, in a very entertaining and engaging form. When people understand public health, they become a little bit of an amateur epidemiologist. They can share the correct information in the form that is most amiable for understanding to their friends and families and that beats any top-down programme.
Thank you very much. That is already mentioning a next word which I would like to pick up it’s “infodemic”. We are all dealing, I think, around the world with the pandemic and its infodemic. The use of messaging and the communication that you nicely described is crucial to getting through a pandemic, I think. There are now politicians using social media to spread, I would call it, “wrong messages” at least in the sense of public health, wrong messages. What do you think about this and how would you handle this if you were not in Taiwan? If I weren’t in Taiwan, I would start employing the Taiwan model as we introduced to many nearby jurisdictions by building an alliance of fact-checkers.
If you have sufficient amount of time and effort put into fact-checking by the social sector, not the public sector by professional journalists, by people who study media competence classes in their primary schools or middle schools or high schools. These are the people you want to fact check the presidential candidates, as they were deliberating and debating for January 2020, for example in Taiwan. Our presidential elections are fact checked by thousands of amateurs but when they participate in the newsroom, when they become the providers of the facts, staff can fact-check, even for the three presidential candidates, they undergo this transformation from media literacy, which is about being viewers and consumers to media competence which is about producers of media and they become inoculated against polarizing messages or the over simplification that some politicians like to say on social media. I think the main way to defend against polarized, wrong information by politicians is by engaging in media and news room work, media competence work, starting from basic education. Oh, I see. You want us all to become fact-checkers and message producers.
That’s right. In our spare time, of course, not full-time. Thank you. I’ll pick that up again and hope to get it further.
Then, my next question would be, I talked about countries outside of Taiwan and in the pandemic I am in Geneva, we are close to UN organizations. We see that multilateralism is being challenged, quite challenged these days. Especially as we are now discussing access to vaccines. How do you think that your strategies could help global governance? I think, first of all, we are part of the COVAX arrangement, even though Taiwan is not officially part of the World Health Organization, we are here to help and contribute our own research capabilities and vaccine production capabilities. We have two vaccines now in phase two. If they do well, they could be rolled out under EUA.
What I’m saying is that Taiwan is all about sharing the model that worked and that didn’t work. In 2003, Taiwan was hit quite badly by SARS. Nowadays we call it SARS 1.0. We did a lot of things wrong. The municipal government was saying different things from the central government. People were panic buying N95 masks, leaving frontline health workers with a shortage of masks.
There was a lot of uncertainty and doubt when we barricaded the Heping Hospital unannounced and so on. But after that, we wrote a play book, the SARS play book. The Constitutional Court of Taiwan charged the legislators saying when SARS 2.0 will come, and it will come, in a decade or two, when SARS comes again, we need to have the public institutions institutionalize when their memory was still fresh in 2004. So we wrote out new legislations, we wrote out the new epidemic command centre, we wrote out the IC card for universal health care and so on. All of which we are happy to share, the play book with the world.
This time around because we essentially played the SARS 1.0 play book very early on, 1 January 2020. That’s at least ten days before the WHO itself. So we would like to participate in not only the early warning systems so that we can warn other ministerial positions around the world for possible human-to-human transmission. But, also work with the other jurisdictions as more of their citizens are vaccinated. We can take a little breath until, I guess, SARS 3.0 comes,
we don’t know whether next year or ten years from now, and help them institutionalize the kind of change that we did in 2004 when it comes to contact tracing, communication as well as many other parts of legislation. In the global setting we love the #Taiwancanhelp and you said another word, very important, “preparedness”. It was among the lines. You talked about the first SARS crisis and I know from one of your interviews that you said “it takes one pandemic to be well prepared”.
I think the experience of the first SARS was very important. You also talked about institutions. What do you think that countries should do first? What should they strengthen in their preparedness for a coming pandemic? What would you rank as most important? Is it institutions? Is it communication? What is your most important part in preparedness? I think the most important part is the preparation of the administration’s capabilities.
That is to say, in Taiwan, this time around, we did not need to declare a state of emergency and so everything the administration does is pre-approved and overseen by the legislature. I say this is the most important thing because if someone in the administration is working in a state of emergency, almost by default, they will make some arbitrary choices without very good justification or due process because it’s essentially acting in the moment, ad-hoc manner, which actually makes communication more difficult because for the everyday person on the street to explain an ad-hoc decision is very difficult, it’s almost impossible because maybe the person making this policy is also just trying something out. But, if you do have the preparedness of the Taiwan equivalent of the Communicable Diseases Act, then the communicable diseases responses are all very easy to explain individually. Contact tracing, physical distancing, the use of masks to protect one’s own face from others and wash hands, and so on.
They are all very reasonable, individually speaking. So we can take a lot more time to prepare the message that will then go, I guess, viral on social media and prepare people for the next epidemic. If the virus mutates, and it will mutate, it is already mutating, we can say now we have longer asymptomatic transmission, now maybe airborne is worth looking into and so on. Then we can build on existing messages and inform the public that now we need to change this measure but this is because we learned something new about the virus.
But if we don’t have an existing base on top to do this delta, then all of this will feel very arbitrary. This is the point of a legal framework, a pre-existing legal framework. This definitely leads us to questions of democracy where you are also a very strong defender of digital democracies, let's call it.
In the preparedness you need strong institutions and you need, as I understand, legal frameworks. How are our societies prepared to do that in a democratic way? First of all, we need to make sure that legislators, in Taiwan there are four major parties in parliament, all of them need to come to terms and will understand the underlying science and technologies associated with the science. It is a form of public education that starts with the legislators and their associates.
But then, spreads to the entire society using whichever culture, language or metaphor that is most fit for that part of society to understand and internalize. Also equally important, is the algorithm side because during contact tracing, for example, we had to collect data in the places of entry, places of public gathering, even in the nightlife district of hostesses and hostess bars, all that data collection has different parameters when it comes to cybersecurity as well as privacy implications. Now in Taiwan, we use a heuristic, we only use the data collection methods that are already there before the pandemic so that everyone has a good intuition about their privacy and cybersecurity parameters associated.
If we prepare sufficient amount of that sort of information and habits really, like using IC card to get refillable prescriptions in pharmacies, when the pandemic actually comes we can repurpose the system and say just take your IC card like you would for the chronic prescriptions and then you get ten masks for two weeks in your nearby friendly pharmacy. That is crucial and that’s a way to do it. The strong democratic society participates, knows, has frameworks. We see quite a lot of democracies under pressure these days, too.
Do you think these democracies, you are a younger one, there are older ones, do they need a new social contract? I think, while the societal memory of COVID-19 is still fresh it is indeed a very good time to have a public deliberation. For example, what is the acceptable parameter for data collection, for quarantine purposes. In Taiwan, the digital fence is applied to the 14+7 quarantine period. It is quite invasive in the privacy framework because the telecoms know exactly where your phones are during the 14-day quarantine.
However, the telecoms already have that data anyway, and it’s not like they are sending it to other non-telecoms to process the data. People are already used to receiving those location-based alerts for earthquake warnings, for flood warnings, evacuation warnings and so on. So, we explained the digital fence in terms of those existing infrastructures but for other, maybe non-island countries that do not have earthquakes and typhoons, that’s fine.
Maybe you do not have as much experience with location-based alert systems but it will be a really good time right after the pandemic to have a societal conversation about how to enforce the current scene in contact tracing, too. That’s the next point. Everybody says islands are different and you said, “yes we have to enter a social discussion”, perhaps to use the open-window opportunity of the pandemic to look at how we want to live together. So, social innovation is also one of your tools, I would say, for yourself as part of a movement. Do you think that social innovation goes by steps, by revolutions, by occupations? Or how can you move forward societal thinking? Social innovation, to me, requires this thinking that everyone's business requires everyone's help.
Of course, as you put it, to help is sometimes like a trickle, sometimes it’s a storm, depending on, more often than not, how urgent the disaster is, how urgent the pressure is. So, for example, to visualize the mask rationing status, Pacific Technologists in Taiwan developed hundreds of visualizations in chat boards, in maps, in voice assistance and so on. So, three- quarters of the Taiwanese population last February can have visibility into which pharmacy near them still has some masks available. And it's done in a very short time and combines thousands of people putting hours of work into it.
So, that's for the crisis work and the same goes for the occupy movement, too. But even in not so urgent situations, even in day-to-day situations, there is still a lot to be done by the social innovators. For example, in Taiwan, a lot of social innovators see democracy itself as a technology or a set of technologies. They're not only content with, for example, uploading every person three bits of information every four years, which they call voting, by the way, but also, they want to communicate more into agenda setting.
So, they work, on for example, e-petitions, participatory budgeting, sandbox applications, the presidential hackers, the list goes on, so that everyone can participate in collective decision-making and agenda setting, not just once every two years or four years. That's something that we can all do day to day to foster social innovation and collective decision-making. So, for you, social innovation needs technology and technology is social innovation? That’s exactly right. And democracy is just another type of applied social technology. Yes. I’m in a country with a direct democracy,
Switzerland, very old, but we are downloading the three bits of information, still, but very frequently. Very frequently. That's right. The referendum system works like clockwork. So, it's definitely not just once every four years. It is on all levels. Yes. But how could we get the clockwork in better shape than in Switzerland? I think Switzerland really has a modern system for what I call a transcultural republic of citizens, in the sense that across the major cultures in Switzerland people agree to the democratic process and agree to improve upon the democratic process.
That's very commendable. One thing I would like to highlight is that in Taiwan, now that we have broadband as a human right, that is to say anywhere in Taiwan, even almost 4,000 meters high, on the tip of Taiwan, anyone has 10 megabits per second at just €16.00 per month for unlimited data connection. If they don't, it's my fault personally.
So, once we have that sort of coverage, we can actually bring the sort of deliberation that we have in our town halls and city halls to virtual reality, to the virtual deliberation experience so that the conversation around say, the participatory budget or the sandbox application, involves not only people in the same community they’re still very important but also people from overseas who care about the community, who have lived in this community or whose want to contribute to the community can also participate, as digital doubles or digital twins, in such discussions. On the face-to-face discussion side, we don't ask people to come to technology. We still bring the technology to the people, but people are joined by people from the great beyond. So, you want a political space that is almost everywhere, high atop mountains and on the seashore.
Well, I know on my To Do List, I have to climb your highest mountain, still, once I can travel again. As a mountain fan, I always ask my Taiwanese friends about your highest mountain and they said, “yes, it's feasible”, so I know I would have a strong Internet connection up there and we could start the same discussion from my hiking spot. That's right. I had a conversation on art, actually, with the curator from the New Museum in New York, and we had that discussion, he in New York and me here, wearing virtual reality headsets. Our co-creation took place on top of the Matterhorn Mountain, so, that is a Swiss mountain, and it was captured through helicopter 360 imaging.
I think it really brings us together in a way that's not achievable by two-dimensional video conferencing. That's true. We will check that out for next time. So now, already with this virtuality and the techniques we are using, we are definitely in the global space. And in the global space where we do live, we have one important problem, besides probably climate, we do have rising inequities.
The gap that is growing between those who have and those who have not. We know that this influences all and every bit of our society and health. So, I would love to have your views on how we can do something about or against growing inequity in countries that are high income, in countries that are low income, but also in in-between countries. Audrey Tang: Yes, in Taiwan our Gini index numbers are pretty good. One of the reasons why, is that not only universal healthcare is spelled out in our constitutional amendments, but also, the right to learn, especially basic education, and the right to health in all its forms, including preventative and public health and also the right to communicate.
These three form the kind of socialist core of our constitution. If any place in Taiwan doesn't have access to learn, to health or to communicate, it's the State's fault. Of course, other parts of the economy, like semiconductors, that's pure market economy. Having these two cores working in conjunction with one another, that's to say, these profit seeking businesses, they do it for profit, but with social purpose.
And the social sector does it for a purpose, but sometimes also with profit, and this makes it much easier for the two sectors to work with one another on aspects like social entrepreneurship. For example, this jacket I’m wearing is made out of 12 recycled plastic bottles and five cups of coffee bean waste, etc. Just by demonstrating this trend of upcycling, it can convince the textile makers as well as fashion designers to work on circular design that is good for the planet but also good for their prosperity. So instead of saying that these two are like the left and the right wing and they balance each other, I think it's best if we make them work together on sustainable goals and grow upwind, that is to say, to simultaneously fulfill prosperity on one side and equitableness on the other. This comes to an anti-polarization view on social market and private markets, on systems that in former days have been opposed by a lot of people.
Do you think that education, communication, health are the socialistic cores for equity and that they can go well together with the market economy? They can do well also by working on social innovation and entrepreneurship. Do you need strong frameworks and regulations to make them work well together? I think we need a strong social sector. In Taiwan it used to be that if a company abuses the planet or the people, then there will be social sanctions against them, and many large enterprises were gone because of the social sanction boycotting. Now for Taiwanese young people in their 10s and 20s, just doing nothing is cause for social sanctions against them.
They must actively give an account of how much they are working on the carbonization, on preserving the planet and things like that. Standing by is no longer an option, and when you have a strong social sector like that, the market players will play in a way that is more pro-social and pro-planet. If I got you right, in Taiwan you get people into the social sector by forcing them, by asking them? No. By having fun, right?
So, in Taiwan, for example, there's a very strong homemakers union that advocates on environmental policies, but the main work of advocacy is just buying together. So, it's actually a consumer co-op that encourages people to, for example, take the plastic bottles in cases back when you are taking another monthly grab of the collective consumer markets. And you go back to the market by the consumer co-op, you bring with you the empty bottles that you have already peeled off the labels and they recycle it right there so that it can be remade into casings for laundry and the chemicals used for the laundry, detergents.
And so all this imbues in very young people in their everyday life. It’s not something that they specifically go out and do, but rather just by coming back to the consumer co-op and buying some new washing liquid, the idea of recycling and upcycling is automatically embedded in their work. I think that is much better than just a once-a-year tour or journey or something. Oh, yes. Make it a habit. Make it your real life. Now we move from managing a pandemic to managing a whole society, and I know that you also are kind of fond of the SDGs because you sometimes mention your job description as being written in the SDGs. Could you explain to the people listening what you think when you say that? Definitely.
So, with the 17 SDGs, some of them are for economic prosperity, some of them are for planetary sustainability, some of them are for equitable society, I focus specifically under the 16th and the 17th. The 16th is about an open, inclusive and responsible governance system and the 17th is about partnership for those common goals. So, I often write my job description in terms of the 17 goals. For example, enhancing reliable data on promoting open innovation and, most importantly, on fostering effective partnership across sectors. But many people also say, “hey, minister we don't have the 169 goals/targets memorized”, so I sometimes also translate that to poetry.
I haven't seen the poems on SDG 17! Oh, you have to send it. I will. It's pinned on my Twitter. It’s literally my job description that talks about, for example, when we see the Internet of things, let's turn it into an Internet of beings.
I think this one is very beautiful. Yes, this one is very beautiful. As I don't want to take all of your time today, I would like to ask you to say this job description that you have, “the Internet of things, turn it into” … If you could explain it to us or just say it.
I like it very much. OK, certainly. So, my job description goes like this: When we see the Internet of things, let's make it an Internet of beings. When we see virtual reality, let's make it a shared reality. When we see machine learning, let's make it collaborative learning. When we see user experience, let's make it about human experience.
And whenever we hear that the singularity is near, let us always remember the plurality is here. So beautiful. I hope that a lot of people listened. I also hope that places with civil unrest, with difficult situations, can listen to these words. I think that you have to get your message through to other places in the world.
If I may, thank you, very much, Audrey, for the time you spent with me and with all our viewers. All the best to Taipei. Hope to see everyone in person very soon. Yeah, same here. Have a good local time, everyone and live long and prosper. Thank you, Audrey. Thank you. Bye.
Bye. [Transcription and revision: Nicole Rosenberg and Lauren Akins Timing: Inka Romero-Ortells Labrada]