Audrey Tang, virtual savior. Photographer: Sam Yeh/AFP/Getty Images
This is a tale of two very different islands, two very different people, and two very different responses to a single global disaster.
The current predicament of the two islands reminds us that great pandemics do not end, like great wars, with a single, glorious day of victory — or a single, ignominious day of defeat. Pandemics seem to end, only to begin again with sudden outbreaks. They necessitate a prolonged game of Whac-A-Mole against the infectious disease in question.
In the past few weeks, this has been playing out in both Taiwan, officially known as the Republic of China but claimed by Beijing as a province, and Britain, officially known as the United Kingdom of Great Britain and Northern Ireland, formerly a member of the European Union. In Taiwan’s capital of Taipei, there has been a sudden surge in cases of Covid-19. The same has been happening in the northern English town of Bolton as well as in London. For politicians and public health officials in both countries, these are anxious days.
Pandemics have fewer heroes than wars. For me, Audrey Tang — Taiwan’s minister without portfolio since 2016 — is one of the true heroes of the Covid crisis, because her pioneering use of information technology was one of the key reasons Taiwan did so very well at preventing the spread of the SARS-CoV-2 virus last year.
By contrast, Dominic Cummings — Prime Minister Boris Johnson’s key adviser from July 2019 until his abrupt and acrimonious departure from Downing Street last November — has frequently been represented as a villain in the British media.
If Tang is now one of the world’s coolest brainiacs, Cummings is more than ever the “career psychopath,” in the damning phrase of former Prime Minister David Cameron. Yet Cummings may in reality have been a hero, albeit an unlovable one. Tang and Cummings are the odd couple of the pandemic. To analyze the roles they played is to give a human face to the radically different experiences of the two islands.
Of course, Taiwan and Britain are scarcely peas in a pod. The U.K. is nearly seven times larger in area, fives time larger in terms of gross domestic product, and three times larger in population. The U.K.’s per capita GDP in 2019 was two thirds higher than Taiwan’s. Culturally, too, they are profoundly different, even if their inhabitants share a love of tea.
Yet it is hard to believe that simple differences in size, wealth or culture can explain the astoundingly divergent paths the two islands have taken since the outbreak of the Covid-19 pandemic.
Taiwan has thus far recorded fewer than 4,000 Covid cases and 15 deaths. The U.K. has had 4.4 million cases and close to 128,000 deaths. Yet the virus responsible for these deaths was first discovered in Wuhan, China, less than 600 miles away from Taiwan’s capital. London is nearly 10 times further away from Wuhan than Taipei.
We may think of a pandemic as a “natural” disaster, in the sense that most experts still think the SARS-CoV-2 virus evolved naturally rather than being engineered (even if the allegation that it was accidentally leaked from a laboratory in Wuhan seems more plausible now than it did a year ago). But only human action can explain the vast discrepancy between the Taiwan and U.K. experiences of this disaster.
The Little Island That Could
Percent change in GDP
Source: International Monetary Fund
Another striking difference has been economic. Last year, the U.K. suffered one of the most severe contractions in its history, with GDP shrinking by close to 10%. Taiwan’s economy grew by 3.1%. The U.K.’s net public debt has jumped from 75% of GDP in 2019 to a projected 97% this year. Taiwan’s was 30.8% of GDP in 2019. It is likely to be 30.6% this year.
In short, even allowing for this month’s outbreak, Taiwan has been all but unscathed by Covid-19. In terms of both public health and economic performance, the U.K. has been hammered.
Bigger Island, Deeper Hole
General government net debt as percent of GDP
Source: International Monetary Fund
The great question of the plague 2020-21 is why so many Western countries — in the Americas as well as in Europe — did so much worse than a few East Asian countries at handling a novel coronavirus. There are a variety of simplistic answers to this question. One is that populist presidents and prime ministers messed up the Western pandemic response. Another is that Oriental collectivism was superior to Occidental individualism in the face of a new pathogen. Neither of these explanations is remotely sufficient, if they have any value at all.
True, Johnson doubtless made errors of judgment last year, though not as many as U.S. President Donald Trump or Brazilian President Jair Bolsonaro. But plenty of Western countries with centrist or technocratic leaders have done even worse than Britain, the U.S. and Brazil in terms of excess mortality.
Italian excess mortality exceeds British, to name just one of the European Union countries that has fared worse. Bolivia, Ecuador and Peru have all suffered higher excess mortality than the U.S. and Brazil. None of the leaders of these countries last year fit the populist paradigm. The idea that Britain would have fared much better with a different prime minister — whether Labour Party leader Jeremy Corbyn or Johnson’s predecessor, Theresa May — seems, on reflection, implausible.
As for the U.S., many Democrats would dearly love to believe that if Joe Biden had somehow been sworn in a year earlier — or if Hillary Clinton had won in 2016 — the country would have handled the pandemic much better. Leadership would doubtless have been far less erratic, but most of the really important mistakes by the U.S. public health bureaucracy would almost certainly still have been made, regardless of who was in the Oval Office.
The Centers for Disease Control would still have bungled testing. The government and the big tech companies would still have failed to enable digital contact tracing. The national and state authorities would still have failed to enforce quarantines. Democratic-controlled state governments, including those of New York and California, would still have failed to keep the infected away from the vulnerable, especially in elderly care homes.
If the swine flu that struck the U.S. in 2009 had been as deadly as Covid, how well would President Barack Obama’s administration have done? In the words of Ron Klain, then as now Biden’s chief of staff, “We did every possible thing wrong. And … 60 million Americans got H1N1 in that period of time. And it’s just purely a fortuity that this isn’t one of the great mass casualty events in American history. Had nothing to do with us doing anything right. Just had to do with luck.”
As for Western individualism, this is a cliche that starts to look absurd when you consider how people actually behaved last year. It was in the U.K., not Taiwan, that the population was placed under virtual house arrest by lockdown orders. To live in London was to be subjected to restrictions that at times recalled the Blitz during World War II.
To live in Taipei, by contrast, was to experience some of the lightest-touch restrictions on personal freedom of any developed country. The Blavatnik School of Government at Oxford created a “stringency index” to capture the scale of restrictions imposed by governments during the past year and a half. The average score for Taiwan has been 25, where 0 would be no restrictions and 100 would be total lockdown. The average stringency score for the U.K. to date is 65.
The key to what happened around the world in the plague year was how far governments and particularly public health agencies followed the epidemiologist Larry Brilliant’s maxim that, in the face of a new, contagious and deadly pathogen, the key things are “early detection and early action.” Taiwan — and other places in Asia and the Pacific — did both. The U.K. — and nearly every Western country — did neither.
In the East, it is true, they had learned the lessons of two previous coronavirus outbreaks, SARS (2003) and MERS (2012). But there was more to Taiwan’s success than that. For example, a website was used to ration face masks when they were scarce. Had there been an outbreak in Taipei, officials had a plan to subdivide the city into separated neighborhoods. Schools remained open, albeit with elaborate and strictly enforced precautions.
In the U.K., by contrast, there was late detection and late action. The responsibility for this double trouble surely lay with the government’s public health experts: Chris Whitty, the government’s chief medical adviser; John Edmunds of the London School of Hygiene and Tropical Medicine, and my near-namesake Neil Ferguson of Imperial College London, the key epidemiological experts on the New and Emerging Respiratory Virus Threats Advisory Group (Nervtag); and the Scientific Advisory Group for Emergencies (SAGE), which reported directly to the prime minister and whichever group of ministers he chose to assemble in the Cabinet Office Briefing Rooms (Cobra).
These experts would appear to have dithered: As late as Feb. 21, Nervtag recommended keeping the threat level at “moderate.” On March 9, four days after the U.K.’s first death, SAGE rejected the idea of a lockdown, as it would only lead to a “large second epidemic wave once the measures were lifted.” At this point, the experts were apparently still thinking of the coronavirus as if it were a new strain of influenza. On March 13, the government’s chief scientific adviser, Sir Patrick Vallance, told the BBC that the aim was to reach herd immunity, but in a managed way, so as to avoid overwhelming the National Health Service.
Then the experts panicked. On March 16, Ferguson published the most influential paper of his career, predicting that without both “mitigation” (social distancing) and “suppression” (lockdowns) — maintained until there was a vaccine — there would be “approximately 510,000 deaths in GB and 2.2 million in the U.S.” With public apprehension mounting, herd immunity was ditched in favor of an unprecedented shutdown of British social and economic life.
Events veered between farce and tragedy in the subsequent days. Ferguson himself developed Covid‑19 symptoms, and both Johnson and Health Minister Matt Hancock tested positive on March 27. Johnson was hospitalized on April 5 and moved to intensive care the next day, though he later rose from his bed, with characteristically immodest timing, on Easter Sunday.
Ferguson was caught violating the distancing rules he himself had recommended in a romantic tryst; Cummings was spotted infringing the lockdown on a cross-country trip. Private-sector computer programmers then got hold of Ferguson’s model and tore it apart. These dramas, manna from heaven for journalists, were no doubt diverting to a people confined to their homes. But they distracted attention from the true nature of the British government’s failure.
Since the breakdown of their relationship, Johnson has found himself in a war of words with Cummings over a bewildering number of issues. Who leaked what to whom? Who paid for the redecoration of the prime minister’s private quarters in Downing Street? But the substantive issue is Cummings’s bitter critique of the government’s Covid response, which he unleashed as a lengthy and typically rebarbative Twitter thread last week.
Full disclosure: I have known Dom for years. We are both Oxford-trained historians, and we were both proteges of the great Norman Stone. But we were on opposing sides of the Brexit debate and it was only after he led the “Leave” campaign to victory that I began to pay attention to his writings on the problems of modern British government.
Earlier, bruising experiences as an adviser to Michael Gove when Gove was education minister had convinced Cummings that Whitehall — i.e., the British civil service — was a profoundly dysfunctional bureaucracy in desperate need of disruption. His latest broadside restates the case and argues that this — and not Johnson’s wayward leadership — was the principal reason for Britain’s poor Covid performance.
“The covid plan,” Cummings notes, “was supposed to be ‘world class’ but turned out to be part disaster, part non-existent.” This is fair comment. On paper, the U.K. and the U.S. ranked as the “most prepared” countries in the world in terms of global health security in a 2019 report. But not only did the U.K. government have, in Cummings’s description, a “joke borders policy” — almost no restrictions were placed on arriving travelers at Heathrow for most of last year — it also persisted with a failing plan long after greater public scrutiny would have forced a change of course.
“One of the most fundamental & unarguable lessons of Feb-March,” writes Cummings, “is that secrecy contributed greatly to the catastrophe. Openness to scrutiny wd have exposed Gvt errors weeks earlier than happened.” The problem is partly Whitehall’s “cultural hostility to openness” and partly its tendency to rate and promote civil servants on criteria other than actual results.
The one thing that the U.K. got very right — its very rapid and efficient vaccination procurement and rollout — was a success precisely because it was taken away from the career civil servants and given to a task force led by a venture capitalist, Kate Bingham.
Love him or hate him — and the haters overwhelmingly outnumber the lovers — Cummings’s critique of “the silent entropy of Whitehall” rings true. He is rightly skeptical of the proposed public inquiry into the U.K.’s handling of Covid because it “will at no point ask: how does the deep institutional wiring of the parties/civil service program destructive behaviour by putting the wrong ppl in wrong jobs with destructive incentives? It will all be about relatively surface errors. … The point of the inquiry is … to delay scrutiny, preserve the broken system & distract public from real Qs, leaving the parties & senior civil service essentially untouched.”
Cummings was one of those who urged the imposition of lockdown measures in mid-March on the ground that the alternative was a level of contagion that would overwhelm the National Health Service. But his preference would have been much earlier action that could have been much better targeted. As he rightly says, the “evidence [is] clear that fast hard effective action best policy for economy AND for reducing deaths/suffering.” Significantly, the “best example” he cites is Taiwan, which “shows that if you REALLY get your act together not only is econ largely unscathed but life is ~normal. But SW1 (Remain/Leave, Rt/Left) = totally hostile to learning from East Asia.” (SW1 is the London postcode for Whitehall as well as Westminster, where Parliament is located.)
Does Taiwan deserve to be held up as a role model for the Western world as whole? The events of recent weeks have proved that even the wizards of Taipei can be caught out by this wily, shapeshifting virus.
The proximate cause of the recent outbreak was lax enforcement of quarantine rules for air crews. Whereas passengers arriving in Taiwan must quarantine for 14 days — a rule that is strictly enforced — pilots and cabin crew are required to quarantine for just five. This was too short a time. A handful of infected pilots spread the virus to family members as well as staff at the airport quarantine hotel, which had failed to separate regular guests from guests undergoing quarantine.
By May 11, community spread was identified at a local chapter of Lions Club International. One gregarious member appears to have been a super-spreader, carrying the virus to a hostess tea shop in Taipei’s Wanhua district and a games hall.
Taiwan’s current wave of Covid infections is still tiny by global standards — a seven-day moving average of 321 cases as of Friday. However, this is by far the largest outbreak of the pandemic so far in Taiwan. The previous peak was only 20 cases per day, in late March 2020.
The near-vertical trajectory of the case curve over the past week indicates that the outbreak is being driven by community spread, not a few super-spreader events. So far, there have been just three deaths in the current wave, but more may follow, as a significant proportion of those infected are over 50.
Earlier this week, Health Minister Chen Shih-chung issued a Level Three alert (the second-highest level) shutting all gyms, bars, clubs and cinemas in Taipei. Gatherings indoors are now limited to five people, outdoor gatherings to 10, and foreigners have been banned from entering without a residency permit until June 18. Fines for not wearing a mask have been increased. School classes have been suspended in Taipei and New Taipei City since May 17. It remains to be seen if these measures will suffice to contain the outbreak.
“We are victims of our own success,” Audrey Tang acknowledged when I spoke with her on Monday night. For example, many people postponed getting vaccinated in the belief that a cheaper homegrown vaccine would be available by July and there was no risk in delaying. A tiny share of the population (0.1%) had received one vaccine dose on the eve of the outbreak.
However, the biggest sin of omission has been the failure to build adequate testing capacity. New Taipei City ran out of testing capacity after just 200 tests on May 17, and the government has accumulated a backlog of unprocessed tests (estimated to be around 30,000).
Yet I am willing to bet that, rather as South Korea did last year, Taiwan is going to be able to bring this outbreak under control within a relatively short period, because it has the key tools to do so.
Thanks to the work of Tang and her colleagues, Taiwan already has a contact-tracing app, officially called a “social-distancing app.” It informs all of a person’s close contacts from the last 14 days in the event of positive Covid test. It did not need to be used in 2020, but now it is being rolled out rapidly, with several million people already registered.
Taiwan’s open-source network for geek-to-government collaboration, G0V (pronounced “gov-zero”) has also created a website to track the outbreak, aggregating data from hospitals and other sources. And citizens have been using Google maps to create “risk maps” in order to help people better social distance.
The most appealing feature of Tang’s approach is her emphasis on using software and smartphones to empower ordinary people, rather than the government. This has its roots in the 2014 student protests known as the Sunflower Movement, which she supported. She was invited to become a minister after successfully creating a media and digital competence program for use in Taiwan’s schools
In an interview last year, Tang spoke of the way Taiwan uses open-source software tools to tap the “collective intelligence” of civil society through “participatory mechanism design.” Examples, such as Join and vTaiwan, are built on top of Pol.is, a software program described by one of its co-founders as a “tool for turning crowds into coherence” — or “rough consensus.” This, Tang argues, is the exact opposite of the AI-enabled Panopticon under construction on the Chinese mainland. “The more they develop,” she says, “the more drawbacks that we see from our lens of human rights and democracy. We’re like, ‘OK, we should totally not go there.’”
Just as her approach to the pandemic was not only to help citizens be better informed but also to help better inform the government, so her approach to misinformation and disinformation was not censorship but satire. “We fought off the pandemic with no lockdown,” she said last year, “and the infodemic with no takedown.” The Tang approach was to deploy “humor against rumor” — funny memes against fake news.
I have learned a lot from the odd couple since I began thinking and writing about networks and contagions back in 2016. It’s not something I would previously have anticipated. There was a time when I regarded Dom Cummings as an incorrigible maverick, who had embraced Brexit mainly to show off his skills as a political wrecking ball. If you had told me that a transgender software nerd from Taiwan would one day be the heroine of one of my books, I’d have scoffed.
But such unusual people — brainiacs or psychos as they may seem to more conventional minds — turn out to be exactly the people you want to have around when disaster strikes. The fact that one is a government minister while the other is a jobless pariah neatly sums up this tale of two islands.
This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.