The WHO Constitution enshrines the principle that the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being. Under this principle, the 23 million people in Taiwan, including more than 400,000 foreign nationals residing on the island, should have the same rights as all other human beings to normal and regular access to the WHO system.

A virus does not need a visa to travel. Just as Dr. Jong-wook Lee, Director–General of the WHO, has emphasized, “The SARS epidemic showed us that we cannot afford any gap in our global surveillance and response network.” Following reports of avian flu cases in Nigeria, he reiterated in a recent statement that, “This latest outbreak confirms that no country is immune to H5N1. Every country is at risk. Every country must prepare.” By the same token, Taiwan’s inadequate access to global disease prevention and control networks poses a great threat not just to Taiwan, but to the world community as well.

With the need to participate in global health cooperation even more urgent as the threat of avian and human influenza pandemic looms, it is absolutely critical for Taiwan to participate in the Global Outbreak Alert and Response Network (GOARN), WHO technical meetings, WHO regional meetings/activities and the International Health Regulations 2005 (IHR 2005) mechanism. In addition, it is legally, morally and professionally justifiable to invite Taiwan to participate in the World Health Assembly (WHA) as an observer.

I. Supporting Taiwan’s Meaningful Participation in the WHO To safeguard the health right and welfare of the 23 million people of Taiwan, including 400,000 foreign nationals residing on the island, it is imperative to ensure Taiwan’s meaningful participation in the WHO. To help achieve this goal, the WHO should be urged to facilitate Taiwan’s partnership with GOARN and other disease prevention and control mechanisms, to regularize Taiwan’s participation in WHO technical meetings and to help Taiwan participate in the IHR mechanism. The WHO should also be urged to exchange letters with Taiwan to regularize Taiwan’s meaningful participation in the WHO in a predictable and systematic manner.

Supporting Taiwan’s Partnership with GOARN

1.GOARN is a technical collaboration of existing institutions and networks that pool human and technical resources for the rapid identification and confirmation of, and response to, outbreaks of international importance. Its partnership does not require statehood.

2. In order to achieve the goal of Director-General Lee’s “no gap’ policy and to enhance Taiwan’s disease surveillance and response capability, Taiwan should be invited to participate in GOARN.

3. Taiwan is gravely susceptible to the spread of avian influenza due to a huge volume of visitor and cargo exchanges with Southeast Asian countries and China, where the human death toll from the H5N1 virus is rising. Taiwan’s unique geographic location also makes it the perfect choice for a regional hub and strategic base for tracking and combating the deadly virus.

4. The experience of Taiwan’s CDC in combating SARS in 2003 is unique and should be shared with the rest of the world as the possibility of pandemic outbreaks increases. In the wake of the SARS outbreak, Taiwan’s CDC has added 30 physicians to its staff in an effort to reinforce its outbreak investigation and response capability. Taiwan CDC has also at times sent disease-prevention teams abroad in collaboration with international humanitarian relief efforts.

5. Taiwan’s office in Geneva has some access to GOARN for technical and information exchanges, but this access is still inadequate and unsystematic. GOARN is by no means state-based, as the network is composed of “partners” such as voluntary scientific institutions, medical and surveillance initiatives, regional technical networks, laboratories and NGOs. Taiwan CDC is eminently qualified for partnership with GOARN.

Supporting Taiwan’s Regularized Participation in WHO Technical Meetings in a Systematic Manner

1.The EU expressed its hope in 2004 that “the Secretariat, and others organizing technical meetings and working groups under the WHO auspices, will show flexibility in finding mechanisms to allow Taiwanese medical and public health officials to participate in these activities.” Canada also encouraged the WHO to “take all measures possible to ensure that Taiwan is provided with all the ongoing benefits of its advice and assistance.” Many other countries share the same positions.

2.Taiwan has been actively seeking opportunities to attend meetings and other activities hosted or co-sponsored by the WHO. However, among the meetings Taiwan has sought to attend since May 2004, it was only allowed to participate in slightly more than one third of them. Furthermore, this number would be much lower if the meetings that Taiwan was interested in attending, but was unable even to seek to attend due to lack of sufficient or timely information, were taken into consideration. The WHO’s request that Taiwan submit its application for attendance at least four weeks prior to the meetings, when invitations are often issued shortly before the meetings, has further created discriminatory barriers for Taiwan’s participation.

3.In general, Taiwan’s participation in WHO technical meetings is increasing, but it is sporadic and is decided on a case-by-case basis, and the scope is limited. Furthermore, Taiwan does not have access to follow-up arrangements or implementation resulting from the meetings it has attended. In addition, it is still difficult for Taiwan to participate in important member-state-based conferences, even if they are technical in nature.

4.The WHO should be urged to invite Taiwan to participate systematically in the technical meetings held or co-hosted by the WHO. The WHO should also be urged to invite Taiwan to observe meetings of Committee A, which handles technical and health matters. Furthermore, the WHO Secretariat should be urged to exchange letters with Taiwan in order to regularize the process and arrangements so that Taiwan may participate in the WHO meetings in a dignified manner.

Supporting Taiwan’s Participation in WHO’s Regional Meetings/Activities

1. The purpose of WHO regional offices is to lead the regional response to public health issues on all fronts—medical, technical, socio-economic, cultural, legal and political—towards the achievement of the WHO’s global health mission, i.e. to support all countries and peoples in their quest to achieve the highest attainable level of health. Taiwan is willing to work with WHO regional offices and contribute to regional health cooperation.

2. The Western Pacific Regional Office (WPRO), located in Manila, the Philippines, represents WHO in the Asia Pacific. Since Taiwan is located in the Asia Pacific region, in order to safeguard the health right of the people of Taiwan and to achieve WHO’s noble goal of “health for all,” it is imperative that Taiwan be invited to participate in WPRO meetings or activities so that the people of Taiwan can also enjoy the timely protection and assistance provided by the WHO and interact properly with neighboring countries in health matters.

Supporting Taiwan’s Integration into the IHR 2005 Mechanism

1.Epidemics and other international health risks do not recognize political borders. It is of paramount importance that the IHR 2005 apply to people, conveyances, cargoes, containers and the like from both WHO member states and non-members if it is to cope effectively with any health risk of an international magnitude such as SARS and avian flu.

2.The IHR 2005 mechanism cannot afford to exclude Taiwan because Taiwan is not only the 16th largest trading power in the world, but also one of the world’s most important international transportation hubs, linking Northeast Asia and Southeast Asia.

3. The new IHR is enforceable in Taiwan by Taiwan’s own health authorities only, and only Taiwan’s health authorities can handle public health emergencies related to Taiwan’s huge volume of international traffic and trade.

4. Taiwan is willing to faithfully implement the IHR 2005. However, as a country ruled by law, Taiwan needs to establish an appropriate connection with the new IHR mechanism in order that it may accordingly implement the IHR 2005 within its territory. In this regard, an exchange of letters or correspondence in some appropriate form between the WHO and Taiwan must be devised.

5. By upholding the principle of “universal application,” the IHR 2005 and Resolution WHA58.3 have provided legal grounds for Taiwan to participate in the IHR mechanism. The WHO Secretariat should be urged to substantiate the principle.

6. The WHO can and should accept Taiwan into the IHR mechanism as a “participating party” or other appropriate capacity, and treat Taiwan CDC as an IHR focal point. WHO members should assist Taiwan CDC in establishing communications and cooperation with its counterparts, and should treat Taiwan CDC as an IHR focal point.

II. Supporting Taiwan’s Participation in the WHA as an Observer

Inviting Taiwan, with its 23 million people, to participate in the WHA as an observer is consistent with the principle of “universal participation,” which is at the core of the WHO’s constitutional mandate to advance the health of all peoples.

Denying Taiwan normal and regular access to the WHO system is comparable to imposing “health discrimination” on the 23 million people of Taiwan. It also deprives Taiwan of its rights to further contribute to and benefit from international health cooperation. Taiwan’s exclusion is not in the common interest of the world community.

Taiwan is willing and able to contribute more to international health cooperation. It has recently established an institution for long-term coordination -- Taiwan International Health Action (TaiwanIHA) -- which is responsible for pooling the strengths and resources of both the government and the private sector with a view to enhancing Taiwan’s contribution to global health cooperation.

To avoid political or sovereignty disputes, the concept of “health entity” is creatively utilized. The “Taiwan health entity” is the functional and technical component of the “Taiwan authority” directly related to the constitutional concerns of the WHO; namely, world health. Therefore, for countries without diplomatic ties to Taiwan, inviting Taiwan as a health entity to attend the WHA as an observer, based purely on professional concerns, has nothing to do with the so-called “One China” policy. Taiwan’s participation in several regional fisheries management organizations, such as WCPFC and the Extended Commission of the CCSBT , in the capacity of a “fishing entity” provides a suitable precedent.

At present, there are six semi-permanent WHA observers of different natures: a sovereign state (the Holy See), a quasi-state (Palestine), a political entity (the Order of Malta) and three international organizations. Supporting Taiwan’s observer status in the WHA should not therefore necessarily be construed as political recognition.

Based on Articles 18 (h) and (m) of the WHO Constitution, the WHA has broad authority to invite any entity it deems appropriate to participate in the WHA as an observer. Palestine, invited to participate in the WHA as an observer by Resolution WHA27.37, is a case in point. Moreover, the practice of the WHO also demonstrates clearly that its Director-General has exercised considerable discretionary power to invite appropriate entities to send observers to the WHA on a regular basis.

It’s time to face the reality. Only the government of Taiwan can represent the health interests of its people and handle health-related matters in Taiwan. Therefore, it is critical for the WHO to invite Taiwan to participate in the WHA as an observer.

Last Update: April 26, 2006