"The global health imperatives for granting Taiwan WHO observership" Ministry of Foreign Affairs, Republic of China
March 19, 2003
According to its Constitution, the goal of the World Health Organization (WHO) is "the attainment by all peoples of the highest possible level of health." Unfortunately, considerations of a purely political nature have kept Taiwan from participating in this professional medical organization with adverse consequences for global health.
This position paper seeks to explain how Taiwan's exclusion from the WHO, the world's most important international health body: (1) impinges on the Organization's ability, in this era of globalization, to ensure the health of the peoples of its member states; (2) harms the medical welfare of the 23 million people of Taiwan, who are excluded from the Organization; and (3) limits Taiwan's ability to share its considerable resources in the health field with other peoples in need.
Globalization has magnified the effects of Taiwan's exclusion from the WHO, turning it from a domestic health problem into a pressing issue of global concern. Therefore, at this juncture, it is imperative that the WHO and its member states allow the "health entity" of Taiwan to participate in the activities of the Organization as an observer.
Taiwan's WHO Observership and World Health in the Era of Globalization
Globalization has vastly increased cross-border flows of goods, services, peoples, and ideas; consequently, it has also facilitated the spread of infectious diseases across the world. As political boundaries pose fewer barriers to interaction, the health, economic, criminal, and environmental issues that arise require the collective effort of all actors and entities.
Indeed, in the field of health security, the WHO Executive Board determined at its 107th session in January 2001 that:
The globalization of infectious diseases is such that an outbreak in one country is potentially a threat to the whole world. The need for international cooperation on epidemic alert and response is greater today than ever before due to increased population movements, growth in international trade and biological products, changes in methods of food processing, social and environmental changes.
The WHO must remain informed of the entire world health situation and be able to obtain and disseminate relevant data, technology, and other resources needed to prevent, monitor, and respond to "epidemic, endemic, and other diseases" as stated in its Constitution. Any weakness in this global health network presents a danger for the entire global community. Taiwan's exclusion from the WHO creates such a weakness, as the following information indicates:
- Taiwan is a major transport hub linking Northeast and Southeast Asia. In the year 2002, Taiwan registered 7.85 million outbound travellers and 2.19 million inbound visitors. At the end of 2002, 303,684 migrant workers from Thailand, Indonesia, the Philippines, Malaysia, and Vietnam were living and working in Taiwan. This combination of factors places Taiwan at the crossroads of any infectious disease outbreak in the region.
- Taiwan is a bustling international trading center with US$243 billion in foreign trade in 2002. As a result, there are innumerable ways for diseases to enter or leave Taiwan. For instance, global trade-related health risks from the flows of animals and animal products (US$2 billion), vegetable products (US$2.3 billion), animal/vegetable fats (US$160 million), and prepared foodstuffs (US$2.5 billion) entering and leaving Taiwan can endanger both its citizens and its trading partners.
- Given the increasing economic and people-to-people ties between Taiwan and the People's Republic of China (PRC), Taiwan is on the frontline of any cross-border epidemic originating in China or its neighbors. In February of 2003, the "bird flu," officially known as the A(H5N1) influenza, re-emerged in Hong Kong and Mainland China, underscoring the danger that Taiwan's exclusion from the WHO creates. The WHO quickly offered its support to the authorities in Hong Kong and China through the Global Influenza Surveillance network, yet if such an outbreak originated in or spread to Taiwan, the WHO's response would be impeded.
Taiwan must be allowed to participate in the WHO because the health authorities of Taiwan are the only ones possessing the information and the data permitting the WHO and the world to be informed ofand respond effectively toan outbreak of any epidemic on the island that could threaten global health. It is clearly not reasonable for the WHO and its members to take the risk of not being informed of an outbreak of a lethal disease in Taiwan.
II. Taiwan's WHO Observership and the Health of Taiwan's 23 Million Citizens
The WHO has gained international respect and support due to its mission to protect the health of all peoples around the world. It is inconceivable that the Organization is not involved in the flow of information, technology, and key medical supplies necessary to deal with any serious health issues occurring among Taiwan's 23 million citizensa population larger than those of seventy-five per cent of WHO Member States.
In particular, Taiwan is excluded from the WHO's "Global Outbreak Alert and Response Network" (GOARN). Through this mechanism, the WHO transmits reports of current outbreaks to, and receives important health data from, public health professionals and global surveillance partners worldwide. This network permits the member states of the WHO to take appropriate protective measures. Taiwan, however, is left out of this mechanism. The negative implications of Taiwan's separation from the global health community on the healthcare of its citizens are outlined below.
(1) Lack of information sharing
A clear example of the dangers that Taiwan's exclusion from the WHO creates is the enterovirus epidemic which struck Taiwan in 1998. Having spread to Taiwan from Malaysia, this virus: - infected over 1.8 million Taiwanese people
- hospitalized 400
- caused 80 deaths
- resulted in over US$1 billion in economic losses
Taiwan needs free and unimpeded access to the collective knowledge of the international health community in order to prevent, minimize, and eradicate such diseases in a timely fashion. The international community should not turn its back on such a need. Indeed, granting Taiwan observer status in the WHO would allow Taiwan to participate in the Global Outbreak Alert and Response Network noted above, and thereby receive significantly improved protection for the country's 23 million people.
(2) Impairing crisis response ability
In addition to the enterovirus case, there have been other medical crises when much-needed WHO aid was unavailable or too late in coming. For instance, on September 21, 1999, central Taiwan suffered a devastating earthquake, measuring 7.6 on the Richter scale, which killed more than 2,400, injured 10,000, and left 100,000 homeless. Since the WHO was forced to spend crucial time trying to work out ways to provide "unofficial" and "indirect" assistance, the organization's ability to help Taiwan to respond to this unprecedented humanitarian crisis was severely obstructed. This failure stands in sharp contrast to the WHO's swift response in sending help to Hong Kong after its avian flu epidemic in 1997.
(3) Negative consequences for domestic health care
There is more to health coverage than simply tracking and responding to epidemics and other medical crises. In order to craft effective health care policies at the government level and in order for Taiwan's scientists to learn about the latest scientific advances in modern medicine, Taiwan must be able to participate barrier-free in the WHO and WHO-related activities. Such events allow for the free flow of information and ideas, research, and exchanges whichas the next section will showbenefit the health of all parties concerned.?
III. The WHO's Role in Facilitating the Sharing of Taiwan's Health Resources
Currently, one sixth of the world's population has achieved a high standard of living, yet another one sixth is still struggling for daily survival. Being a member of the global community that is concerned with about a disparity, Taiwan is willing to share its own resources and experience in the field of health care with those parts of the world that are in need of such assistance. Taiwan's exclusion from the WHO, however, significantly hinders its ability to effectively and fully share its resources. This further underscores how granting Taiwan observer status in the WHO would not only greatly benefit its citizens, but also enable Taiwan to contribute to the global community more effectively.
(1) Taiwan's experience, accomplishments, and resources
Every year, more than one million children die unnecessarily worldwide. One quarter of the world's children have no basic immunizations against polio, diphtheria, whooping cough, tetanus, measles, and tuberculosis, older vaccines against hepatitis B, haemophilus influenzae B (Hib), and yellow fever.
In this context, Taiwan has special experiences, resources, and achievements that it can share with the world. In 2000, the Economist Intelligence Unit of the U.K. rated the medical practice in Taiwan as being second among all the developed countries and newly industrialized countries, next only to Sweden. Indeed, Taiwan has made some unique medical achievements:
- Taiwan has established a universal health insurance system, the first in Asia, with a 97% coverage and 70% approval rate.
- In 2001, there were 18,265 health care institutions in Taiwan and one physician for every 649 people, one dentist for every 2,570, one nurse for every 280, and 30 hospital beds for every 10,000. Taiwan has established a respectable network of disease treatment, reporting, and medical research facilities.
- Taiwan enjoys one of the highest levels of life expectancy in Asia. At present, life expectancy at birth is 73 years for males and 78 for females. Taiwan's maternal and infant mortality rates are only 6.9 per 10,000 and 6.0 per 1,000, respectivelycomparable to those of Western countries.
- Taiwan has eradicated infectious diseases such as plague, smallpox, rabies, and malaria. No new poliomyelitis cases have been reported since 1983. Taiwan was the first country in the world to provide children nationwide with free hepatitis B vaccinations and, in the early 80s, established effective monitoring and control systems to respond to the HIV/AIDS epidemic.
- Taiwan's active pharmaceutical industry is exploring new drugs for cancers and viral diseases as well as chronic diseases such as cardiovascular illness.
(2) Taiwan's willingness to respond to the health needs of others
Despite being excluded from the WHO, Taiwan has sought to share its resources with people in need around the world:
- From 1995 to 2002, Taiwan donated to the international community over US$120 million in medical and/or humanitarian relief to 78 countries spanning five continents.
- In response to the 911 terrorist attacks in New York in 2001 and the resulting worldwide anti-terrorist campaign, Taiwan has also contributed in significant ways. Both the Taiwan Tzu Chi Charity Foundation and the Taiwan Red Cross, for instance, swiftly assisted the victims and their families. Together with overseas donations and government contributions, Taiwan provided over US$20 million to the Afghanistan humanitarian relief effortincluding medical goods, freight trucks, wool blankets, and other supplies.
- Four Taiwanese medical teams are currently stationed in Burkina Faso, Malawi, Chad, and São Tomé and Principe, where they assist the respective local governments. Over the last two years, Taiwan has also held international forums, workshops, and public health training seminars attended by health professionals from 27 countries.
- Taiwan also works cooperatively with many disease prevention programs. For instance, Taiwan is involved in Care France's AIDS prevention program in Chad, donates yellow fever vaccines to Senegal, and provides condoms and medicine to Burkina Faso and Swaziland to promote anti-AIDS campaigns. Taiwan also funds a polio eradication program through Rotary International, and is involved in malaria eradication and hospital improvement programs in São Tomé.
- Taiwan has contributed thousands of wheelchairs to hospitals and charity organizations in Africa and Latin America. Recently, Taiwan also donated US $1 million to the Global Fund to Fight AIDS, Tuberculosis, and Malaria.
(3) Taiwan's inability to share its health resources with other nations
- Despite Taiwan's efforts and goodwill, its ability to constructively share its resources is hampered by the island's exclusion from the WHO. The cases below underscore situations where both the international community and Taiwan could have benefited substantially from Taiwan's participation in the WHO.
- The US Population Crisis Committee has twice rated Taiwan's family planning program the best of all programs among the developing countries efforts. However, Taiwan is shut out of the World Fertility Survey, the Demographic Health Survey, and other related medical data-gathering and analysis efforts that are under the auspices of the WHO.
- Taiwan is also excluded from the United Nations Single Convention on Drugsresulting in a significant gap in the global tracking of the flow and quantity of controlled drugs.
- Taiwan implemented a multi-stage program for separating the prescription and distribution of drugs in 1997. This policy was praised as a "textbook example" by the Asian Wall Street Journal. Unfortunately, Taiwan's forced exclusion from the WHO continues to hinder Taiwan's ability to share its related experiences from this successful multi-stage program.
- Despite having set up a comprehensive surveillance and reporting system for adverse drug reactions, Taiwan is excluded from contributing its experiences to the WHO Collaborating Center for International Drug Monitoring.
In sum, a lack of WHO participation results in Taiwan's inability to effectively share its health-related experiences, manpower, and other resources with the international community. Subjecting the Taiwanese people to a form of "health apartheid" is not only morally wrong but also inconsistent with the ideals and commitment that are the very foundation of the entire WHO system. This de facto health care segregation seriously weakens the international disease prevention network.
IV. Granting WHO Observer Status to Taiwan: A Global Health Imperative
The WHO, as demonstrated above, cannot fulfill its goal of protecting the health of all peoples unless it allows Taiwan's 23 million citizens to have a voice in the Organization. This fact has been recognized through the public support of Taiwan's participation in the WHO in recent years from major professional medical organizations such as:
- World Medical Association
- International Pediatric Association
- British Medical Association
- Lancet, Britain's premier medical journal
- Standing Committee of European Doctors
- World Congress of Traditional Medicine
- Philippine Medical Association.
In addition, many parliaments and congresses throughout the world have also passed official resolutions calling for Taiwan's meaningful and constructive participation in the WHO as an observer. They include:
- United States Congress
- European Parliament
- Central American Parliament
- Belgium Chamber of Representatives
- Liberian National Legislature
- Dominican Republic House of Representatives
- Uruguayan Chamber of Representatives
- Philippine House of Representatives
V. Conclusion
Based on the fundamental principles of the WHO, it is abundantly clear that the world community cannot afford to allow political differences to endanger the health of all peoples. Taiwan is willing to put aside the politically contentious issue of WHO membership and is instead seeking only to become an observer in this important global health institution in the capacity of a health entity. Moreover, as a willing participant in the world health community, we are determined to fulfill our obligations to the peoples of the world. Therefore, the world community must include Taiwan in the global health network for the greater well-being of all.
The recent outbreak of the lethal Severe Acute Respiratory Syndrome (SARS) in East and Southeast Asia is another disturbing example of the danger inherent in Taiwan's isolation from the WHO. Thus far, six suspected cases of SARS have been identified in Taiwan. The health authorities in Taiwan duly reported the situation to the WHO on March 14, but the WHO waited until March 18 before it posted any information about Taiwan on its website.
The WHO, moreover, has unfortunately declined to provide any assistance to Taiwan in fighting the disease, despite repeated requests. Given the mysterious nature of this disease, the unwillingness of the WHO to share information with Taiwan could prove very costly to all. The WHO's refusal to help Taiwan, ironically enough, stems entirely from concerns about offending the nation that bears the most responsibility for this grave crisis, the PRC.
The world has recently learned that this outbreak began last November in China's Guangdong province, yet the PRC has only just begun to inform the WHO about what occurred. Even now, the PRC adamantly refuses to provide biological samples from patients, test results, and essential details about treatment methods and the extent of the outbreak, while also suppressing information about the outbreak and the subsequent WHO warning in the official media. The PRC's silence over the last few months and its continued intransigence today have already cost lives, and could in the longrun prove to be catastrophic.
