How Taiwan rationed mask during pandemic — interview with Digital Minister Audrey Tang

Taiwan just celebrated the 17th consecutive day without local transmissions of Covid-19, as well as the 4th day without any new cases, local or imported. Total cases in Taiwan hover at 429, most of them recovered and released from quarantine. Life in Taiwan have almost returned to normalcy, with restaurants busy, schools open and hotels packed on long weekends. People continue to wear masks in public, keep social distances, and avoid large gatherings, of course, but mostly out of habit instead of fear.

Taiwan’s success of containing the virus is the result of many small, swift decisions. One of them is the early adoption of masks. Taiwanese learned the hard lesson from SARS (Severe Acute Respiratory Syndrome) that masks were essential equipment. In January this year, not long after news spread that “SARS” re-appeared in Wuhan did Taiwanese start panic buying masks. Combined with the fact that China — the main exporter of masks to Taiwan — not only stopped exporting masks, but started procuring masks globally, a mask shortage began.

Taiwan government tackled the shortage from two ends: nationalizing mask production, and rationing mask distribution. The latter is spearheaded by Digital Minister Audrey Tang（唐鳳）, who worked with National Health Insurance Administration (NHIA), and many civil developers to build the “eMask” distribution platform.

To share Taiwan’s lessons with other countries, I invited Minister Tang for an interview. We conducted the interview in English. A Mandarin translation can be found here.

Below is the transcript of our conversation, lightly edited for clarity.

CHOU: [00:01] Hi, this is Michael Chou from daodu.tech. Usually our program is in Chinese. But today we are very honored to have minister Audrey Tang to join this program.

For the purpose of sharing the experience from Taiwan, particularly how we overcame the mask shortage, I decided to record this podcast in English. Hopefully it will be beneficial to people overseas who are curious. This conversation will be in English, and we will provide English transcript as well as the Chinese translation.

First of all, thank you for coming here, Ms. Minister. May I first ask what is the role of Digital Minister? What do you actually do? And what is your role in this response to the pandemic?

TANG: First of all, I’m really happy to be sharing our experience countering the coronavirus. As you know Taiwan is one of the few places in the world that has schools and business remain open during this pandemic.

My role as the Digital Minister is part of the cabinet, working with the Premier and the Deputy Premier to make sure that everybody can get access to digital services, digital transformation and digital development.

And my job description . . . I actually wrote it myself. So I’ll just briefly read through my job description, which 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, that is always remember the plurality is here. That’s my job description.

CHOU: [01:49] That is a very unconventional job description. I heard that you consider yourself a “poetician” instead of a politician?

TANG: I am still a poetician. And a hacktivist.

CHOU: [02:08] We people in Taiwan are quite familiar with your background. But for our audience today, could you briefly explain how did you come to this job?

TANG: Sure. Back when I was 33, there was a protest outside of the legislation, the legislative yuan（立法院）. That’s called the Sunflower Movement.

And the night before the Sunflower Movement, I was there supporting the students demonstrate against the CSSTA, or the Cross-Straits Service and Trade Agreement. The Agreement was fast tracked into parliament without deliberation. Because of that, a bunch of students just went in and occupied the parliament for 22 days.

But the demonstration turned out to be a demo, not just a protest, but rather showing how half a million people on the street and many more online can come to consensus. And they reached four demands, not one less, and got accepted by the head of the parliament at the time. It was a successful occupy.

My role during the occupy is to use digital technologies to facilitate conversation of more than 20 NGOs, to make sure that everybody can debate in a matter-of-fact manner on how they would be affected by the CSSTA. When ministers of parliament (MP) go on strike, people took the MPs’ positions, literally physical positions, and deliberated together.

So right after that, I was invited by the cabinet as a reverse mentor to (then Premier) Jiang Yi-Huah‘s cabinet. Jiang Yi-Huah cabinet then lost the local election at the end of that year. The government took a swift shift into Mao Chi-kuo‘s cabinet, which prioritized open data and collective intelligence and open government as the direction ever since.

CHOU: [03:37] I think open data will be important in our later discussion about how we manage this mask shortage. So you’re invited to the cabinet in 2016?

TANG: Well, I already worked in the cabinet for two years since the end of 2014, as a reverse mentor or as an advisor to the then Minister Jaclyn Tsai. And so I worked with both cabinets.

I think the idea of open data and open government is an idea that has broad agreements. Nowadays, if you ask anybody in the legislation whether they’re from the DPP (Democratic Progressive Party), the KMT (Kuomintang), the New Power Party or the TMD (Taiwan People’s Party), everybody would say, they are for open government. That is one of the very few things that they agree on.

CHOU: [04:21] Fast forward a little bit to the pandemic. In early late January or early February, there was a panic and people were buying masks and there was a shortage of masks. How were you informed? And what was the duty in terms of the whole government response? What part did you play?

TANG: Well, it actually started last year, not this year. Last year, Dr. Li Wenliang（李文亮）, the PRC (People’s Republic of China) whistleblower shared on social media that there were seven SARS cases being detected around Wuhan. Although he got inquiries, and eventually disciplines from their local police.

The same social media whistleblowing gets reposted on PTT, which is Taiwan’s equivalent of Reddit. But instead of getting inquiries or punishments, this person called “nomorepipe,” I think that was the nickname, eventually escalated this message because the people in the CDC (Center of Disease Control) in Taiwan just took notice of that post.

And within 24 hours, [our office] started getting news that there was health inspections of all passengers that flew from Wuhan to Taiwan. So the response started last year. Unlike many other countries which started this year. So we’re really grateful to Dr. Li Wenliang, of the whistleblowing.

My role during this, in additional to social innovation plan to counter the coronavirus, is to ensure not only the fast response, but also the fairness of mask distribution.

And precisely as you said in the very beginning, when convenience stores started selling the masks, there was a limitation of how many masks a person can buy. But there was no way to verify if the same person just hopped to the next convenience store. If people know that convenience stores received their mask supply by 2 am, actually by 3 am, they ride scooters and buy all the available masks. Because there’s no way for a convenience store to verify it’s not the same person across multiple purchases.

So because of that, I worked with the civil society, who have developed at the time a map of convenience store’s stock supply. It’s a crowd sourcing attempt developed at the very beginning by Howard Wu（吳展瑋 ）in Tainan. He runs this platform, where everybody can voluntarily report their stock level of the convenience stores, and add it to the map.

But of course the problem is it relies on people to voluntarily report. There could be a time difference between people reporting and when the stock actually gets depleted. So people can still run to the convenience store and see it is out of stock.

Because of that, we [later] switched to pharmacies and made sure that all pharmacies are connected to the same system, that is run by the National Health Insurance Agency (NHIA). So that if you take your NHI card to one pharmacy, [we] use the same mapping concept that was developed by Howard Wu at the very beginning, and by asking him and his colleagues as well as many other developers in the g0v community (online community of civil developers) to work with the same open data. But this time it is not voluntarily reported, rather published by the NHIA.

We publish every three minutes. To date, there’s more than 130 applications, including maps, voice assistance, LINE chatbots and so on [built on the platform]. That lets everybody see plainly where nearby in their neighborhoods are there pharmacies that provide the masks.

CHOU: [07:37] I think there are at least two ends working at the same time. One end is interactive map that you described — how the mask are distributed. On the back end is the government nationalizing the production.

TANG: It’s the NHI making sure that the distribution is fair. And of course, the National Post Service is also very important, they deliver from those manufacturing places and make sure that all the pharmacies receive them in time. And of course, the manufacturing lines have itself been extended and that was also made a decision very early on.

CHOU: [08:13] Right. The audience may not know that in Taiwan there are a lot of pharmacies, there are a lot of convenience stores, and they are sort of like a distribution . . . .

TANG: Ya. We are an island with 23 million people. A lot of people. But from Taipei to Kaohsiung with high speed rail is just one hour and half. So it’s interesting because the density is so dense. There are more than 12,000 convenience stores participating in mask distribution, and about 6,000 to 7,000 pharmacies as well.

CHOU: [8:42] Sounds like in the beginning there is the crowd sourcing effort to build up a map to show where the masks are. But eventually we had to move to a real name system because we have to ratio the distribution of the masks.

TANG: Yeah. But the map is still useful and it’s actually even more useful. Because in addition to maps, there are also people making the kind of overview map that lets you see whether there is an oversupply or an undersupply in certain regions in Taiwan. There are even people who make something like a stock exchange to predict the demand in certain place using historical data and so on. (laugh)

None of this are government procured. All of these are contributed by civic hackers. That is to say, programmers programming for the public good.

CHOU: [9:31] How did this data become available? It’s probably not available immediately in a moment. How do a person like Howard make use of the data? And then following that, have this government started to open more data? From the health insurance?

TANG: In the beginning it was relying on voluntary contributions. But as soon as that went online, the g0v slack channel, of which there are thousands of people just working for a public good every day in their part time, I noticed their exchange very early on.

What happened was that the very next day, I think it was a Monday, there was a meeting in the cabinet with the Premier. And I just showed Howard’s contribution and the map to the Premier. The Premier, Su Tseng-Chang, understood what this was within two seconds. He looked at the map and said: “oh, this is like Google map navigation. If you see a fast route now colored red, it means that it’s congested or it is low on stock. And it would suggest us to a slightly farther pharmacy, which may take you a little while to get here, but it’s green, meaning that it has plenty of mask in stock.” which is a perfect analogy, right?

So he got it immediately and said, ok, we’ll switch to pharmacies for real name rationing distribution, which should still enable people to use this kind of map. And because of this, I immediately went to the g0v slack channel the next day. And I told Howard and also Jiang Mingzong（江明宗）, who was also working on a map. So there were two maps at the very first day of the new mask rationing policy. Each acting as a kind of backup service as the other.

CHOU: [11:03] That’s very interesting because there is a slack channel. And people are proposing ideas and channeling through you to the government?

TANG: That’s right.

CHOU: [11:13] I understand it’s your role in the government in terms of promoting open data and promoting open government. How is that perceived by the cabinet or the Premier? How do you help to facilitate?

TANG: The best innovations are always from the social sector. We are a democratic country. So it is obvious that we need to respond to the real-time citizen’s needs. So this is nothing new. What is new though is the kind of slack channel or the policy conversation we just launched at cohack.tw as well as the join platform join.gov.tw that enable us listening and to scale.

A liberal democracy must listen to the citizens, of course. But, if you receive their calls one at a time using telephones, LINEs and so on, it is very time consuming. And you need a lot of staff to suss out the innovations from the sheer number of calls to the (pandemic hotline) 1922 telephone line, which we still do provide.

But in addition to that, this kind of digital platform that I just mentioned enables people to see each other’s idea, and upvote or downvote or to contribute more to each other’s ideas. And this real opening innovation, make sure that the things that get the most upvotes, just like Reddit, and so on, is more worthy of people’s attention. So that we can concentrate on the shared purpose much more easily than if it’s a one to one telephone call.

CHOU: [12:40] How is a proposal approved? How does a person in charge get funded on this platform?

TANG: For the Cohack hackathon as well as the Presidential hackathon, all you need is a short description, maybe 300 characters of the ideas that you are proposing. And then what we’re doing is we form data collaboratives, meaning that if you start from the private sector, we find you partners in the social and public sector. If you start from the social sector, we find you partner in the private and public sector. And public servants themselves can also propose novel ideas, in which case we help them find private and social sector partners.

But everything at the end becomes tri-sectoral, meaning that it is both verified by the academia or the social sector to be of public use. It is self-sustaining when it comes to the economic model [as certified] by the private sector. And also it is legal as well as furthering a sustainable goal as certified by the public sector member. So what we’re trying to do is to form those cross-sectoral teams, which can then fund itself using either crowdsourcing, crowdfunding or public funding.

And public funding is evidenced by the five winning teams in every yearly Presidential hackathon, [who] receive a trophy from our President, which is a micro projector. If you turned it on, it projects the President handing the trophy to you, which is a self-describing trophy (laugh). What that means is that whatever you made in the past three months, the President promised as her platform to make it a reality within the next twelve months. So it is the political binding power instead of any award prize money as the reward of promoting social innovation.

CHOU: [14:18] That’s very interesting. And right now, as you said in the beginning, Taiwan, we have almost an oversupply of masks today. We have like daily they produced around 15 million masks.

TANG: The latest numbers is 16 million.

CHOU: [14:36] Oh 16 million! It can be done. And I thought the production ramp up is very impressive. The distribution is very impressive as well. So now we’re going in Taiwan starting from pharmacy. Now we’re doing in convenience stores?

TANG: Uh-hum.

Chou: [14:50] For the masks, what is the next stage? Will it eventually return back to the market system that we don’t do need ratio? What is the foreseeable future?

TANG: First of all, the convenience store system is really new. It used to be that you have to install an app or a go to a website to pre-order to the convenience store. But starting a couple days ago, you can just go to the convenience store, insert your NHI card as you would in a pharmacy, and immediately pre-order for the next week.

This proved to be a real success. The eMask 3.0 system, as we call it, on the very first day, which is April 22nd, [become] the channel with the most number of pre-orders. It dwarfed the pharmacies, the online apps and website.

What this means is that first, people really find the convenience store very convenient, they open 24 hours a day, and also the staff at a convenience store is very helpful. So even for elderly people or people who don’t speak Mandarin and so on, they can just go to a convenience store and expect a friendly staff to help them to walk through the 30 second process of completing a pre-order.

I think right afterwards, what we’re doing nowadays is to move more selection of the mask into the convenience store system. At this moment, you can only choose between adult mask and young child mask. But there is also a pre-teen mask size. There’s also really young child, like 4 years old and younger sizes. There are 4 different tiers of children’s masks. So the next step is to enable the pre-order to select an even more finely grained selection. And this is only possible because of preordering.

CHOU: [16:30] I understand completely. I have two young kids and it has been a struggle to find the right size of the masks.

TANG: That’s right.

CHOU: [16:40] So I think lots of people are concerned about privacy. And this distribution system which we all benefit from it and we are very grateful for it; but at the same time, we recognize that the NHI card is very powerful and it goes with us [wherever we go]. So what do you say about what is the benefit worth its tradeoff here that we should make?

TANG: There’s no tradeoff.

We make sure that when you go to a convenience store and you insert your NHI card, the screen doesn’t even display your name. You enter your own phone number, of course. But the zero number, your national I.D. number, we only display the first couple digits and the last one digit. So there’s minimal privacy harm, even if there are people who stand behind you looking at the screen. We really take a lot of care to minimize the privacy harm.

And the convenience store kiosk, it cannot reach your NHI history or pharmaceutical history or whatever, because they’re not a clinic. All it can do is to connect that card back to the NHI app. The application running within the NHI VPN, the virtual private network, only does one thing, which is to ensure that this card is legit. It doesn’t do anything else. And so there is no access of the other medical information or pharmaceutical information that is possible by the kiosk in the convenience store.

And it’s the same actually for the vending machine. We thank the vending machine team in the Taipei City Smart City Office for prototyping this disconnection, because their vending machine also used the same VPN connection back to the NHI, and the privacy orders and so on. They did that work. So by the time that we’re connecting the convenience stores, we’re reusing the existing VPN connections and APIs that the vending machine team has been worked through. So I’m really grateful to the Taipei Smart City Office.

CHOU: [18:27] From a software perspective, how difficult was it to develop this whole system in terms of security? Is there a secure risk so it has to be very careful? Compared to other countries . . . some seem almost paralyzed. What is it that make this development work so fast?

TANG: First of all, an almost universal coverage around 99.99% of NHI itself is the most powerful thing. Because it ensures that if somebody develop symptoms, they can just put on a medical mask, go to a local clinic, get checked and apply for PCR testing. But in other countries if there is no universal coverage, there will be people who think this will increase financial burden on me or things like that. And they would not go to the clinic, which increase the possibility of other people getting infected.

But in Taiwan, because there is no financial burden at all for any of the diseases, not just the coronavirus, but pretty much anything else. So basically, everybody knows because of the single-payer health insurance system that you only have to pay for the registration fee, which is like five U.S. dollars.

CHOU: [19:47] The risk is overusing it or wasting resources.

TANG: (laugh) Yes. The risk of human overusing it actually is being solved by the coronavirus situation, because people don’t go to large hospitals anymore. They’re too crowded. People do go to local pharmacies and local clinics more because of the pandemic. In any case, social distancing.

So what I’m trying to say is that the NHI card itself assures people that they will be treated fairly and fine even if they contracted the coronavirus. And based on the NHI card and the general availability of the NHI VPN network, that’s why we can do the convenience store pre-order system. That is why the vending machines can work. Without the NHI VPN system, that would not be possible.

CHOU: [20:30] Right. We live in Taiwan, we almost take this for granted. We just carry the card with us everywhere we go. Even we have a mild symptom, we go to a clinic.

TANG: Just to be sure.

CHOU: [20:40] Right. I think we just build on that and then it has been very beneficial to the country. It’s almost a national pride right now.

The last few questions are about the open data government initiative. How do you think this cross-sector collaboration? I guess it helps the Taiwan tech scene.

TANG: Definitely. All the 130 applications are portfolios for those creators.

CHOU: [21:14] And I understand we are exporting some of the applications?.

TANG: Right. Jiang Mingzong as I mentioned, his map with a lot of triangles — Korean people are already using it. The Tokyo dashboard has also a lot of contributors from the zero community and so on.

At least in our part of the world in East Asia, this is almost a shared infrastructure now.

CHOU: [21:34] Seems like East Asia has been reacting pretty well. Part of the reason is that we had so many waves of pandemics.

TANG: Also we don’t have to rebuild a culture of wearing a mask.

CHOU: [21:44] We have a societal immunity.

TANG: That’s right. It’s like a physical vaccine.

CHOU: [21:54] Thank you Audrey for joining this conversation. Particularly on behalf of Taiwan citizen, we appreciate the government’s prompt response. I don’t think many citizens in many country can say that. But I think we should say that. And I see that lots of people in the government are overworking and hopefully will to be able to take a break soon.

TANG: Yes. The pharmacies at least are finally taking this Sunday off. But we really thank them for the service.

CHOU: We do. Hopefully we can keep this as long as possible. We’ll see. But hopefully our experience in Taiwan is maybe beneficial to some people or some countries. And if they need help, please seek out to us.

TANG: Yeah, please connect to Taiwancanhelp.us.

CHOU: Right. Thank you very much.

TANG: Thank you.