POLI0078 Semester Project: The World Health Organization and Taiwan Human Rights vs.

. Sovereignty Word Count: 3005 Andrew Shen 2009931745 adshen@hku.hk Introduction: The World Health Organization is a branch of the United Nations that has been at the head of international efforts and coordination in promoting general public health in the world since its inception in 1948. It is the foremost authority in organizing international efforts to monitor outbreaks of disease and in sponsoring programs to combat and to prevent these diseases. Beyond directly dealing with infirmity and sickness, the goals of the World Health Organization, as declared in its constitution, aim to facilitate public awareness and participation in promoting health and well being. Although it is officially a body of the United Nations, the World Health Organization is chartered to be impartial to political circumstances, stating the following objective in its constitution: 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 5.

Despite this clause, however, Taiwan, the Republic of China, has repeatedly been barred from participation in the World Health Organization due to the controversial political conditions the island shares with the Peoples Republic of China. Issues of contested territorial sovereignty have impeded the Republic of Chinas attempts to gain international recognition and support.

A press release from April 2008 made by the Taiwanese Health Minister urged for international support to allow Taiwan to partake in the World Health Organization as a participant or as an observer. As twelve of the Republic of Chinas past appeals since 1997 to join the World Health Organization have been rejected due to the influence of United Nations Security Council member state, China 7, Taiwan has essentially been left to tackle outbreaks of communicable diseases in the past with its own resources and means. The Taiwanese Health Minister, Sheng-mou Hou, in the press release, brought up assertions that Taiwan does indeed play a vital role in the prevention and containment of disease and with the role played by the Republic of China in the international arena, to isolate Taiwan from participation in the World Health Organization seriously impedes the ability of the Organization to promote health in the East Asian region 1. Having the legacy of being one of the Four Asian Tigers during the mid to late twentieth century, the Republic of China was one of the first industrialized regions on the Asian continent. Even to this day, it has remained a key economic player on the world scene and continues to be a major economic and travel hub in the East Asian region, seeing millions of travelers pass through its airports and sea ports every year. With such a tremendous volume of annual international traffic, there is a great urgency in addressing the general level of health in Taiwan due to the risks involved with communicable diseases and the need to promote the effective methods to reduce the spread of such diseases. In May 2009, the Republic of China attended the World Health Assembly (the annual governing summit of the WHO) for the first time since the United Nations had given its seat to the Peoples Republic of China in 1971, as an observer, coinciding with a year of improved relations between the two governments. Taiwan, as such, was able to deal with the H1N1 swine

flu outbreak in East Asia with the combined efforts of the international community, in stark contrast to the outbreak of Severe Acute Respiratory Syndrome in 2003. This essay will attempt to address the reasons why the World Health Organization took half a century to acknowledge that it had overlooked an integral population and how its reluctance to admit Taiwan, even as an observer, had been both detrimental to Taiwanese efforts to combat disease and in opposition to the WHOs principle to promote the highest attainable level of health of all peoples. Due to the highly charged political relationship between Taiwan and mainland China, Taiwans rights as a sovereign state will also be analyzed. Ultimately, this essay will aim to ascertain the basic human rights involved in Taiwans admission to the World Health Organization. Severe Acute Respiratory Syndrome (SARS): In early 2003, the SARS (Severe Acute Respiratory Syndrome) epidemic ravaged the Asian continent and within days became a threat that could not be overlooked by the World Health Organization. Beginning with a single case in Guangdong province, China, twenty hospital workers who tended to a traveler from Vietnam who had begun developing symptoms of a respiratory infection en route to Shanghai, began showing symptoms of atypical pneumonia. By February 10, the Chinese government had reported over 100 cases of the strange contagious disease, which at that point had been yet to be identified. The World Health Organization issued a global travel advisory on March 15, 2003 and it would not be until the following day that the disease would be identified as SARS. The highly contagious and fatal disease would, from China, spread to the rest of the world, quickly reaching even North America through a visitor to

Toronto, Canada. By May 2003, over 8000 probable cases of the disease and 745 deaths had been reported worldwide. Unlike current global epidemics with higher fatality rates which are carried by insect vectors, the virus that causes SARS is carried and transmitted by a human vector, immediately posing a threat that no government can overlook. SARS, unlike malaria or Japanese encephalitis which are carried by mosquitoes, has no geographic boundaries due to climate and can be spread so as long as a human population is present. With the close proximity of the island of Taiwan to the mainland of China, SARS had spread to Taiwan early on, conveying a dire need for Taiwan, as a fully developed, de facto state, to be allowed to participate in the World Health Organization, as an observer in the least. As a developed nation near the center of the SARS outbreak, Taiwan was seen by many in the international community as a potential asset to international efforts to curb SARS; having initiated a rigorous response to the outbreaks within its own boundaries, the Republic of China had gathered valuable experience which could have been well utilized by the international community had it been granted an audience through the World Health Organization. Petitions to the World Health Organizations made by Taiwan to access WHO resources and virus samples, even throughout the SARS outbreak, however, were swiftly turned away due to pressure from China, which regards Taiwan as a provincial territory with no rights to international participation and distinction. Instead, China claimed that it would provide any necessary aid and support to Taiwan on behalf of the WHO, disregarding the fact that it has never had jurisdiction over the government of Taiwan let alone any involvement in the public health affairs of the island.

Coinciding with the SARS outbreak, Taiwan presented a bid to join the World Health Organization as an observer in May 2003, with the annual World Health Assembly approaching. The Washington Post, on May 9, 2003, ran a piece written by former Taiwanese President, Chen Shui-bian, imploring the WHO to extend an invitation to the Republic of Taiwan to attend the World Health Assembly as an observer. The article brought forth several issues of concern, including the fact that viral experts and epidemiologists in Taiwan were unable to receive prompt samples and information regarding the SARS virus resulting in a lacking ability on the part of Taiwan to treat and address the disease, despite Taiwans willingness to join in the worlds efforts to curb the spread of the disease 6. Taiwan health officials were reduced to gleaning information from the WHO Web site since Taiwan had no formal relationship with the WHO at the time. It took a month for any WHO specialist to arrive on the island, where 37 people died 7. Political figures and medical experts from around the world extended their support in granting Taiwan observer status in the WHO, followed by stern comments made by a spokesperson from the Chinese Foreign Ministry saying that Taiwan, a Chinese province, does not have qualifications to join WHO under any terms, and that no countries or individuals have the rights to invite Taiwan to join the WHO as an observer" 3. The United States, Japan, along with twenty-one other countries had also expressed support in Taiwans bid to join the WHO. Taiwans efforts to participate, however, were met by a Security Council veto from China, who had taken the petition as an attempt by Taiwan to gain international support towards the cause of Taiwanese independence. But as defined in the WHO constitution, the promotion of worldwide health is a basic inalienable right and is something that political beliefs cannot take precedence over 5. Through

pressure from China, Taiwan was denied this right and in turn faced the outbreak of SARS apart from the coordination of the WHO. H1N1 Swine Flu; Taiwan as an observer in the WHO Following the efforts against SARS and the end of the SARS threat, Taiwan has made multiple petitions to join the WHO, citing a necessity to be prepared in the event of the outbreak of a similarly devastating communicable disease. However, all of these attempts faced the same outcome as the Taiwans appeal in 2003 to attend the World Health Assembly. It would not be until after the election of President Ma Ying-Jeou in 2008 that China would entertain any such requests. Prior to the election of Mr. Ma, the previous president of Taiwan, Chen Shui Bian, had been a representative of the Democratic Progressive Party of Taiwan which, since its founding, has been historically tied to the Taiwanese independence movement. The previous

administration of Taiwan, under the Democratic Progressive Party, had fostered near hostile relations with the mainland by promoting a distinct Taiwanese separation from China, a position that the mainland Chinese had likened to an unofficial declaration of independence. Where Taiwanese independence had been a key factor in the Democratic Progressive Partys ascension to the highest seat of the Taiwanese government, Ma Ying-Jeou, the Kuomingtang (the Chinese nationalist party with historical origins on the mainland) candidate for presidency had campaigned on the platform of maintaining the status quo, improving Taiwanese relations with the mainland, and repairing the ailing economy of Taiwan. Since his inauguration in May 2008, President Ma has tactfully diffused the hostile position held by the mainland towards Taiwan. Within just the first year of his term, cross-strait relations between Taiwan and China have already shown significant signs of improvement due to

President Mas proposal of a mutual dtente, urging both sides of the conflict to put the issue of sovereignty to the side 8. Both sides have since taken down barriers to mutual trade and commerce and have allowed for direct flights, while businesses from both Taiwan and China have increased the amount of cross-strait investments and trade dealings. Early 2009, the fear of the spread of a new communicable disease, Swine Flu (H1N1), pressed the international community for cooperation and for a united global response, drawing from the experiences gained from the crisis faced during the SARS outbreak of 2003. This in conjunction with the improved relations between Taiwan and China cultivated by the Kuomingtang administration on Taiwan led to the lifting of Chinas veto to the repeated petitions of the Republic of China to join the World Health Organization 7. In April 2009, the World Health Organization extended, for the first time since 1971, an invitation to Taiwan (as Chinese Taipei 9) to participate in the 62nd World Health Assembly to address the agenda of dealing with the global outbreak Swine Flu. This, in turn, would be the first time the Republic of China has been allowed participation in a United Nations sanctioned affair since recognition of China had been given to the Peoples Republic of China in 1971 8. While this initially may seem like a step forward for Taiwan in gaining the international audience and recognition it has sought as a state, the lifting of Chinas veto is more likely the acknowledgement by the Peoples Republic of China of the significant role Taiwan plays in maintaining the level of health in China and in the world in general. With the recent opening of direct passage between Taiwan and China, spread of disease across the strait has become a new health concern that directly affects the ability of China to contain and combat communicable disease within its own territorial boundaries. Furthermore, widespread criticism of Chinas politically expedient veto of Taiwans request to participate in the World Health Assembly in

2003 during the immobilizing SARS outbreak may have also acted as a key factor in Chinas decision to lift its veto on the participation of the Republic of China in the World Health Organization. The WHO initially recognized the threat of Swine Flu in April 24, 2009 when cases of influenza-like illnesses were diagnosed in Mexico and in the United States. By April 26, the disease had spread to Europe, and by May 1, 2009, the number of diagnosed cases had jumped to 141 including instances in the Hong Kong Special Administration Region of the PRC. The WHO would recognize escalate the situation from an outbreak of influenza to a pandemic on July 1, 2009, when a cumulative total of 77,401 cases were diagnosed along with 332 confirmed deaths worldwide. Taiwans admission to the World Health Organization has had a positive impact on its ability to deal with global pandemics. In a surface level comparison, the 11% mortality rate of SARS cases in Taiwan in 2003
14

was significantly higher than the mortality rate of Swine Flu in

12

2009 which had been maintained at 0.5% of all confirmed cases by the end of November 2009
13

. Drawing from cumulative world efforts, the Taiwanese response to the more recent pandemic

has been much more effective. On the other hand, Taiwans admission to the WHO as an observer likewise has had a similarly positive impact on global efforts to address the 2009 pandemic. As a developed nation capable of maintaining its own health systems, Taiwan, even before the first reported case of Swine Flu took place on May 20, 2009, had offered its support with a pledge to join the world coalition against H1N1, In the face of the swine flu threat Taiwanmobilized its biotechnology and pharmaceutical industries to join the campaign against swine flu 11.

Human Rights and the World Health Organization The case of the pressure applied by China, the Peoples Republic of China, to forestall Taiwans admission to the World Health Organization in the past has been criticized by many to have been a blatant dismissal of the basic rights of the people of Taiwan. Meeting all of the requirements as stated in the WHO constitution to be entitled to membership, Taiwan is a fully developed, self-governed political entity that has complete jurisdiction over the health of its people 5. Claims made by China over the sovereign status of the island have, however, impeded Taiwans participation in the international organization, allowing political circumstances to take priority over facilitating the maintenance of Taiwans basic inalienable rights to the attainment of the highest level of health. Although international support for Taiwans admittance to the WHO as an observer was present, fear of spoiling relations with China prevented any motions to oppose Chinas veto against Taiwans participation. The existence of a political agenda in the World Health Organization is further evidenced in the fact that it was not until an administration change in Taiwan which increased ties between the ROC and the PRC that Chinas veto was lifted. Furthermore, the pressure using of the Chinese Taipei designation to represent the independently governed state of Taiwan, although commonly accepted by the general Taiwanese populace, further shows Chinas political expedience even in a supposedly politically neutral and indifferent organization such as the WHO. Conclusion: The recent affair of Taiwans admission to the World Health Organization in 2009 serves as an important case study to ascertain the effects of participation in the WHO and its annual

World Health Assembly summit on a developed nation while also indicating the partiality the WHO holds towards the political concerns of its member states, specifically those of United Nations Security Council members. For many years, Taiwan has been an eligible candidate to become a full fledged member of the WHO with one major obstacle, the sovereign claims of the Peoples Republic of China. During the SARS outbreak of 2003, China vehemently rejected Taiwans petition to attend the 2003 World Health Assembly during a time where international cooperation was of utmost need. Claiming that Taiwan has no rights to membership and as it is a provincial territory of the Peoples Republic of China, China alleged that it would act to employ the findings of the WHO on the island, ignoring the fact that the island of Taiwan has been a self-governed political entity and that the PRC does not have a say in the health affairs of the inhabitants of Taiwan. At the same time, China has made claims that Taiwan had used the petition to join the WHO in an attempt to gain international recognition and could potentially use it as a foothold to eventually claim independence. SARS, however, was a harsh reality and the denial of Taiwans observance in the WHO had led to difficulty in dealing with the pandemic. The whole ordeal showed the world that political circumstances can only get in the way of promoting world health and well being. In 2009, with a whole new administration in Taiwan, one that exhibits an objective to lessen the tensions between the ROC and the PRC, China finally relented, lifting its continuous vetoes of Taiwans petitions to join the WHO. The 2009 World Health Assembly was attended by Taiwanese representatives, observers from the Chinese Taipei jurisdiction, and with the recent pandemic of 2009 (H1N1), global coordination in responding to swine flu, especially in the East Asian region have been much more effective than pandemic responses in the past.

Bibliography: 1 Taipei Representative Office in Denmark. Health Ministry. Taiwanese Minister Hou Calls for Support for Taiwan's WHO Bid. 25 Apr. 2008. Web. <http://www.roctaiwan.org/DK/ct.asp?xItem=57258&ctNode=1062&mp=142>. 2 "Situation Updates - SARS." WHO Situation Updates. WHO, 18 May 2004. Web. <http://www.who.int/csr/sars/archive/en/>. 3 Lam, Willy W. "Beijing fights Taiwan WHO entry." CNN.com. 14 May 2003. Web. <http://edition.cnn.com/2003/WORLD/asiapcf/east/05/13/taiwan.who/>. 4 "China slams US support for Taiwan WHO bid." CHINAdaily.com.cn. Xinhua, 5 Dec. 2004. Web. <http://www.chinadaily.com.cn/english/doc/2004-05/12/content_329963.htm>. 5 Constitution of the WHO. <http://www.who.int/governance/eb/who_constitution_en.pdf>. 6 Chen, Shui-bian. "WHO 2003 Campaign." Editorial. The Washington Post 9 May 2003: A35. <http://www.fapa.org/who/2003/CSB-WP0508.htm>. 7 Love in a Time of Swine Flu. (2009, April 30). Wall Street Journal (Eastern Edition), p. A.14. Retrieved December 1, 2009, from ABI/INFORM Global. 8 Rowan, Callick. "Detente delivers as China liftsTaiwan WHO veto." The Australian. 1 May 2009. Web. <http://www.theaustralian.com.au/news/detente-delivers-as-china-lifts-veto/story-e6frg6t61225705552390>. 9 Harris, Stuart. "Taiwan, China, and the WHO." Web log post. EastAsiaForum.org. 7 May 2009. Web. <http://www.eastasiaforum.org/2009/05/07/taiwan-china-and-the-who/>. 10 "Situation Updates - Pandemic (H1N1) 2009." WHO. 27 Nov. 2009. Web. <http://www.who.int/csr/disease/swineflu/updates/en/index.html>. 11 Y, Jou C., Ching-fang Chen, and Wu Sofia. "WHA participation benefits Taiwan, world: health minister." GlobalSecurity.org. ROC Central News Agency, 20 May 2009. Web. <http://www.globalsecurity.org/wmd/library/news/taiwan/2009/taiwan-090520-cna01.htm>. 12 Wang, Flor. "174 H1N1 hospitalized cases in Taiwan: health officials." Taiwan News. 9 Oct. 2009. Web. <http://www.etaiwannews.com/etn/news_content.php?id=1053678&lang=eng_news>. 13 "A(H1N1)-related school closures hit new high: CEC." Taiwan News. Central News Agency, 29 Nov. 2009. Web. <http://www.etaiwannews.com/etn/news_content.php?id=1119 909&lang=eng_news&cate_img=logo_taiwan&cate_rss=TAIWAN_eng>. 14 "Cumulative Number of Reported Probable Cases of Severe Acute Respiratory Syndrome (SARS)."WHO. 17 Mar. 2003. Web. <http://www.who.int/csr/sars/country/en/index.html>.