key: cord-0902609-j3n1qtw0 authors: Yen, Wei‐Ting; Liu, Li‐Yin title: Crafting Compliance Regime under COVID‐19: Using Taiwan's Quarantine Policy as a Case Study date: 2021-08-29 journal: Glob Policy DOI: 10.1111/1758-5899.12967 sha: 7ecc865366b9f4b035e8b7f6b85498922c22d793 doc_id: 902609 cord_uid: j3n1qtw0 One year after the World Health Organization declared COVID‐19 a global pandemic, governments around the world adopt similar practices in containing the COVID‐19 spread. Nevertheless, variation exists in the level of policy compliance, which directly contribute to policy success/failure across countries. As the pandemic continues, pandemic fatigue also decreases the public’s willingness to comply. Increasing policy compliance during the remainder of pandemic has become a transnational concern. Using Taiwan’s quarantine policy as an example, this article illustrates three aspects to craft an effective compliance regime to fight public health crises like COVID‐19: (1) a comprehensive policy mix to reduce heterogeneous compliance barriers that impact different social groups; (2) constant and various policy communication with heterogeneous target audiences; and (3) leveraging and integrating street‐level bureaucrats in the policy implementation stages. Taiwan’s case provides several policy lessons for other countries: compliance regime is not driven by top‐down enforcement but through the integration of policy design and implementation that remove all barriers for compliance. Taiwan’s street level bureaucrats are the glue of the compliance regime. This article bears policy implications for policy makers around the world when aiming for increasing policy compliance. Coping with low compliance with public measure has been one of the biggest challenges for governments to cope with COVID-19 (Bargain and Aminjonov, 2020) . One year after the World Health Organization declared COVID-19 as a global pandemic, governments around the world are still learning from each other and adopting similar practices proven successful in containing the coronavirus spread (Sebhatu et al., 2020) . Social behavior measures (e.g., social distancing, quarantine, mask-wearing, etc.) are common regulations across nations. Yet, this global-level policy diffusion does not yield similar results, and the variation of public compliance directly contributes to the discrepancy observed in policy outcomes across countries (Clark et al., 2020) . For example, across Europe and the US, COVID-19 cases and deaths reach record-high numbers, while countries, like Singapore and Taiwan, are able to ensure the effectiveness of COVID-19 related policy due to public's willingness to comply. Policy compliance is indispensable to achieving the intended COVID-19 policy goals. Regulations designed to prevent the coronavirus spread are useless unless the majority of citizens comply (Weaver, 2014) . Ensuring public compliance is already a challenging task under normal circumstances (Howlett, 2018; Weaver, 2015) ; such difficulties are exacerbated under emergency contexts like COVID-19 (Atalay and Meloy, 2020) . In particular, growing pandemic fatigue has decreased individual risk perception against the virus and lowered trust levels in government authority, which further hinders willingness to comply with policies. Despite the fact vaccines are in sight, vaccination alone will not be sufficient to end the pandemic immediately (Reuters, 2020) . Vaccine uptake compliance will also need to be high enough to achieve herd immunity. Effective policy design and implementation have become more important than ever to overcome pandemic fatigue and to improve policy compliance. With that in mind, this article uses Taiwan's quarantine policy as an example to illustrate what the compliance regime looks like in theory and in practice. While most countries are still struggling with rising cases and public noncompliance, Taiwan blocked COVID-19 out of its local communities for more than eight months, with the total cases only around 1,000. Due to its proximity to China, Taiwan started coping with the COVID-19 crisis three months earlier than most Western countries. Instead of showing pandemic fatigue, Taiwan citizens relentlessly show high levels of policy compliance (Huang, 2020a (Huang, , 2020b . How does Taiwan maintain the public's willingness to comply with COVID-19 regulations, which are often burdensome and inconvenient for people's lives? The answer is not in the culture to which many people attribute, but in sophisticated compliance-friendly policy designs. Specifically, this article argues that Taiwan was able to create a policy compliance regime that integrates policy design and implementation together to increase public's capacity and willingness to comply. This effective compliance regime includes; (1) a comprehensive policy mix to reduce heterogeneous compliance barriers that impact different social groups; (2) constant and various policy communications with heterogeneous target audiences; and (3) leveraging and integrating street-level bureaucrats in the policy implementation stages. Through intertwined and expansive policy designs and implementation plans, in Taiwan, policy compliance does not merely rely on top-down enforcement. Instead, compliance is achieved through increasing target population's compliance capacity, which is the ability that citizens possess to achieve compliance by themselves, and reduce their compliance barrier. In this article, we discuss each aspect at the theoretical level first, followed by concrete examples from Taiwan's quarantine policy in practice. We end the article with some policy suggestions and implications for policy makers of other countries. The 14-day quarantine policy is one of the main policies (along with the mask policy) buttressing Taiwan's COVID-19 success (Yen, 2020) . The island was free of local transmission for more than 200 days until late-December. Detecting imported cases immediately during quarantine is vital in keeping the local communities intact. There are four major components/steps constituting Taiwan's quarantine policy: a health declaration form for contact tracing and future quarantine tracking purpose before border entry, a qualified quarantine location minimizing transmission risk (especially for the high-risk population), safe modes of transportation to the quarantine location, and a multi-level policy implementation network to ensure compliance during the quarantine. Figure 1 visually presents each of the quarantine components and the process of each component. All elements are essential to a successful quarantine policy. For example, without safe transportation modes to the quarantine location, there is still a transmission risk despite one being isolated for the next 14 days. Another crucial aspect for policy success is that citizens understand and comply with the quarantine regulations every step along the way, following instructions in filling out the form, staying away from public transportation, choosing rule-abiding quarantine locations, and staying indoors for 14 days, etc. Ensuring compliant behavior requires a comprehensive framework that accounts for multiple barriers to compliance (Weaver, 2014) . The early literature on policy compliance and recent studies on public health have heavily emphasized the importance of motivation, such as associating monetary rewards with conformity and sanction with deviance (Alford, 2009 ). The emphasis on motivation is based on the utilitarianism assumption that human behavior is the product of rational calculation (Howlett, 2018) . However, compliance is more complicated than utilitarian assumptions (McLeod et al., 2015) . Complication can come from unclear policy communication with target policy population (Kim and Oh, 2015; Weaver, 2014) , the lack of resources or ability to comply, skepticism toward governmental authority and policy effects (Coombs, 1980; Weaver, 2015) , the lack of public trust in governments' actions (Bargain and Aminjonov, 2020; Blair et al., 2017; Pak et al., 2021) , inadequate administrative resources to monitor target population (Liu et al. 2015; Weaver, 2014 Weaver, , 2015 , and insufficient incentive/sanction (Weaver, 2014) . All the above-mentioned factors can create barriers to compliance. In order words, using incentives to ensure compliance is necessary but may not be sufficient. We argue that, to ensure compliance, policy makers, and public administrators should work together to consider the heterogeneous needs of the target population. Policy makers should 'think comprehensively about the barriers keeping targeted populations from compliance and design feasible policy tools to target these barriers' (Weaver, 2015, pp. 806) . What is required as the first step to establish the compliance regime is a well-design policy tool mixa comprehensive plan throughout the policy process to achieve a high level of compliance and accounts for all compliance barriers (Howlett, 2018) . In addition, under an emergency context, the public often loses the sense of control and is against regulations that further remove their autonomy. Thus, the top-down coercive approach is not as effective for increasing compliance during an emergency context as in normal time. A better strategy is to recognize human nature and behavior tendency and design policy compatible with human behavioral tendency. For example, people in general like to make their own decisions. If individuals are provided with a sense of control, they are more likely to comply with regulations (Atalay and Meloy, 2020). Therefore, developing plans for flexible accommodation for the target population can better ensure compliance under emergency context, but the choice should not be overloaded to create confusion (Gopalan and Pirog, 2017) . Multiple policy tools can be identified in Taiwan's quarantine policy that aim to facilitate compliance for different social groups. First, there are multiple barriers hindering incoming passengers to comply with strict quarantine regulation. During the quarantine period, incoming travelers using public transportation is completely prohibited. They not only have to find the financially affordable quarantine sites but also actively seek for safe transportation modes to the quarantine sites. To remove barriers for incoming travelers, the government has been relying on multiple policy tools. Specifically, it collaborates with the private sector to provide affordable quarantine taxi service and quarantine hotels. The government directly provides financial subsidies to hotel/taxi businesses to increase their supply. All participating private sector partners are, in turn, required to follow the safety protocols. Moreover, the government provides quarantine subsidies (around $35 dollars per day for 14 days) as well as fixed transportation fare benefits (fares again vary depending on locations and mode of transportation) to incoming travelers to alleviate their financial costs going through quarantine. For example, the normal taxi fare from the airport to Taipei costs around $55 dollars. The taxi fare is fixed at $35 dollars for the incoming travelers, so people are not deterred by the taxi meter's uncertain costs. The government would pay for the remaining fare (about $20 dollars) and further subsidize 30% of the total fare to the taxi driver. In addition, for people who cannot work during the quarantine period, the government provides $40 compensation per day. These policy tools in the quarantine policy mix remove the barriers to comply for many and reduce the possibility for rule violators. With regard to the sense of control, putting people back in the driver's seat and having a sense of control despite being under the quarantine requirement can be clearly observed in Taiwan's quarantine location options and transportation choices to the quarantine location. Unless a Taiwanese citizen has COVID-19 symptoms or is currently having COVID-19, in which case one has to do centralized quarantine, each citizen has the option of home/residence quarantine or hotel quarantine. Hotel quarantine is needed if one's home does not meet the residence quarantine requirement. The government also offers multiple, yet finite, transportation options to the quarantine locations. To Health Declaration Froml •The first encounter incoming travelers would have with Taiwan's quarantine policy is the health declaration form. One has to fill out the health declaration form in the airport before departure. Upon arrival in Taiwan, one will receive a link on the cell phone to complete the process. The step is used to verify that one has a local cell number that can be used for location tracking during the quarantine period. The system will automatically generate the quarantine notice. The quarantine notice will activate the local level policy implementaion network. achieve a public transportation-free system for incoming travelers to avoid any COVID-19 spread risks, travelers have the choice of driving themselves, using a government-contracted taxi/bus/rental car, or being picked up by relatives/ friends. The government keeps a record of people's choices in case any contact tracing is needed. In this way, while citizens are required to go through quarantine, they remain having some level of control in terms of where and how to do it. The ability to choose and the sense of agency would prompt citizens to hold their ends of the bargain and comply more easily. To comply with a policy, one has to first understand the policy. Hence, policy takers' knowledge of policy being implemented is positively associated with their compliant behavior (Kim and Oh, 2015) . Providing timely information and increasing information salience can further promote desired behaviors and increase public compliance with public policy (Gopalan and Pirog, 2017) . Moreover, information needs to be consistent, coherent, and well-communicated through governmental agencies. Mixed messages from difference sources usually lead to noncompliance behaviors (Wang et al., 2021) . Thus, adequate communication quality and quantity is the second vital step to create a compliance regime. Moreover, citizen's trust in governments' action is a crucial determinant to increase public compliance of public policy (Braithwaite and Makkai, 1994; Perry and Lindell, 1991) . The importance of public trust is further elevated during emergency (Choi and Wehde, 2020; Murphy et al. 2018; Terpsta, 2011) and public health crisis (Bargain and Aminjonov, 2020; Blair et al., 2017; Pak et al., 2021) . Scholars have demonstrated that public compliance to COVID-19 related policy are higher in those regimes and countries with higher level of trust in governments' decisions (Bargain and Aminjonov, 2020; Pak et al. 2021) . Communicating credible information, especially during a pandemic, can boost public trust toward government, which in turn increase their willingness to comply with public policy (Li, 2020) . In addition, Adequate communication also can boost the public's sense of responsibility in containing COVID-19. Specifically, studies have found that the sense of civic duty increases compliance with COVID-19 social behavior measures (Barrios et al., 2020; Durante et al., 2020) . Therefore, if government can effectively communicate with target population, the willingness to comply can be elevated. In Taiwan, the government communicates with citizens about what the expected behaviors are through multiple channels and in multiple languages even before passengers arrive in Taiwan. In regard to the quarantine policy, clear expectations are laid out in the 'Health Declaration of Quarantine System for Entry' form, the first stop incoming travelers encounter in the quarantine policy. All incoming travelers are required to complete the form before entry. In the form, standard information (e.g., ID number, passport number, flight information, quarantine locations, and transportation) is collected for future contact tracing purposes, if needed. At the end of the form is a clear color-coded (blue and red) warning section in which the government lists all the rules and regulations by which one needs to abide during the quarantine period. The legal basis for quarantine-related regulations is the Communicable Disease Control Act. The blue-coded points show the regulations one has to follow, such as mask-wearing, the standard procedure to follow if symptoms emerge, etc. Following the blue-coded to-do list is another section of red-coded warning section about the fines one would receive should one violate the quarantine policy. All the fines are bolded with inverted color. From the policy tool perspective, the government aims to not only educate and increase people's knowledge and capacity in terms of the expected behaviors but also deter any attempts to break the quarantine regulation by highlighting the fine. The color scheme sends a very strong signal that people should not violate the rules, and any violation will lead to a penalty. The color-coded warning section is presented both in Mandarin and English so all incoming travelers understand the expectations and rules before border entry. During the quarantine period, village level officers would also contact and remind you of the regulations. The government sends daily text messages to check one's health conditions and to remind people of the quarantine regulations. Moreover, the government constantly runs 1-minute expert announcement-type advertisements on TV (in various languages) and makes memes on the internet to target different social groups for more effective communication. This type of frequent communication also boosts the public trust in Taiwan, which increases the public's willingness to participate in COVID-19 crisis management and comply with public policy (Huang, 2020a (Huang, , 2020b . In addition to communicating technical information, the daily press conference hosted by the Central Epidemic Command Center (CECC) often delivers the message that it is everyone's responsibility to contain COVID-19. The CECC director also frequently express his appreciation for the public to 'coproduce' in fighting COVID-19 and attribute Taiwan's success to the public. These messages in turn boost the policy takers' sense of responsibility to not break the rule. In other words, the effective communication takes social behavior measure beyond the level of compliance. Effective communication resort to hortatory discourses to strengthen citizens' voluntary compliance. Due to the changing nature of the COVID-19 crisis, the Taiwanese government recalibrates their responses and focus depending on the international environment. To make sure they, the people (citizens and foreigners alike) can have the most accurate and update information, the CECC also set up a 24/7 hotline at 1922 to ensure open and prompt communication channels between citizens and the government. The centralized hotline further helps with nudging compliance on the ground as citizens are clear understanding about what is expected. Step 3: policy implementation through the street-level bureaucrat A comprehensive policy design and communication are not sufficient to remove all barriers to compliance. Adequate administrative resources to monitor the target population's behavior is essential to ensure compliance behavior (Liu et al., 2015) . Moreover, during implementation, public administrators also are responsible for removing or reducing burdens for policy takers to make sure that compliance is not too onerous for citizens (Coombs, 1980) . Thus, public administrators, especially street-level bureaucrats who directly interact with policy takers, are another indispensable element of the compliance regime. Taiwan's quarantine policy relies heavily on the local quarantine safety web composed mainly of the district-level office, village clerks (i.e., civil servants at the lowest level), and local police stations. The district/village level bureaucrats serve as focal points bridging the quarantined and the central government. They are the extension of the central government at the village level. The local level bureaucrats have dual functions. On the one hand, they provide support for the central government to check and monitor the quarantined. On the other hand, they provide all kinds of administrative support and resources to make sure compliance is possible and achievable for the quarantined. On monitoring, when incoming passengers arrive in Taiwan, their quarantine site information is immediately sent to corresponding local government offices. Then, each incoming passenger will be assigned to a responsible street-level bureaucrat (village clerk). All incoming travelers need to have local cell numbers during the quarantine period. Those without local numbers have to rent a local cell phone at the airport. The number is used to generate the quarantine notice and mobilize the designated local level network based on the provided quarantine locations. Once the person arrives at the quarantine location, s/he would receive a phone call from the district-level officer (in most cases, the village clerks) to confirm basic information, phone number, and address. The local monitoring network is then activated. The government, in collaboration with the telecom companies, keeps track of the phone's location through triangulating cell phone towers. There is also an extensive horizontal collaboration between different government agencies and an effective vertical communication channel between the central and the local level. An alarm would be activated if the signal disappears, is lost, or moves, etc. Once the alarm is triggered, the local police station would be notified to check on the person and report back to CECC. The local police network weaves a comprehensive web assisting monitoring on the ground. Daily compliance is not only achieved through monitoring. Street-level bureaucrats also play an important role in solving potential issues one may encounter during the quarantine. Those obstacles might be idiosyncratic. For example, the street-level bureaucrats would provide mental check-ins especially with people living in quarantine hotels who may feel more confined compared to home quarantine. In some apartment complexes for home quarantine locations, doormen would block food delivery to the quarantined person due to unknown fear. In this situation, villager clerks would serve as facilitators to minimize the obstacles for the quarantined. Use Taipei's trash policy as another example. In Taipei, trash has to be handled in a specific way (i.e., in designated bags at a specific time of the day). To make sure that people under quarantine abide by the quarantine rule as well as the city's trash policy, the district-level office offers a care package including trash bags with clear instructions about how to handle trash at the beginning of the quarantine period. When there is a demand to handle trash, the village clerk would coordinate with the health bureau to collect the trash so people do not risk violating any quarantine requirement. In short, the high-level policy design may run into numerous problems and enforcement issues during the implementation stage. District/village-level clerks and local police officers, who are more embedded in the local communities, provides the dense compliance support needed at the lowest administrative level. Quarantine is a regulation that often seems very invasive and restrictive to civil liberties. In a democratic society, this type of strict regulations often evokes public dissatisfaction or complaints against governments. In many cases, people view quarantine as a huge infringement to their individual freedom and right to work. Many other people do not have the financial freedom for not working for two consecutive weeks. As such, even though quarantine might be a very effective strategy to contain the coronavirus spread, citizens may not have the willingness to do so. Even if citizens have the willingness to undergo quarantine, they may fall short in their ability for full compliance due to outside conditions, such as work requirements or the need for income making. Put differently, even with the best-intentioned policy design, it does not guarantee desirable policy outcomes. How to craft the design to enhance and nudge higher policy compliance is key. Taiwan's compliance regime on quarantine policy provides several lessons for countries that are utilizing social behavior measures to contain the spread of COVID-19. A successful quarantine policy consists of multiple layers of protection steps and involves collaborations among bureaucratic organizations of all levels and private businesses. Based on the literature of policy design, to achieve higher policy compliance, the policy mix must include various components aimed to reduce heterogeneous compliance barriers facing different social groups. Moreover, policy knowledge enhances policy compliance. Various and clear policy communications are essential to reach heterogeneous target audiences to increase citizens' capacity and compliance. Adequate communication also boosts policy taker's sense of civic duty. Last, policy design and implementation need to merge to ensure all barriers to compliance can be removed. Both policy makers and administrators need to work on the plan together to create a so-called compliance regime. The street level bureaucrats in Taiwan plays a vital role in filling every gap in quarantine policy design, such as clarifying quarantine rules, removing personal level barriers of compliance, and provide sense of care to target populations. A successfully compliance regime, therefore, is not only a top-down strict enforcement. Instead, it turns an inconvenient regulation into bearable process and a process for the public to coproduce in disease prevention. During the policy implementation stage, leveraging and integrating street-level bureaucrats into the process is essential to the last mile of policy compliance. 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Yen's research interest lies in the political economy issues and social policy development in the developing world, with the region of focus on Asia.Li-Yin Liu is an Assistant Professor of Political Science at the University of Dayton. Liu's research focuses on public policy in general, with special attention to environmental policy, environmental governance, and cultural theory.