Taiwan urges to be invited to participate in the WHO

to protect the health and well-being of its 23 million

citizens, and to further contribute to global health

cooperation. 

To understand why that is necessary,  please read

through the articles provided s follows:

1.Taiwan: Contributing to Global Healthcare

2. INVITING TAIWAN TO BE AN OBSERVER OF THE WORLD 

   HEALTH ASSEMBLY (WHA)

3. THE GLOBAL HEALTH IMPERATIVES FOR GRANTING

   TAIWAN WHA OBSERVERSHIP

4. TAIWAN’S REBUTTAL TO PRC ARGUMENTS AGAINST

   its PARTICIPATion IN THE WHO

1. Taiwan: Contributing to Global Healthcare

Overview

In the early 1950's, Taiwan's GNP per capita income was less than US$200.  Throughout the fifties and into the early sixties, Taiwan was the beneficiary of numerous aid programs sponsored by international organizations such as the WHO and UNICEF, which led to the successful eradication of malaria and smallpox, the establishment of TB prevention programs, and the advancement of healthcare for mothers and children.  In the years that followed, more than 70 medical experts representing Taiwan participated in WHO events, sharing their expertise and ¡§the Taiwan experience¡¨ with the world health community.  By the 1970's, per capita income had increased five-fold and Taiwan had become an active participant in the international arena.

Unfortunately, 1972 marked the beginning of Taiwan's ¡§international isolation,¡¨ with China (the PRC) henceforth proclaiming itself as Taiwan's representative in the WHO, although China has not provided any assistance in that nonconsensual capacity and is known for blockading all official access by and to Taiwan.  In the thirty years since, Taiwan has remained expressly and completely barred from formally participating in any WHO-sponsored events and related venues.   Notably, over that same period of time, the tiny island-nation has emerged as a major player in the global economy and history has witnessed its transformation into Asia's pillar of democracy.

 By the year 2000, Taiwan had become the world's 14^th largest trading nation, with foreign exchange reserves that ranked third highest in the world.  Since 1995, Taiwan has contributed hundreds of millions of U.S. Dollars in aid toward international aid programs and humanitarian causes.  Yet, despite growing international support for its bid to participate in the World Health Organization, Taiwan remains uniquely excluded from this global health forum

Ironically, the recent multi-continent outbreak of Severe Acute Respiratory Syndrome (SARS), despite challenging Taiwanese health officials to combat an unknown¡Xand potentially epidemic¡Xdisease without assistance from the WHO, has bolstered momentum in the ongoing international campaign to support Taiwan's inclusion in the World Health Organization.

 International Assistance

Taiwan continually strives to reciprocate the international assistance it received in the past by extending assistance and aid to other countries, though doing so requires overcoming a myriad of diplomatic obstacles.  Taiwan is dedicated in its commitment to contribute toward humanitarian causes and has launched numerous healthcare cooperation projects overseas.  More often than not these actions, whether engaged through governmental agencies or Taiwanese NGO's, are voluntary and undertaken without diplomatic credit.  Government statistics and findings from an informal survey carried by the Department of Health show that since 1995, government entities and private organizations have disbursed over US$180 million through aid programs in 95 countries and areas, of which only 26 have official diplomatic ties with Taiwan.  Distribution of assistance comprises three main categories: Technical Support and Training, Medical Aid, and Humanitarian Assistance (see Chart). 

* Data from January 1995 to June 2002

Technical Support & Training

Programs include joint research studies, training of healthcare personnel, sponsoring international conferences and symposiums, transfer of technology.

         Short-Term Training Programs

Sponsorship of foreign medical personnel to receive short-term training in Taiwan for up to one year (140 participants representing 21 countries)

        TB Control & Family Planning Programs

Education and training for foreign healthcare providers, organized by the Department of Health in collaboration with the National Tuberculosis Association and the ROC Planned Parenthood Association (270 participants)

        Anti-Smoking Programs

The John Tung Foundation has spent approximately US$720,000 on educational programs to warn against health hazards related to smoking and tobacco use.

        Asia-Pacific Regional Training Program

Training for health education professionals and craniofacial physicians in many locales throughout the region, in collaboration with The Catholic Sanipax Socio-Medical Service and Education Foundation and the Noordhoff Craniofacial Foundation (169 participants).

Medical Aid

Programs include monetary contributions in addition to donations of drugs and medical supplies and equipment, as well as the construction of hospital facilities.

        US$150 million in donations made by 57 organizations to 88 countries over the last eight years, including 92 ambulances and 9,000 wheel chairs donated by the Eden Social Welfare Foundation and the ROC Buddha's Light International Association 

        US$9.2 million contributed by Taiwanese Rotarians since 1995 to the Global Campaign to Eradicate Polio program spearheaded by Rotary International and the World Health Organization

        3,500 wheelchairs donated to landmine victims in ten countries in the Asia-Pacific region, Central Asia, Africa and Europe, by The Eden Social Welfare Foundation, member of the International Campaign to Ban Landmines (ICBL)

        US$210,000 donated by the ROC District Kiwanis International since 1995, in coordination with UNICEF's Global Elimination of Iodine Deficiency Project, a program that helps over eight million children around the world.

        US$20 million in contributions toward crisis relief efforts for Afghanistan, responding to worldwide anti-terrorism campaigns

        One million US dollars presented to the UN Global Fund to Fight AIDS, Tuberculosis, & Malaria, in 2002 

Humanitarian Assistance

Medical teams are dispatched overseas for the purpose of health education, to facilitate communicable disease control, and administer medical care services, or, to provide drugs and medical supplies for timely disaster relief.

        Since 1998, the Noordhoff Craniofacial Foundation has provided corrective surgery to 297 cleft palate patients in the Asia-Pacific region.  The four hospitals of the Foundation regularly send medical teams to several countries in the region to provide medical services.  One physician is stationed in Northern Thailand, and two health workers are now in Kazakhstan to provide health and welfare services.

        The Buddhist Compassion Relief Tzu-Chi Foundation of Taiwan has sponsored healthcare and medical care visitations to 44 countries across six continents.

        The Taiwan Root Medical Peace Corps has spent more than US$890,000 providing relief and medical care in remote areas of less developed countries.

Taiwan believes in the universal right to healthcare. 

Taiwan actively demonstrates its commitment to global health. 

Taiwan embraces the principles and ideals of the

          World Health Organization.

Hunger, poverty and disease heed no geographical, political, or ethnic boundaries.  Likewise, healthcare and humanitarian assistance should be universal and unconditional.  As Taiwan strives to take its rightful place in institutions of global collaboration such as the WHO and the UN, we look to our friends around the world for your collective support and advocacy.    (Ministry of Health)

HEALTH FOR ALL  LET TAIWAN JOIN THE WHO

Other Contributing Organizations: Taiwan National Tuberculosis Association; The Planned Parenthood Association of the ROC; The Red Cross Society of the Republic of China (Taiwan); The ROC National Kidney Foundation; National Association for the Blind; The National Zen Association; The Chinese Fund for Children and Families/Taiwan; The Chinese Relief Association; Taipei Municipal Chung Hsiao Hospital; City of Taipei Import and Export Association; Taiwan Pharmaceutical Manufacturers Association; Yungshun Pharmaceutical Company; Ming Daw Culture Center; Fo Guang Shan Nan Hua Temple; The Health, Welfare and Environment Foundation; Puli Christian Hospital; Caritas Taiwan ROC; Kaohsiung Chang Gung Memorial Hospital; Caleb Pharmaceuticals Inc.; The Buddhist Compassion Relief Tzu-Chi Foundation; World Vision Taiwan, and others.

2. INVITING TAIWAN TO BE AN OBSERVER OF THE WORLD HEALTH ASSEMBLY (WHA)

In order to protect the health and well-being of its 23 million citizens, and to further contribute to global health cooperation, Taiwan urges to be invited to participate in the WHO.  The reasons for such a request are as follows:

◎   The WHO Constitution states that “The objective of the World Health Organization shall be the attainment by all peoples of the highest possible level of health”.  This shows that the WHO is obligated to reach all peoples throughout the world, regardless of state boundaries.

◎   The WHO Constitution permits a wide variety of entities—including non-member states, international organizations, national organizations, and non-governmental organizations—to participate in the activities of the WHO.  Five entities, for instance, have acquired the status of observer of the World Health Assembly (WHA) and are routinely invited to its assemblies.

◎    Both the WHO Constitution and the International Covenant on Economic, Social, and Cultural Rights (ICESCR) declare that health is an essential element of human rights, and that no signatory shall impede on the health rights of others.

◎    Taiwan seeks to be invited to participate in the work of the WHA simply as an observer, instead of as a full member, in order to allow the work of the WHO to proceed without creating political frictions, and to demonstrate Taiwan’s willingness to put aside political controversies for the common good of global health.  This request is fundamentally based on professional health grounds and has nothing to do with the political issues of sovereignty and statehood.

◎    Taiwan currently participates as a full member in organizations such as the World Trade Organization (WTO), Asia-Pacific Economic Cooperation (APEC), and several international fishing fora, in which the People’s Republic of China (PRC) is also a member.  Taiwan has become an asset to all these institutions via flexible interpretation of the terms of membership.

◎    Closing the gap between the WHO and Taiwan is an urgent global health imperative.  The health administration of Taiwan is the only competent body possessing and managing all the information on any outbreak in Taiwan of epidemics that could potentially threaten global health.  Excluding Taiwan from the WHO’s Global Outbreak Alert and Response Network (GOARN), for example, is dangerous and self-defeating from a professional perspective.

◎    Since its establishment in 1949, the PRC has never exercised jurisdiction or control over Taiwan, nor do UN GA Res. 2758 (1971) and WHA Res. 25.1 (1972) address the question of the representation of Taiwan.

◎    The PRC has never used any fund for its national budget on the health needs of the Taiwanese people.  Instead, it has relentlessly blocked Taiwan’s cooperation with the international health community.

◎    Taiwan seeks to participate in the WHO in order to both protect the health and well-being of its 23 million people, and further contribute to the multilateral health cooperation of the WHO system.  There is simply no legal, professional, and ethical justification for the PRC’s objection to Taiwan’s participation, or for the WHO’s complicity in the implicit institutionalization of “health apartheid” against the 23 million people of Taiwan.

While the 23 million people of Taiwan are entitled to equal and fair protection under the WHO system, Taiwan is also committed to playing its part by working together with the world community and contributing its resources and experience to advancing the noble goal of health for all peoples

3. THE GLOBAL HEALTH IMPERATIVES FOR GRANTING

   TAIWAN WHA OBSERVERSHIP

The goal of the WHO is the “attainment by all peoples of the highest possible level of health.” Taiwan’s exclusion from the WHO is fundamentally inconsistent with this objective and produces major adverse consequences: (1) It impinges on the Organization’s ability to ensure the health of the peoples of its member states, (2) harms the medical welfare of the 23 million people of Taiwan, and (3) limits Taiwan’s ability to share its considerable resources in the health field with other peoples in need.

Globalization has vastly increased cross-border flows of goods, services, and peoples, which has also facilitated the spread of infectious diseases across national boundaries. The WHO must remain informed and must obtain and disseminate relevant information to monitor, prevent, and respond to all conceivable diseases.

Taiwan should be allowed to participate in the WHO because the health authorities of Taiwan are the only ones possessing the relevant information on any outbreak of the epidemic that could potentially threaten global health. Excluding Taiwan from the WHO’s Global Outbreak Alert and Response Network (GOARN), for example, is simply irrational and self-defeating from a professional medical perspective. Thus, closing the gap between the WHO and Taiwan is clearly an urgent global health imperative. 

In addition, while the 23 million people of Taiwan are entitled to equal and fair protection under the WHO system, Taiwan is also committed to do its part by working together with the world community and contributing its resources and experiences in order to advance the noble goal of health for all peoples.

THE GLOBAL HEALTH IMPERATIVES FOR GRANTING TAIWAN WHA OBSERVERSHIP

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. 

                                                          I

Taiwan’s WHA 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 107^th 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 loophole in this global health network presents a danger for the entire global community.  Taiwan’s exclusion from the WHO creates such a loophole, as the following information indicates:

●   Taiwan is a major transport hub linking Northeast and Southeast Asia. In the year 2003, Taiwan registered 5.92 million outbound travellers and 2.25 million inbound visitors. At the end of 2003, 300,150 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$ 271.5 billion in foreign trade in 2003. 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$ 2.3 billion), vegetable products (US$ 2.6 billion), animal/vegetable fats (US$ 238 million), and prepared foodstuffs (US$ 2.7 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 administration of Taiwan are the only ones possessing the information and the data permitting the WHO and the world to be informed of—and respond effectively to—an 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 WHA 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 quite 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 citizens—a 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:

l infected over 1.8 million Taiwanese people,

l hospitalized 400,

l caused 80 deaths, and

l 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.

That blockade happened again in 2003 when the Severe Acute Respiratory Syndrome (SARS) hit Taiwan.  As soon as Taiwan detected its first case in early March, Taiwan called for the WHO’s assistance.  However, the WHO did not respond quickly enough, and what had been a mild outbreak then had escalated to 73 deaths.  Both SARS and the Avian Flu continue to threaten Taiwan; the need for Taiwan to have access to the WHO to face the emergence of these diseases is now more pressing than ever before.

(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 which—as the next section will show—benefit the health of all parties concerned.

III

The WHO’s Role in Facilitating 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 who is concerned with such 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 children in the world have no basic immunizations against polio, diphtheria, whooping cough, tetanus, measles, and tuberculosis, much less newer vaccines against hepatitis B, haemophilus influenzae B (Hib), and yellow fever.  For example, the ravages of AIDS, malaria, and tuberculosis have been shortening life expectancy of many millions of people in Africa.

         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 nearly 98% coverage and 70% approval rate.

●            In 2002, there were 18,228 health care institutions in Taiwan and one physician for every 632 people, one dentist for every 2,446, one nurse for every 251, and 40 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, the life expectancy at birth is 73.03 years for males and 78.82 for females. Taiwan’s maternal and infant mortality rates are only 7.68 per 100,000 and 5.35 per 1,000, respectively—comparable to those of Western countries.

● Taiwan has eradicated infectious diseases such as the plague, smallpox, rabies, and malaria.  No new poliomyelitis cases have been reported since 1983.  Taiwan has also been the first country 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 illnesses.

(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 2003, 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 Buddhist Compassion Relief Tzu Chi 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 effort—including 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 fora, workshops, and public health training seminars attended by health professionals from 45 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, and collaborates with the US Centers for Disease Control and Prevention (CDC) to help Vietnam in controlling AIDS. Taiwan also funds a polio eradication program through Rotary International, and is involved in malaria eradication and hospital improvement programs in São Tomé and Principe. International collaborative projects relating to SARS with Japan, the EU and the U.K. have also been conducted recently.

●   Taiwan has contributed thousands of wheelchairs to hospitals and charity organizations in Africa and Latin America. In the end of 2002, 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.

●   On August 17, 1999, an earthquake measuring 7.4 on the Richter scale devastated Turkey, yet our experienced medical teams were not allowed to assist the rescue efforts; this would not have been the case if Taiwan was able to work through the WHO to dispatch medical aid.

●           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 Drugs—resulting in a significant gap in the global tracking of the flow and quantity of controlled drugs.

● Taiwan implemented a multi-stage program for separating prescription from dispensation 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 Centers 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 WHA 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 Health Professional Alliance

●   International Pharmaceutical Federation

●   International Congress of Nurses

●   World Medical Association;

●   International Paediatric Association;

●   British Medical Association;

●   Lancet, Britain’s premier medical journal;

●   Standing Committee of European Doctors;

●   World Congress of Traditional Medicine; and

●   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 the:

●  United States Congress;

●  European Parliament;

●  Central American Parliament;

●  Belgium Chamber of Representatives;

●  Liberian National Legislature;

●  Dominican Republic House of Representatives;

●  Uruguayan  Chamber  of Representatives; and

●  The Philippine’s 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.

Recent outbreaks of SARS (Severe Acute Respiratory Syndrome) and AI (Avian Influenza) in East and Southeast Asia, which have caused panic around the world, are another disturbing examples of the danger inherent in Taiwan’s isolation from the WHO. Nevertheless, Taiwan has conducted an influenza and SARS control program to prevent SARS from re-emerging in the winter season since October 2003. To control the endemic outbreak of AI, a strict stamping-out policy and intensive surveillance have also been carried out in Taiwan even if H5N1 has not been detected yet.

All measures mentioned above are for the purpose of preventing and controlling the re-emergence and epidemic outbreak of SARS and AI. Taiwan strongly believes that health matters recognize no boundaries, and will and shall take its responsibilities in preventing the spread of infectious diseases to other countries.  Nobody, including the WHO, can afford to have a loophole in the global health care network.

4. TAIWAN’S REBUTTAL TO PRC ARGUMENTS AGAINST

its PARTICIPATion IN THE WHO

Taiwan exercises exclusive jurisdiction over its health care system, and is the sole authority in charge of the health affairs of its citizens.  The People’s Republic of China’s claims that (1) Taiwan’s participation in the WHO violates the PRC’s sovereignty, (2) there is no precedent for Taiwan to participate in the WHO as a health entity, and (3) the PRC cares for the health of the Taiwanese people, do not hold merit.

         First, since its establishment in 1949, the PRC has never exercised jurisdiction or control over Taiwan, nor do UN GA Res. 2758 (1971) and WHA Res. 25.1 (1972) address the question of the representation of Taiwan.  Second, Taiwan is only seeking to participate as an observer of the WHA in the capacity of a “health entity”.  The request is fundamentally based on professional health grounds and has nothing to do with the political issues of sovereignty and statehood.  Third, the PRC has never used any of its national budget on the health needs of the Taiwanese people.  Instead, it has relentlessly blocked Taiwan’s cooperation with the international health community.

         Taiwan seeks to participate in the WHO in order to both protect the health and well-being of its 23 million people and to further contribute to the multilateral health cooperation of the WHO system.  There is simply no legal, professional, or ethical justification for the PRC’s objection to Taiwan’s participation, or for the WHO’s complicity in the institutionalization of “health apartheid” against the 23 million people of Taiwan.

REBUTTAL TO PRC ARGUMENTS AGAINST INVITING

TAIWAN TO PARTICIPATE IN THE WHO

In order to protect the health and well-being of its 23 million citizens, and to further contribute to multilateral global health efforts, Taiwan seeks to be allowed to participate in the WHO.  The People’s Republic of China (PRC) has opposed this, stating that (1) Taiwan’s participation in the WHO violates China’s sovereignty, (2) there is no precedent for Taiwan to participate in the WHO as a “health entity,” and (3) the PRC cares for the health of the Taiwanese people, so there is no need for Taiwan to participate in this important global health organization.

         This rebuttal paper seeks to demonstrate that these three claims do not hold merit.  First, in order to avoid the political issue of sovereignty, Taiwan is only seeking to become an observer in the WHA (rather than a full member) in its capacity as a “health entity.”  Second, there exist clear precedents for such observership both in the actual practice of the WHO and also based on the important world-wide trend towards inclusive participation in international fora.  Finally, such participation will benefit the health of the entire international community—including Taiwan, the PRC, and all other countries.

I

Taiwan’s Participation in the WHO has NOTHING to do with

the PRC’s Sovereignty

The PRC has put forward a number of arguments against Taiwan’s participation in the WHO that are grounded in the so-called defense of PRC sovereignty:

Such a proposal [to grant Taiwan observer status in the WHO] . . . is in fact a challenge to the sovereignty and territorial integrity of a [WHO] Member State.

. . . [the] WHO is one of the specialized agencies of the United Nations and only sovereign states can become its members. UN General Assembly Resolution 2758 and Resolution WHA 25.1 clearly stipulate that the representatives of the Government of People’s Republic of China are the only legitimate representatives of China to [the] UN, [the] WHO and all other UN agencies.  Taiwan, as a province of China, is not eligible to participate in the WHA.

[Following the logic behind Taiwan’s application for WHO observership based on its capacity as a “health entity”], only after all the provinces or states, shires, cantons of sovereign States joined [the] WHO respectively, could “health for all” be possible. This is an open challenge to WHO’s Constitution and its membership composition.

However, the reality is that observership—unlike membership—in the WHO does NOT require sovereignty. Article 3 of the WHO Constitution does indeed stipulate that “membership in the organization shall be open to all states.”  The case could certainly be made that Taiwan does indeed deserve membership as a state:

l     By the established standards of international law, Taiwan meets all the requirements of statehood. Taiwan has a permanent population, which—at 23 million—is larger than those of three-quarters of WHO member states.  Taiwan has control and authority over a defined territory, and has diplomatic relations with 27 countries and substantial economic, cultural, and other ties with the majority of the world’s states.  Taiwan is a fully-established democracy with a government elected and accountable to the island’s citizenry and is capable of effective decision-making and of fulfilling its international obligations.

l     Since its establishment in 1949, the PRC has never exercised jurisdiction and control over Taiwan, not even for a single day.  It is absolutely clear that Taiwan is not a province of China, and that the government of Taiwan is not a local government of the PRC.

l     UN General Assembly Resolution 2758 (1971) and WHA Resolution 25.1 (1972) have successfully resolved the issue of the representation of the People’s Republic of China (PRC), but they have not dealt with the question of the representation or sovereignty of Taiwan’s 23 million people.

l     UN membership, furthermore, is not a prerequisite for membership or participation in the WHO: currently, Niue and the Cook Islands are both full members of the WHO despite the fact that neither is a UN member state.

Despite the fact that Taiwan is a sovereign state, Taiwan has put aside the controversial political issue of membership, and has—since the first request for participation was made in 1997—simply sought observer status in the WHA in the capacity of a “health entity.”  Seeking observer status in the WHA, therefore, is Taiwan’s innovative and pragmatic solution for putting aside political disagreements for the sake of protecting and promoting the health of all peoples—including Taiwan’s 23 million citizens.  

II

Clear Precedents Exist for Taiwan’s Participation

as an Entity-Based Observer in the WHO

The PRC has countered Taiwan’s request for observership in the WHA with a second set of arguments—that there is no precedent for Taiwan’s participation in the WHO as a “health entity.”  The PRC has argued:

[The] WHO is a UN agency whose membership is open only to sovereign states. It is not something made up of so-called entities. There is no such a concept as “health entity” in the WHO Constitution, and there has never been any case of health entity in over fifty years of practice of WHO.  

(1)      WHO practice clearly allows observership for various types of entities:

According to Article 2(b) of the WHO Constitution, one of the Organization’s principal functions is “to establish and maintain effective collaboration with the United Nations, specialized agencies, governmental health administrations, professional groups and such other organizations as may be deemed appropriate.”

Based on the WHO’s own practice, moreover, the Organization has deemed it appropriate for a number of “entities” to participate in the sessions of the World Health Assembly (WHA) as observers.  This practice is well established and has given rise to a new category of “quasi-permanent observers” invited on a routine basis to the Assembly.

At present, five such entities are regularly invited to participate as observers: (1) the Holy See, (2) Palestine, (3) the Sovereign Military Order of Malta, (4) the International Committee of the Red Cross, and (5) the International Federation of Red Cross and Red Crescent Societies.  These examples constitute powerful precedents for Taiwan’s participation as an observer in the WHO.

These entities are invited on a constant basis to participate actively in the work of the WHO, in particular by sending observers to the sessions of the Assembly, precisely because they have responsibilities falling within the purview of the WHO, and their aims conform with the Organization’s objectives.

Taiwan’s participation in the activities of the WHO would be consistent, moreover, with the fact that several major international organizations have made special arrangements to allow Taiwan’s participation.  Taiwan is a full member of the World Trade Organization (WTO), the Asia-Pacific Economic Cooperation (APEC), and the Asian Development Bank (ADB). Taiwan competes in the Olympic games and enjoys full membership rights in various international institutions dealing with fishery concerns.

(2)      The emerging principle of inclusive participation in IGOs and NGOs:

Globalization assumes that all international actors and entities work together for the benefit of the global community.  International law and practice have therefore moved towards a broad-based inclusiveness. Rather than basing participation in transnational institutions upon the outmoded and overly restrictive definition of statehood, many entities have been integrated into international and regional organizations on the basis of functionality.  It should be especially noted that:

l     On January 1, 2002, Taiwan became a member of the World Trade Organization (WTO) under the designation of the “Separate Customs Territory of Taiwan, Penghu, Kinmen, and Matsu” as a “customs entity.”  Both states and customs territories are treated as equal members of the WTO.

l     Taiwan has been admitted as an economic entity into Asia-Pacific Economic Cooperation (APEC), a regional economic cooperation process whose membership is composed of 21 member “economies” in the Asia-Pacific region.

l     In recent years, Taiwan has been successfully accommodated into regional multilateral fisheries management conventions as a “fishing entity.” Examples include the Multilateral High-Level Conference on the Conservation and Management of Highly Migratory Fish Stocks (MHLC) in the Western and Central Pacific; the International Convention for the Conservation of Atlantic Tuna (ICCAT); the Inter-American Tropical Tuna Commission (IATTC); and the Commission for the Conservation of Southern Bluefin Tuna (CCSBT).

In fact, the integration of all functional entities into appropriate international and regional functional organizations coincides with the spirit of the twenty-first century. It should be especially noted that when the world community admitted Taiwan as a full member of the WTO and APEC, the PRC’s claim over its sovereignty was not affected.  Therefore, inviting Taiwan to participate in sessions of the Assembly as an observer is clearly consistent with WHO practice and international trends and would in no way constitute a statement regarding Taiwan’s political status. 

III

There is a Pressing Medical Need for Taiwan’s

Participation in the WHO

A final claim that Beijing has made is that there is no need for Taiwan to participate in the WHO because, in part, the PRC looks after Taiwan’s health interests: 

The Chinese central government is always committed to the health and well-being of people from Taiwan . . . Taiwan, like any other Chinese province, has full access to [the] WHO’s health information including that of the early warning of global epidemics and can benefit from the progress made by [the] world in [the] health field.

(1) The PRC has never cared for Taiwan’s health needs:

Since its creation in 1949, the PRC has never exercised any authority or jurisdiction over Taiwan’s health care system, nor has the PRC contributed any part of its national budget to the health needs of Taiwan.  The PRC claim quoted above is simply untrue. 

Far from aiding or assisting the people of Taiwan, the PRC has in fact on many occasions actively worked to undermine the health and welfare of the island’s 23 million people.  In 1998, for example, the PRC prevented WHO experts from helping Taiwan combat a deadly outbreak of enterovirus. The following year, when a massive earthquake struck central Taiwan, killing over 2,400 people and leaving more than 10,000 injured, the PRC betrayed its so-called commitment to Taiwan by using its diplomatic muscle to obstruct the shipment of emergency medical equipment and rescue assistance offered by the Red Cross and the Russian Federation to Taiwan!

During the SARS crisis of 2003, the PRC did not make any effort to help Taiwan contain the spread of the disease, but blatantly claimed that they have “conducted multi-form cooperation and exchanges on SARS control with the region of Taiwan” (statement by Wu Yi, Vice Premier and Minister of Health of the PRC at the General Debate of the 56^th WHA on 20 May 2003).  And worst of all, the PRC forced the WHO to turn a deaf ear to Taiwan’s request in March 2003 for help, long before the WHO sent experts to Taiwan to provide assistance in May 2003.  This delayed response from the WHO enraged not only the families of the 73 victims of SARS, but also the people of Taiwan as a whole.

Furthermore, the PRC directly threatens the health of all people in Taiwan by targeting them with hundreds of ballistic missiles.  Do they really show concern for the welfare of the Taiwanese people with those missiles?

Finally, in 2001 and 2002, according to Chinese official statements, “medical groups from the mainland that visited Taiwan reached 1,249 and 2,246 persons/times, respectively.”  China wants to imply that such visits contributed significantly to Taiwan’s medical and health system.

What Beijing did not state, however, is that two-thirds of these visitors came to Taiwan mainly for the purpose of touring medical schools and hospital facilities, and the remaining one-third for conferences and seminars.  Only one percent of these visitors could be counted as having engaged in more meaningful research cooperation.  The truth of the matter is that the so-called “medical exchanges and cooperation” across the Taiwan Strait are basically one-sided.  Taiwan’s medical system is far more advanced than the PRC’s.  Such “exchanges” are by no means evidence of China’s goodwill and generosity towards Taiwan.

(2) China’s levels of health and medical care lag far behind Taiwan’s, and are unable to ensure the health of the people of Taiwan:

According to a WHO report published in 2000, China’s various medical and health indices lag far behind those of Taiwan.  In terms of the performance of its medical system, for example, China was ranked 144^th in a list of 191 countries; and in terms of the fairness of medical care, China was ranked 188^th.  But according to an evaluation published by the Economist Intelligence Unit in 2000, Taiwan was ranked second.  Moreover, in terms of the number of hospitals and clinics per 10,000 people, Taiwan claimed a level of 8.07 while China could only claim 2.51. Therefore, China is clearly not in the position to help the people of Taiwan in their health needs.

(3) Taiwan’s WHO participation is indispensable for its own health and that of the world:

Exclusion from the WHO can endanger the health of any population, even one such as Taiwan’s that possesses an outstanding domestic health care system.  No isolated group of people can possibly match the massive resources, technical expertise, and shared knowledge that the WHO provides.  Even more serious, from a global perspective, is the threat that Taiwan’s exclusion poses to peoples even beyond its jurisdiction.

Regarding the revision of the International Health Regulations (IHR) which is under discussion and demands the participation of as many partners as possible, only the government of Taiwan is in the position to represent and voice the needs of the people of Taiwan.  Only the government of Taiwan is in the position to monitor and administer the health-related issues stemming from the general trend of globalization.  By the same token, the WHO has in-depth data and expertise on the emergence of communicable diseases, including HIV/AIDS, malaria and tuberculosis, as well as on threats to global public health posed by the use of biological and chemical weapons by terrorists.  The WHO and Taiwan should therefore work together in order to ensure both regional and global health.

The exclusion of Taiwan’s 23 million citizens from the WHO system creates a situation where there is one system guaranteeing the highest level of health care for the rest of the world, and one enforcing the marginalization of the people of Taiwan.  This has been called a form of “health apartheid,” which is not only morally questionable but also self-defeating.

The PRC’s campaign to exclude Taiwan from the WHO not only poses serious threats to the well-being and functional effectiveness of Taiwan’s health care system, but also seriously undermines the Organization’s stated objectives. Thus, for the sake of the peoples on both sides of the Taiwan Strait and in the interests of the rest of the world, the PRC should have the grace to respond positively to the goodwill offered by Taiwan.  Furthermore, the PRC should seize the opportunity to demonstrate its willingness to join the world community in working towards the noble goal of protecting and advancing the highest possible level of health for all peoples.

IV.

Taiwan is Willing to Share its Medical and Health care Experience with Other Countries

(1) Taiwan is a member of the global village, and is willing to share its medical and health care experience with the world and with China:

When it comes to achievements in welfare policy, public health, medical insurance, and disease prevention, Taiwan can claim many success stories.  Taiwan is willing to share its experience with the international community.  In recent years, both its public and private sectors have actively assisted other countries (including China) and regions by providing medical care and humanitarian assistance.  For example, Taiwan has provided assistance to Africa and Asia in the fight against tuberculosis and other diseases.  Taiwan has also participated in the work of building local hospitals and clinics, assisted with public health projects, helped train health professionals such as medical doctors and nurses, and supported AIDS-prevention projects.  According to statistics, the government and civil groups in Taiwan have provided more than US$373 million since 1995 for health cooperation and financial aid to other countries or regions.

(2) Pursuing and safeguarding health is the right and obligation of every country and individual:

The experience of the SARS epidemic in 2003 has taught us that disease prevention transcends national borders and no country or region should be excluded. In the WHO Constitution it states: “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.”  Therefore, health transcends politics.  Politicizing health issues is not in line with the WHO Constitution.  It is unfair that the people of Taiwan are not able to participate in the WHO due to China’s opposition.  They have become the victims of politics.  Taiwan is willing and able to make more active contributions to the WHO.  Taiwan’s right to participate in the WHO’s work and activities should not be denied.