From the WHO Constitution preamble:
"The State Parties to this Constitution declare, in conformity with the Charter of the United Nations, that the following principles are basic to the happiness, harmonious relations and security of all peoples:[1]
...
The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, political belief, economic or social condition.
The health of all peoples is fundamental to the attainment of peace and security and is dependent upon the fullest co-operation of individuals and States.
...
The extension to all peoples of the benefits of medical, psychological and related knowledge is essential to the fullest attainment of health."
As a body dedicated to improving the lives of all people, the World Health Organization can rightly boast of a proud history of medical and humanitarian successes, from the eradication of polio to ongoing efforts to combat malaria and improve public health and hygiene in the developing world. But its handling of recent issues like Taiwan’s representations in the WHO and accreditation of Taiwanese journalists have tainted the WHO’s image as an organization above politics and beyond reproach. In this diary entry I’ll discuss the obstacles Taiwan faces in attaining representation in the WHO, and focus in on how it is adjusting its strategy to overcome these obstacles. I’ll discuss the WHO’s ban on Taiwanese journalists in a second part.
First, a little history: Taiwan (officially “the Republic of China” or ROC) left the United Nations in 1972 following the passage of UN Resolution 2758, which addressed the question of representation of China. At that time, both Chiang Kai-shek’s Nationalist-led ROC vied with Mao Zedong’s communist government in the People’s Republic of China (PRC) over the right to represent all of “China”. After the PRC won that right in the UN, Chiang angrily withdrew Taiwan from the world body and with it its membership in all associated agencies. Years passed and Taiwan eventually made the successful transition from dictatorship to representative democracy. No longer interested in claiming sovereignty over what is now known as the PRC, Taiwan began to re-apply for full membership in the UN and in the WHO as an observer under its official name in deference to the status quo in the Taiwan Strait.
This year will mark Taiwan’s 11th attempt at participation in the WHO, a quest made all the more difficult by China’s ongoing campaign to smother the democratic island nation’s international presence. In the past, one of Taiwan’s dwindling number of diplomatic allies would move to include discussion of the issue of Taiwan’s participation as an observer under its official name, the Republic of China, on the agenda of the World Health Assembly, which sets WHO policy for the coming year in an annual confab in Geneva. And every year the WHA would vote down the measure in deference to the PRC, which despite a myriad of facts to the contrary claims to be taking good care of the health needs of Taiwan’s 23 million people.
Despite its advanced public health system of its own (The Economist once ranked Taiwan’s health system second best in the world, behind only Sweden’s) Taiwan has been wary of contagious disease since the 2003 SARS outbreak that saw the virus carried into Taiwan by an infected traveler and subsequently spread to 345 others. Despite being “officially” blocked out of the WHO, Taiwan for a time was able to “unofficially” send health experts to WHO-sanctioned technical-level meetings under the vague rubric of “meaningful participation”. But this arrangement ended in 2005 when Beijing signed a secret memorandum of understanding with the WHO Secretariat giving it the right to first refusal in any matter regarding Taiwan. Ethical considerations of such a back-room deal aside, the 2005 MOU has unwittingly created a major blind-spot in the WHO’s long-term strategy to establish a disease surveillance system in Asia.
Now unable to send its experts to these working meetings, Taiwan is left with no way to access or share data on contagious diseases like H5N1 in a timely manner. Since the secret MOU was signed, Taiwan’s attendance at those meetings has declined to nearly zero. From June to December 2006, four out of six applications were turned down flat, while the new and unwieldy approval process for each application to attend takes over four weeks to complete (by way of Beijing) before invitations are sent out to Taiwanese health experts, often too late for the experts to secure visas. This is not simply a small matter of bureaucratic red tape, given Taiwan’s role as one of the world’s major transshipment centers for cargo and international travel, and over 1,183 flights each week between Taiwan and the six Asian nations already affected by H5N1. In 2005 alone a total of 181,755 flights to and from Taiwan carried 25 million passengers. If we look back on how quickly SARS spread across the Pacific in 2003, we’ll see that any effective strategy to detect and contain a virus like H5N1depends on open and instantaneous lines of communication among affected states.
Looking to sidestep the pitfalls now found in its traditional push for unofficial participation through observer status (a form of participation currently enjoyed by entities like the Inter-parliamentary Union, the Knights of Malta and the Palestinian Authority), the Taipei government has changed its strategy this year and has applied for full membership under the island’s unofficial name, “Taiwan”. Taiwan has adopted this strategy for two reasons, the first being a general sense of frustration among Taiwanese voters with past failures of pursuing observer status under the “meaningful participation” banner. A recent poll by the private organization Taiwan Thinktank in Taipei showed 94.9 percent of people interviewed believe that Taiwan should be a member of the WHO, and after a decade of failure the democratic government there now seems open to trying something new.
The second reason for the new strategy stems from the breakdown of the old system of “unofficial participation” since the 2005 MOU that essentially handed an important chunk of the WHO Director-General’s authority over to an individual member state. In other words, Taiwan has both domestically and diplomatically reached a dead end in its willingness to defer to the WHO’s better judgment over what constitutes “meaningful” participation, and now seeks a fresh start with the bid for full membership.