[Executive Summary]
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.
CONCEPT PAPER #3
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:
- 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.
- 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.
- 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.
- 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:
- 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.
- 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.
- 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 56th 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 144th in a list of 191 countries; and in terms of the fairness of medical care, China was ranked 188th. 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.
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