Following the outbreaks of mad cow disease and SARS, the World Health Organization (WHO) is revising its regulations to eliminate weaknesses identified in its global outbreak alert and response network. But the WHO is overlooking a big gap in the world's collective effort to counter infectious diseases -- the exclusion of Taiwan from the system. While there is an urgent need to improve technical procedures, it is even more important not to leave out the 2.7 million international passengers who travel in and out of Taiwan every year.
The International Health Regulations (IHR) currently being reviewed are a code of practices and procedures for preventing the cross-border spread of infectious diseases. Since the adoption of the current code in 1969, the return of old epidemics such as cholera and the emergence of new infections such as the Ebola virus have shown a clear need for revision. But only after the outbreaks of mad cow disease and SARS did WHO decide to establish a working group to overhaul the regulations.
Member states will endorse a final draft at the Intergovernmental Working Group meeting, currently convening in Geneva, for presentation to the World Health Assembly early next year.
The proposed revision broadens the scope of reporting from cholera, plague and yellow fever to the outbreaks of existing, new and re-emerging diseases, including emergencies associated with food safety and animal diseases. Most importantly, the revised IHR strengthens procedures for rapidly gathering information, for determining when a disease constitutes an international threat and for mobilizing international assistance.
New notification procedures and the designation of national contact units known as "IHR Focal Points" are aimed at expediting the flow of timely and accurate information to and from the WHO about international health emergencies.
Amid these efforts to strengthen the global network against infectious deceases, Taiwan continues to be ignored. Although 225,000 international flights carry 2.7 million passengers in and out of Taiwan every year, it will have neither IHR Focal Points nor any direct contact with WHO at all.
Due to political pressures and its peculiar status in international law, Taiwan is prevented from joining any intergovernmental organizations based on statehood. Admission to the WTO in 2002 was made possible because the WTO and its predecessor, the General Agreement on Tariffs and Trade (GATT), defined eligibility in terms of function. GATT characterized its contracting parties as "governments" instead of "states," stipulating that "a government acting on behalf of a separate customs territory possessing full autonomy in the conduct of its external commercial relations" may also accede to GATT.
Similarly, the Convention on the Conservation and Management of Highly Migratory Fish Stocks in the Western and Central Pacific Ocean created a mechanism for participation by "fishing entities" in 2000, enabling Taiwan to take part as such an entity.
Long before such practices were adopted by intergovernmental organizations, non-governmental organizations (NGOs) began recasting their rules to make membership based on functionality rather than sovereignty. The International Olympic Committee (IOC) in 1979 revised the definition of "country" to mean "any country, state, territory, or part of a territory" which the IOC deems as "constituting the area of jurisdiction of a recognized National Olympic Committee." Since that amendment, both China's "Chinese Olympic Committee" and Taiwan's "Chinese Taipei Olympic Committee" have been sending athletes to compete in the games. Other international sports federations soon followed the Olympic formula.