The Global Health Imperatives for Granting Taiwan WHO Observership
<Spanish>
<French> <German>
[Executive Summary]
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 state, (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.
CONCEPT PAPER #2
THE GLOBAL HEALTH IMPERATIVES FOR
GRANTING TAIWAN WHO 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 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 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 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 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 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 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:
infected over 1.8 million Taiwanese people,
hospitalized 400,
caused 80 deaths, and
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 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 expectancies for many peoples
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 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, the 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, respectively-comparable 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 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 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 effort-including medical
goods, freight trucks, wool blankets, and other supplies.
-
Four Taiwanese medical teams are
currently stationed in Burkina Faso, Malawi, Chad, and Sao Tome
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 Sao Tome and Principe.
-
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.
-
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 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 the:
-
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:
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.
Addendum to Concept Paper #2:
March 19, 2003
The recent outbreak of the lethal
Severe Acute Respiratory Syndrome (SARS), in East and Southeast Asia,
which has caused panic around the world, 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 within 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 long-run
prove to be catastrophic.
Frequently Asked Questions
TOP
