To begin, I don’t know why they picked me to give this report on the Taiwanese response to the pandemic. They should have picked some Taiwanese person, but here I am.
(laughter)
Maybe it will give them a more objective view…
I don’t know. [laughs]
Is this a kind of international comparison study?
Yes. The conference is an international conference of the Law and Society Association. It’s composed of scholars who are doing law and sociology, law and history, law and literature, law and health, law and this or that.
Excellent.
It’s quite an interdisciplinary conference. Since I was here in Taiwan and I’ve been active in that organization, they asked me to give the report on Taiwan.
That’s excellent.
I’m very flattered to have the opportunity to speak with you. This is a real honor. I really appreciate it. Thank you very much for joining our conversation.
All right. We’ve got like 40 minutes, give or take.
Great, that’s wonderful. I think that you saw my questions.
Yes, I did.
Maybe you would like to begin with telling me something about the very end of December 2020 or 2019, when the information about Wuhan came in?
It’s called COVID 19. It’s December ‘19?
Yes, December of 2019. Taiwan reacted very quickly and very effectively.
Thanks to one Dr. Li Wenliang, he literally saved Chinese people.
Could you tell me something about the process by which the cabinet ministries coordinated their various efforts early on at that time? As you know, in America our departments of this and departments of that were all fighting with each other. The different states had different policies, and everything was quite uncoordinated.
We had that in 2003.
(laughter)
It happened with the SARS.
Yeah. Basically, it could be divided to two like times. One is after the CECC, the Central Epidemic Command Center get started. That’s around the middle of January, if I’m not mistaken, one day before we have our first local case. Before that, frankly speaking, I wasn’t personally too involved in that because it’s mostly within the Ministry of Health and Welfare.
After the CECC got setup. I read that it’s because of a medical officer, Philip Lo is the name, or Yi Chun, who got an advance notification very early in the morning, December 31st, from a public open source intelligence. From the Taiwanese equivalent of Reddit it’s called PTT.
It’s a National Taiwan University student pet project that’s been running for 25 years. [laughs] It’s like social media but more pro social because it doesn’t have advertisers or shareholders to report to, just NTU pet project.
On there, a young doctor with the nickname No More Pipe reposted Dr. Li Wenliang’s message from Wuhan that said, “Seven new SARS cases has been discovered in the Huanan Seafood Market.”
While that message didn’t get to the citizens of Wuhan for obvious reasons, it did get upvoted a lot on PTT. People volunteered their expertise and time to triage, to fact check, that particular whistleblowing so that it get upvoted a lot within a few hours.
The medical officer’s chat group notice that and Philip Lo logged in to PTT to check it for himself and discovered it’s probably legit, it’s probably SARS happening again. He informed what would be the CECC expert team and they decided to start health inspections for all flight passengers coming from Wuhan to Taiwan the very next day, the first day of 2020.
Between the 1st and 15th of January is our presidential elections, among other things.
(laughter)
Everyone is busy on other things too. From what we gather after the CECC setup, the insulation of the CECC followed essentially, the SARS playbook. Before we even have any idea whether this is the same as SARS or is different from SARS which is assumed that it’s exactly SARS happening again.
We played the SARS playbook that’s institutionalized in 2004, including health inspection and setting up a CECC, but also an investigation. The Minister of Health and Welfare sent two experts to Wuhan on the 12th of January to gather evidence about human to human transmission.
Can I ask for a moment? The SARS playbook, is that something that would be available, do you think, in English translation?
Sure. The legal part is the Communicable Disease Control Act, the CDCA, which is everything that we didn’t do right during SARS.
(laughter)
The Constitutional Court charged the legislature to revise the CDCA to put in things like the Central Epidemic Command Center and the measures necessary to ensure a fast, rapid response into the revised CDCA. That act went through a major overhaul right after SARS. When I say SARS playbook, I mean primarily the CDCA.
There’s also the fightcovid.edu.tw that lists all the specific regulatory measures and guidelines which are authorized by the CDCA but published by the CDC, the Communicable Disease Control Center, part of the Center for Disease Control. These are the playbook. You can take a look at that at fightcovid.edu.tw.
Let me get that down. It’s fightcovid?
.edu.tw. It’s voluntarily translated by many students and their professors of epidemiology.
Could we go back a little bit to something earlier that you mentioned, the PTT, the student project. What does PTT stand for?
It stands for…Let me double check… Professional Technology Temple.
Professional Technology Temple.
(laughter)
Very local spiritual tradition.
(laughter)
Interesting. I had never heard of that before.
It’s like a social chatroom among the students.
Currently, only NTU students get to register new accounts, but it did open to the general public. I also have an account there.
My students in my class would also have access to it.
Of course, because you are a NTU professor.
(laughter)
All of your students can have PTT accounts.
(laughter)
Now, naming it BBS…
It’s a bulletin board system. It’s real time social media, but initially, before the world wide web, it was done through terminals, like dial out and things like that. If you want to take a look at PTT, it looks like this, like super retro, from the pre world wide web days. Then we can find this young doctor “nomorepipe”.
No More…?
She’s a young doctor. We can trace her post, which is pretty much pandemic related for the past year. Here you can see that it’s mostly about the measures of the pandemic.
You can also see that this person posted quite a few things about the CDC and have a discussion. This says “爆” or explosive. It means that this has a lot of people talking about the content of this post.
That’s the second column there? How many people talk about it?
Right, that’s the second column. For example, No More Pipe posted on December 31st, 2019, that says, “Asking for a gossip” (問卦). This board was named Gossiping. “Asking for a gossip: Wuhan is suspected to have SARS again in a human to human transmission.”
It’s 12/31?
Yeah, at half past two AM.
Then you can see a lot of people triaging this particular post that she posted, which was from Dr. Li Wenliang in Wuhan. It contains this link of this screenshot of the Wuhan announcements, and the people started having a lot of conversation.
This is terrific. I’ve never known about this before. Thank you very much. This is excellent. Nomorepipe is really a national hero.
Yes, she is a national…Well we only know her under the pseudonym.
She has never gone public?
So, this is what I call digital public infrastructure. Rather than in Facebook or Twitter where their primary shareholders are stakeholders because this is student project. There’s no advertiser or shareholder interest. People concentrate on things of public interest.
Before continuing this fascinating conversation, I just wanted to mention to you that when I got out of law school a long time ago, as you see from my gray hair, I worked for a federal judge for a year.
Then I went to work for my hero of that era, Ralph Nader. I spent three years in the Nader Organization in its Health Research Group as a consumer watchdog on the FDA.
The social factor.
I have the same kind of public interest orientation.
That’s excellent. What we’re seeing is the experts contributing in and to check whether it’s legit or not. Then after the fact, you’d just see this very repetitive replies that says “朝聖” or just worshiping the hero.
(laughter)
By February, it says, “Worshiping the hero: Rest in peace, Dr. Li Wenliang.”
Although my Mandarin is at an extremely elementary level, I have a teaching assistant who would, I’m sure, translate all this for me. That’s great. That’s really great.
That’s how the Ministry of Health and Welfare responded to it by activating the SARS playbook. Once the CECC gets formed, each relevant ministry then send dispatch secondments into the CECC. On the CECC’s gathering hall, they have secondments from pretty much everyone that’s related to the epidemiology response.
They can, for example, start to coordinate the mass production, start to work on the home quarantine and hotel quarantine systems and so on, from within the Ministry of Health and Welfare building. All the relevant ministries like Interior, Economy and so on all have staff staffed full time in the CECC building.
That started January the 20th. Before that, it was a MOHW thing. After that, it’s an all of society thing.
Now, in the US, as you know, there has been a tremendous amount of resistance to simple things like wearing masks. Much as that is politically driven. To what extent was there anything resembling that kind of public or editorial resistance to CDC policy on COVID 19?
For a while, because our mass production was less than two million a day around mid January, for a couple of days, the CECC did say that for healthy people, there is no need in well ventilated places such as metros, to wear a medical grade mask. There was a lot of backlash. People didn’t like being told that they don’t have to wear a mask.
That they don’t have to wear a mask? [laughs]
That’s right. There’s a lot of resistance, so we changed our way of saying things about the mask. The premier promised that we will ramp up the production until such a day that we will have sufficient masks for everyone. This is referred to the National Mask Team or 口罩國家隊.
I think by April, we have exceeded 20 million mask per day in production. That’s more than tenfold increase. The rationing system was born out of popular demand for the country to do more to equip people with PPEs. People wouldn’t buy anything like healthy people don’t have to wear masks in metro.
That’s fantastic. Taiwan actually — you probably know this — exported some masks to my home state of Arkansas…
We had a system where people who already have some mask at home can choose to not pick up the rationed masks and then instead dedicate that for international humanitarian aid. To date, there is more than 700,000 citizens which dedicated almost eight million medical mask for the foreign service to send to international people free of charge.
Eight million, did you say?
Yeah, here is the number. It’s in TaiwanCanHelp.us. Half of these citizens choose to publish their name. It’s kind of a award honor thing. Half of the citizens choose to remain anonymous.
(pause)
This is a fascinating story. Thank you. What about issues of surveillance and privacy? I’ve heard from some scholars over at, for example, Academia Sinica, that some lawyers’ groups have raised concerns about potential privacy invasions.
Earlier on, the human rights groups focus on the home quarantine measures.
We use what you would call conditional quarantine system to make sure that when people choose to go to a home quarantine, the sim card of their phone is registered to their telecoms. That the telecoms can send automated SMS messages if they break out of their quarantine, as measured by the signal strength, to the nearby cell phone towers. It’s called the electronic fence.
If they venture out, a alarm SMS is first sent to their phone and then to the local officials, usually health officers. If they are already diagnosed with symptoms, then it’s also sent to the police so that people wouldn’t break out from quarantine and will collect, I think, $100 per day as a stipend. If they break out the quarantine, it’s 1,000 times that.
The human rights watch groups were quite worried about whether it is telecom data, metadata, location data, which are of course private data, personal data, which gets processed by third parties, whether it will leak out into advertisement or whatever and things like that.
The Ministry of Justice did a official response to the legislature which did a public hearing on it in April 9th, 2020. This report contains the Ministry of Justice explanation of why this is proportional necessary. No better alternative measures exist and a criminal penalty that a public servant will suffer if they somehow work outside of the very strict boundary of the CDCA.
When you say public servant will somehow suffer, what is…?
The idea here is that the CDCA says that, for example, quarantining somebody at home using physical means like sending police to guard the door, that is what CDCA authorizes. By extension, something that is less severe than this such as the digital quarantine is proportional because it’s fulfilling the same need.
There’s no conceivable alternative measures that could fulfill that same need. We do have a Personal Data Protection Act that protects the privacy. For example, if the telecoms send it not just to this CECC, but using this as an excuse with the collusion of some public servants to sell it to advertisers say, then that falls outside of the CDCA mandated purpose.
When that happens, then of course the Personal Data Protection Act kicks into place. People who violate that get punished five years or lower, five or less years in jail, and NT$1 million or less, as a fine. Personal Data Protection Act also stipulates that if it’s a public servant doing the same privacy violation, then their penalty, whether criminal or fine, could be increased by up to 50 percent.
I see. Is the only thing that triggers the Personal Data Act, the PDPA the sale or commercial use? Are there other things also that could trigger its provisions?
There’s two things. The first is to advance an illegal interest of oneself or some other third party. The other is to harm the interest of other people. Either there’s an illegal interest that’s fulfilled, or if it’s a harm, either way, this PDPA criminal and fine code enters into effect.
If the information was used for some personal retaliation against an enemy or something like that?
Of course, and there were cases for death, as well, these are punished.
As I mentioned in my questions, I’ve heard that at least in a few cases, people have been fined or penalized or arrested for violations of quarantine or other regulations.
They have to pay a fine if they break out of the quarantine, up to, I don’t know, a million NT dollars or 3 million, something like that. A very heavy fine, and it’s authorized by law.
If they do break out of the quarantine and they are sent to the centralized quarantine places. They no longer have the choice of going back to home quarantine. They have to remain there until 14 days are over.
That’s part of the CDCA. This is the article in the CDCA, pertaining to what you just asked, “Competent authorities may impose quarantine measures on persons entering the country, and that includes home based quarantine, concentration camp…”
(laughter)
“…isolation care or other necessary measures.” This is basically if you do a home based quarantine, then it’s coupled with the necessary measure of the digital fence. If you break out of that, you get into a concentration camps quarantine.
(laughter)
Concentration camps, back during World War II, the American government rounded up Japanese American citizens.
I’m aware of that.
Sent them to places like Arkansas to what are called concentration camps there. Actually, my aunt was a teacher of Japanese American kids at one of those places in Arkansas.
(laughter)
Oh, wow. OK. That was a lot longer than 14 days…
They were sure there longer than 14 days.
(laughter)
It’s more concentrated.
So it’s not putting people in prison…
Are these phrases part of the amended Act after SARS?
Part of the revision after SARS?
Yes, so that whole digital fence depends on the interpretation of whether this is a necessary measure in order to impose home based quarantine.
That’s something that’s entirely within the discretion of the CDC?
Yes, or the MOHW, but yes.
(pause)
With Taiwan having a strong centralized government, you don’t have the same kind of issues about local jurisdictions disagreeing with these measures?
In 2003, I remember very vividly.
The Ho Ping Hospital case was one such case but this time around, no. According to the revamped CDCA, the local health authorities are simply in charge of implementing the measures by the central CECC.
I’ve heard mention of this hospital case back in 2003 that you just adverted to. Could you tell me more about that? I haven’t learnt about that much.
Sure. It was a case of a unannounced sudden barricading of the hospital so that the people there which it were deemed a high risk of SARS carrying couldn’t get out. It was quite traumatic really because there weren’t sufficient PPEs within the hospital. I think at least one staff tried to jump outside. Things like that. It wasn’t pretty.
They brought it all the way to the Constitutional Court, arguing that such a unpre announced sudden barricading is unconstitutional. I think the Constitutional Court said that because there was no way that the legislatures could have foreseen this particular scenario, so it’s not quite unconstitutional.
Now we had the experience of SARS, there is no excuse for the legislature not to put the due process in law so that when SARS 2.0 comes, if we still do something like that, that would be unconstitutional.
I see. Mr. Yeh has been sitting silently all this time but now that we’ve raised the constitutional point, could you please explain…
…decision of 690 of Constitutional Court just as Minister said. They said maybe it is necessary for quarantine or other necessary measure to be taken by the health agency, but there have to be specific rules and principle and special limitation in the periods of all that kind of measures. That’s why there is a revision of that Act after the Constitutional Court ruling.
Oh, so the revision was a direct result of the Constitutional Court ruling?
These rulings happened in 2011. Number 690 of the Constitutional Court.
(pause)
I think that the Constitutional Court said that according to Article 23 of the ROC Constitution, this is then of course to avert an imminent crisis. What didn’t go right the first time was that there wasn’t a fixed time limit to such isolation measures. It was not predictable. It was not pre announced.
This time around, all the home quarantine, concentration camp quarantine or whatever, has a date. There’s no unpredictability.
When someone gets into a home quarantine, they know exactly how many days they are going to be in there and how many extra days they have to self manage their health, for example, not attending rock concerts and things like that. It’s currently 14 plus 7.
The seven, I’m told at least I can still ride my YouBike around, but I can’t teach my students. I don’t know if that’s true or not.
Depending on the ventilation condition. We have quite a few outdoor places which are comparatively fine. If there’s no measures taken in that place to prevent strangers or overcrowding of people to enter into the same place, then the plus seven people are not supposed to go to this place. Rock concerts is one of…
I could teach my students in one of those parks within the NTU campus?
(laughter)
Yes, actually. Probably yes, though I’ll check with NTU first.
(laughter)
Yes, I should check with NTU. As you know, that’s quite a bureaucracy in and of itself.
That’s the case. If you can, because of the design of this place, even if it’s indoor, to maintain social distance at all times and you won’t run into strangers, like you meet with people you already know, then that’s entirely fine.
I see. Just as a matter of personal curiosity, usually I commute between my apartment in Wanlong and to the NTU on a YouBike back and forth every day that it’s not raining. I’m wondering since I carry my cell phone in my pocket, does that mean that our movements…?
Your telecoms know exactly where you are up to a 50 meter radius. That’s true in any place that has 3G connection because that’s how they provide raw materials.
In Taiwan, we already use this location based tracking for earthquake warnings, flood, evacuation warnings and so on. People do understand the SMS and its limitations, and also the fact that sending SMS based on the location definitely doesn’t read your emails or WhatsApp communication. They use a different layer.
(pause)
Interesting. What kinds of disagreements between the central government and the local governments were there in 2003 besides the one…? I’m sorry, what was the name of the hospital?
Ho Ping Hospital.
Ho Ping. OK, right there in…Have there been other kinds of disagreements?
I don’t remember exactly… I was, what? 22?
(laughter)
There was some argument about is it necessary to lock down the hospital? The final decision is it is necessary. It was solved. Maybe that’s the major allegation.
Of course, I don’t exactly remember, but at that time, no one know how to do the most appropriate measure to react to the pandemic. We had no experience or any other experience to prevent that kind of pandemic.
From that time to the COVID 19 is different case. SARS was maybe the first time Taiwan engaged a global pandemic, so nobody knows how to do which we strive is none. There are some arguments such as like lockdown, wear a mask, quarantine. I don’t remember that there was really legal disagreements such as litigation…
The Constitutional Court ruling that we just cited was because of Ho Ping Hospital doctor, Dr. Chou, who checked the WHO guidelines at that time around SARS, and chose to do home quarantine instead of going back to Ho Ping Hospital for the concentrated quarantine.
The Taipei City government didn’t like that and used police to force him back to the Ho Ping Hospital. There is a lot of legal appeals after that, all the way to the Constitutional Courts while his choice of public quarantine, he has been sued for threatening public safety or things like that. This wasn’t the case in the final Constitutional Court.
On the other hand, the Taipei City government also didn’t lose the case about his being forced back to quarantine because it was deemed also proportional because the legislator couldn’t have foreseen this medical situation.
To clarify, this very traumatic case is the design of the CDCA in wider proportion, and the first choice of home quarantine if the residence is preferable to that person and the residence is a safe enough place. All that come out of this prolonged legal case of Dr. Chou.
You have a pretty deep experience with American thought and history, I perceive.
Maybe?
(laughter)
I would value your perceptions on the reasons why so many people in America who believe that being required to wear a mask is somehow a violation of their constitutional rights and this kind of thing, and refusing to wear a mask.
Why that is attitude, which is quite prevalent even today and a threat to public health, so different from the general view of Taiwanese that they didn’t like to be told that they didn’t have to wear masks?
That’s right. Yeah.
Tell me about your thoughts about the reasons for that difference.
In Taiwan, we have long marketed masks as something that protects oneself. That’s not the case from what I gather in many American public communications. Masks serve, of course, three very different purposes.
One is it prevents you to transmit virus to other people. One is it prevents a direct transmission by somebody speaking to you. One is it protects your own face against your own unwashed hands touching the surface. It has three different uses.
Depending on the kind of virus, the three strengths are different. It all depends crucially on the fabric of the mask, and so on.
What we did in the beginning of the CECC, it is a spokes dog of the CECC, a real dog. A Shiba Inu named Zongchai.
[laughs]
Whenever CECC rolls out a measure, their participation officer walks back home, which is just a few blocks away from CECC, takes a new photo of the dog and say, “When you’re indoor, keep three Shiba Inu away. When you’re outdoors, keep two of those dogs away. Otherwise, wear a mask.” It’s very creative and people share that all the time.
Why wear a mask? This says wear a mask asked to protect yourself from your own unwashed hand. This is a message that resonates well in individualist societies because this is provably true.
If you were a mask, it’s less likely you’ll touch your face without remembering to clean your hands using hand sanitizers or soap first. It doesn’t speak to respecting the elderly, protecting them from health workers, showing respect, which probably would fly. [laughs]
Also wouldn’t have to add value that this has…By add value I mean people voluntarily share this message. Even very young children remind each other, “Wear a mask to protect yourself against your own hands.”
That initial formulation of the public health communication really matters, because when we say it’s something of a self protection, of course, when a state doesn’t manufacture sufficient personal protective equipment it’s the state’s fault. [laughs] People will say that the state need to rationing and so on.
If you say where it is to respect the elderly, to respect the others, then it become a social altruism signaling sign. If the state forces you to do that, so the state is probably encroaching individual rights.
That’s very perceptive. Implicit in what you just said is a criticism of the American CDC and public health authorities for not taking action like this to put out this kind of message that might appeal to individualist among the American public.
That’s right. There’s less of this humor over rumor thing that we roll out here.
(laughter)
It’s a bit too serious, I guess?
(pause)
I’m sure that I can count on you to send these excellent slides to me.
Of course.
Thank you very much. This is really great. One other factor that some people have mentioned to me as contributing to the effective Taiwanese response is…Well, a couple. One, of course distrust of China and information coming out of China.
Another is — this is counterintuitive — Taiwan’s exclusion from the WHO. The argument goes that the exclusion forces Taiwan to become self reliant and to take measures as to which other countries might wait for WHO guidance. But self-reliant Taiwan needed to act immediately, and you did. Something along those lines. What do you think of that?
If you look at the timeline, at the 14th of January, WHO was still saying, and I quote, “There’s no clear evidence of human to human transmission.” Compare that with the flight inspection that we already said starts the 1st of January.
Depending on the accounts, we gained at least 10 days or 14 days of time. By denying Taiwan ministerial access to the WHO, it means the world collectively lost 10 days or 14 days.
(pause)
We did have some scientific access, but there’s no ministry access.
WHO has sent their experts to Wuhan now, and they’re engaging in…They say they’re not restricted by the government. Who believes that? [laughs] Do you have a sense of how trustworthy the current WHO’s investigations are likely to be?
(laughter)
I have no idea. We’re not in a ministerial level contact with WHO teams.
Who do you think might be willing to…Few people would be so generous with their time as you are, but I need to talk with people within MOHFW and within the CDC. I’d be very grateful for your suggestions, maybe introduction of whom to contact within those two ministries.
You’re asking about the epidemiologically related issues?
Our main contact is Philip Lo there, the person who saw the PTT post. I don’t know whether he has time for an interview because of this vaccination logistics thing, but at least, Yeh Ning can forward your invitation to Philip Lo.
Thank you.
Maybe Philip can find someone else…
That would do the job. Philip who?
Philip Lo.
(pause)
This has been an enormously helpful interview.
Thank you.
I can scarcely express how grateful I am to you. If you wouldn’t mind following up by both sending me the transcript that you come up with…
Yes. Of course, and the two slides.
…and the various information that you were so kind to put together. It’s just extraordinary.
Thank you.
I feel very privileged that both of you have met with me.
Yeh Ning will follow up with the link to the slides and if you have specific legal questions…
(laughter)
I’m sorry to burden your time so much because…
We have find someone from the Ministry of Justice to…
That’s right.
(laughter)
Yeh Ning, you’re going with me to the weekly BOST meeting? We need to run.
Thank you so much. This has been absolutely great.
Thank you.