Special Feature: Blocking Taiwan From Joining WHO Affects Global Health Security, Officials Say

TAIPEI, Taiwan – Two years after the victory of Taiwan Democratic Progressive Party (DPP) and President Tsai Ing-wen, Taiwan is feeling the effects of the DPP’s position against the “One China principle.” At the World Health Organization, China is allegedly successfully blocking Taiwan from participating in the annual World Health Assembly, and in a number of WHO technical meetings, officials say. Beyond the political dimension of the dissent between China and Taiwan, the situation may hurt the Taiwanese and global health security, Taiwanese officials said.

The Chinese mission in Geneva was contacted about the issue, but did not respond by press time.

In an attempt to shed light on what they feel is an unfair and prejudiced behaviour on the part of the WHO, the Taiwanese government invited an international group of journalists to come and see what Taiwan can offer in terms of cooperation and collaboration in global health security, and why they should be invited to participate in the World Health Assembly (WHA) from 21-26 May, and in the WHO technical meetings.

Taiwan was invited to the annual WHA as an observer from 2009 to 2016. The Taiwanese government during that time was led by Ma Ying-jeou of the Kuomintang party, which was said to have been amiable to China and accepted the concept of the “One China principle.” Following the 2016 elections, Taiwan was not invited to the WHA by WHO Director General Margaret Chan, a former Hong Kong official, in 2017, despite the support of several countries, in particular the United States (IPW, WHO, 22 May 2017).

What Will Dr Tedros Do?

This year, new WHO Director General Tedros Adhanom Ghebreyesus (Dr Tedros) has not yet invited Taiwan. According to sources, a group of like-minded countries supporting Taiwan whose names are undisclosed, is trying to convince the WHO to invite Taiwan, so far without results.

According to a Taiwanese source, it is at the discretion and prerogative of Dr Tedros to invite Taiwan as an observer to the WHA. A WHO spokesperson told Intellectual Property Watch that when the two parties agree, then an invitation can be sent, but did not answer about whose responsibility it is to make the decision.

The WHO spokesperson further explained that, “Until 2016, a cross-Strait understanding was the foundation for a special arrangement for Chinese Taipei to participate as an observer in World Health Assembly.” Cross-Strait refers to the China-Taiwan relationship as a reference to the channel of sea between the mainland and Taiwan, and Chinese Taipei is the official name used by the United Nations to refer to Taiwan.

“Unfortunately, in 2017, there was no such cross-Strait understanding so there was no basis for an invitation for Chinese Taipei last year,” a WHO spokesperson said. “If and when cross-Strait understanding on WHA participation is restored, the WHO Secretariat would look forward to facilitating future participation of Taiwanese observers at the World Health Assembly.”

Background

Taiwan, whose formal name is [corrected] the Republic of China, was constituted by Chiang Kai-shek, who fled mainland China in 1949, and claimed to represent the whole of China at that time. Taiwan held China’s seat on the United Nations Security Council until 1971, at which date the UN switched diplomatic recognition to Beijing, forcing the Republic of China out.

According to sources, China is seeking to avoid Taiwan’s independence and considers Taiwan as Chinese territory. Taiwan is a self-governed democracy and although having strong commercial links with China, is technically independent from the mainland.

According Director General Pei-Yung Hsu, Department of International Organizations, Ministry of Foreign Affairs, Taiwan, the increasing economic power of China gives it greater leverage in international affairs and Beijing is taking a more aggressive approach on international issues using its newfound influence to block Taiwan’s participation on all fronts, and in particular at the WHO.

Taiwan Minister of Health and Welfare, Shih-Chung Chen

He said during a press briefing at the ministry, that Taiwan Minister of Health and Welfare Shih-Chung Chen will lead a delegation to Geneva at the time of the WHA and host bilateral meetings with other countries to discuss public health issues. A series of events will also be organised, including a symposium on health and equality, during the WHA.

Hsu said the only way to overcome the decision being made by the WHO Director General would be if the WHA passed a resolution supporting Taiwan’s participation in the WHA.

The WHO has 194 member states and two associate members (Puerto Rico and Tokelau). Palestine and the Holy See have permanent observer status.

Some 23 million people live in Taiwan, over 36,193 square kilometres (km2). The country’s GDP per capita was US$22,294 in 2015. As comparison, South Korea spans over some 90,000 km2, with a GDP of US$27,105 in 2015, and China, spanning over 9,597,000 km2, has a GDP of US$8,069, according to the World Bank.

Comparable 2015 GDP per capita levels in Europe include Spain with a territory of 510,000 km2 and a GDP of US$ 22,789, Belgium with 30,000 km2 and a GPD of US$40,375, Portugal with 92,000 km2 and a GDP of US$ 19,252, and Switzerland with 41,277 km2, has one of the highest GDP per capita in the world with a GDP over US$82,000.

In 2015, according to the WHO, South Korea had a life expectancy of with 82.3 years, Portugal 81.1, the US 79.3, and China 76.1. Taiwan, according to Taiwanese sources, has a life expectancy of 80.2 years

Taiwan Barred from WHO Technical Meetings

According to Minister Chen, in 2017 Taiwan was not invited to 13 of 18 WHO technical meetings. A document obtained by Intellectual Property Watch shows that Taiwan for example was invited to two WHO information meetings on the composition of influenza virus vaccines for use in 2017-2018, one for the Northern Hemisphere influenza season in March, and one for the Southern Hemisphere influenza season in September.

The document says both meetings were open to the public upon registration but Taiwan had to file an application before an invitation was issued to them, and for the March meeting the invitation was received one day prior to the event. Taiwan is in both the eastern and northern hemispheres.

Among the WHO technical meetings Taiwan was not allowed to attend, according to the document, were: a consultation meeting on the composition of influenza virus vaccines for use in the 2017-2018 Northern Hemisphere influenza season; a meeting on national action plans on antimicrobial resistance in the western Pacific region; the Sixth Ministerial Conference on Environment and Health; the seventh meeting of the vaccine-preventable diseases laboratory network in the western Pacific region; and the WHO global conference on non-communicable diseases: enhancing policy coherence between different spheres of policy making that have a bearing on attaining SDG target 3.4 on NCDs by 2030.

Various reasons were given by the WHO, according to the document, including that: invitations were only issued to WHO members and major sponsors; that only European Union member states were invited; there were some restrictions due to event format; and technical issue. Some of those reasons were unsubstantiated, according to the document.

Not being able to participate in the WHO technical meetings deprives Taiwanese experts from accessing important technical information and recommendations on global public health, and from sharing their own information.

Taiwan would like to participate in the Universal Health Coverage 2030 multistakeholder initiative (UHC2030), but is not allowed to, a ministry spokesperson said. The WHO and the World Bank provide support to the UHC2030.

WHO Involved with Taiwanese Experts, It Says

According to a WHO spokesperson who was asked how many technical meetings Taiwan was allowed to attend, “WHO continues to be actively involved in technical work with Taiwanese health experts and public health officials.”

“While the Secretariat does not track the number of instances in which this has occurred, Taiwanese experts regularly participate in relevant WHO technical meetings,” the spokesperson told Intellectual Property Watch.

“WHO also continues to work with a Taiwanese point of contact for the International Health Regulations (2005). This helps support the IHRs objective of safeguarding people everywhere against the international spread of disease. WHO wishes to reiterate the importance and priority that the Organization attaches to its ongoing technical work with Taiwanese health experts and health authorities,” she said.

According to the document obtained by Intellectual Property Watch, it appears that a number of other actors participate in WHO technical meetings, such as observers, international organisations, experts, and other actors. Taiwan would be invited as an observer country.

From Receiver to Donor, a Model of Universal Health Coverage

Taiwan in recent decades went from being a developing country to a high-income economy in Southeast Asia, along with Hong Kong, Singapore, and South Korea. Once the recipient of international aid, Taiwan is now providing health relief services to other countries, mainly its diplomatic allies. The World Bank lists Taiwan in the high-income economy category, although no specific data seems to be available on the World Bank website. Taiwan is still considered a developing country at the WTO, which dates back to the negotiations to become a WTO member. Taiwan has been a WTO member since January 2002. All countries at the WTO provide self-assessment of their economic development, according to a WTO source.

Taiwan Minister of Health and Welfare Shih-Chung Chen told journalists that Taiwan is proud of its universal health coverage system. Through a single payer national health insurance programme, the country covers over 99 percent of the population, and a national survey showed that some 85 percent of the population is satisfied with the system.

In place since 1995, the national health insurance programme, run by the Taiwanese government, costs 6.2 percent of the gross domestic product (in 2014) (compared to France – 10.1 percent; Germany – 9.4, and the US – 13.1). Chen said less than 1 percent of the total cost of the system is spent on administration.

Dr Tedros, visiting Beijing in August 2017 and speaking at the Dialogue Series in South-South Collaboration On Health Development and Innovation, said, “China is leading by example on universal health coverage with over 95 percent of its population now having basic health insurance.”

Chen also underlined the good results in communicable and non-communicable diseases. As an example, he said Taiwan successfully contained an outbreak of Dengue fever epidemic two years ago, with only 10 cases of Dengue fever now documented in the country.

Consequences of Exclusion, National, Global Health Security

Taiwan’s successful efforts at achieving universal health coverage can be used to help other countries, Chen said, adding that not participating in the WHA is hurting Taiwan but also means a lot to the international community since it loses a capable ally.

During his campaign, Dr Tedros called for equality of healthcare and said that no one should be left behind, but if Taiwan is not invited to the WHA, doubts would arise about some of the values for which the WHO stands, Chen said. Leaving Taiwan behind means leaving out the 23 million people living there, he said. No country experience should be left out in terms of universal health coverage, Chen said.

Under its One China principle, China seeks to represent all of what it considers to be China’s territory at the UN, including at the WHA. But China does not have access to Taiwan’s data, and has no influence on Taiwan’s health system, so should not be representing Taiwan, according to Taiwanese officials.

Diseases know no borders, and if any country or region is excluded from participating for political reasons, it creates a gap in the global epidemic prevention network, and represents a global threat, Chen said. It is important to share experiences and get information about diseases and it is WHO’s responsibility to further the dissemination of information with all parties involved, he added.

Global health could benefit from Taiwan’s experience and expertise, he said, citing as an example Taiwan’s development of a rapid test for insect-borne diseases, which it could share with other countries.

Taiwan is “more than willing” to send out health personnel to help contain severe outbreaks in the international community, “so we can do our part” as member of the global community, he said.

The matter of inviting Taiwan to the WHA is a matter of global health security, Hsu said. Taiwan has a key position in East Asia and shares an environment with similarities in communicable disease outbreaks with neighbouring countries. Taiwan is also visited by international travellers, which makes Taiwan vulnerable to cross-border transmission and cross-transmission of communicable disease pathogens.

Taiwanese peoples’ right to health is being denied by the WHO, he said.

Dr Tedros keeps calling for WHO members to adopt universal health coverage, but “there is no place for Taiwan in the WHA” despite the fact that Taiwan is a pioneer, and was the first country in Asia to establish a national health insurance programme, Hsu said.

The WHO did not answer questions on how Taiwan can participate in WHO programmes such as the Pandemic Influenza Preparedness (PIP) Framework, the Global Influenza Surveillance and Response System (GISRS), and the Global Antimicrobial Resistance Surveillance System (GLASS).

According to Taiwanese sources, Taiwan does participate in the global influenza surveillance system by providing samples to Japan and to the US. Taiwan shares those samples with the WHO Collaborating Centers in those countries.

Taiwan also submits its influenza virus data of both human and animal cases to the Global Initiative on Sharing All Influenza Data (GISAID), according to a source. Since 2009, Taiwan has submitted thousands of influenza virus data, according to GISAID database EpiFlu. The database is used by most GISRS laboratories, according to several sources, including some WHO documents.

UN – WHA resolutions

According to Hsu, at the WHO Executive Board in January, six of Taiwan’s diplomatic allies, as well as Japan and the United States, asked that Taiwan be allowed to participate in the WHA. China, under the One China principle, used its right of reply, citing United Nations General Assembly Resolution 27.58 (Restoration of the lawful rights of the People’s Republic of China in the United Nations) from 1971; and WHA resolution 25.1 [corrected] from 1972, he said, adding that Dr Tedros uses resolution 27.58 to “justify his decision to exclude Taiwan.”

However, resolutions 27.58 and 25.21 do not provide legal authorisation for China to represent Taiwan and its 23 million people in the UN system, including the WHO, nor do they mention the One China principle, according to Hsu.

Support for Taiwan, China Reacts

Taiwan is seeking assistance from its allies and other friendly countries in urging WHO to invite Taiwan to the WHA and counter the pressure China is exerting on the director general and the WHO secretariat, Hsu said.

This year is the first WHA for the new director general (who took office in July 2017) and if Taiwan is not invited or does not make a strong enough case for its participation, the new DG could use this as a reason to refuse next year and beyond, in what could become the new norm, he explained.

Diplomatic allies of Taiwan include: (In East Asia and Pacific) Kiribati, Marshall Islands, Nauru, Palau, Solomon Islands, and Tuvalu; (in Africa) Burkina Faso, and Swaziland; (in Europe) the Holy See; (in Latin America and the Caribbean) Belize, the Dominican Republic, Guatemala, Honduras, El Salvador, Haiti, Nicaragua, Paraguay, Saint Kitts and Nevis, Saint Lucia, and Saint Vincent and the Grenadines.

According to Hsu, a group of like-minded countries proposed to meet with Tedros, and the WHO secretariat allegedly answered that they could meet with Amb. Michèle Boccoz, WHO Assistant Director General for External Relations, which they did with the promise from Boccoz that she would convey their request to Dr Tedros. So far no response has been given.

A new “Friends of Taiwan” group was established in Geneva last year with diplomatic allies, he said, with two co-chairs, one from Paraguay, and the other one from Swaziland.

The United States has been a long-time supporter of Taiwan. On 16 March, the US enacted the Taiwan Travel Act. The Act includes a paragraph declaring that “peace and stability in the Western Pacific area are in the political, security, and economic interests of the United States and are matters of international concern.”

It also states that “The United States considers any effort to determine the future of Taiwan by other than peaceful means, including by boycotts or embargoes, a threat to the peace and security of the Western Pacific area and of grave concern to the United States.”

It adds that “Taiwan has succeeded in a momentous transition to democracy beginning in the late 1980s and has been a beacon of democracy in Asia, and Taiwan’s democratic achievements inspire many countries and people in the region.”

The Act encourages visits between officials from the United States and Taiwan at all levels.

According to an article in Xinhuanet, the Chinese official press agency, China opposed the US signing the Taiwan Travel Act. Some clauses of the act, “though not legally binding, severely violate the one-China principle and the three joint communiques between China and the United States,” a Chinese Foreign Ministry spokesperson said in the article.

“We urge the US side to correct its mistake, stop pursuing any official ties with Taiwan or improving its current relations with Taiwan in any substantive way, and handle Taiwan-related issues properly and cautiously so as to avoid causing severe damage to China-U.S. relations and cross-Strait peace and stability,” the spokesperson said.

In December, the US National Defense Authorization Act for Fiscal Year 2018 was passed into law. Section 12.59 is about strengthening the defence partnership between the United States and Taiwan, and aims at improving Taiwan’s self-defence capability.

In sum, Taiwan is seeking to bring attention to what they consider a profoundly unfair situation and is working on all fronts to influence the WHO director general’s decision to invite Taiwan to the next Health Assembly. So far, signs have not been positive, according to Taiwanese sources, but the next few weeks will tell if their efforts turn out.

 

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