There have been 64 cases of enterovirus 71 (hand, foot and mouth) infection in Taiwan this year, resulting in two deaths. This current outbreak is reminiscent of a similar one in 1998 that killed 78 Taiwanese. In China, 4,500 people have been infected by this virus and 22 of them have died, Chinese government announcements have said.
This situation is a chilling reminder of the need for prompt action to prevent the spread of such diseases. Transnational epidemiological outbreaks do not respect borders and therefore require the intervention of a global health system to stem their spread.
Since China has persistently and irrationally used its “one China” policy to block Taiwan’s bid to become a member of the WHO, when a global emergency response is required to arrest an epidemic in Taiwan, it is generally much too slow in coming. In the case of the 1998 outbreak, it took an appeal from the US Centers for Disease Control and Prevention to nudge the WHO into action in Taiwan.
We all remember the big scare of early 2003 when, within a matter of a few months, a transboundary airborne disease that had struck Guangdong Province in November 2002 quickly spread to Hong Kong and then to Taiwan and other countries. It took more than two months after the SARS outbreak for the WHO to dispatch health experts to Taiwan simply because Taiwan, as a non-member of the WHO, did not have a direct channel for communicating data to the world health body about the outbreak.
Once SARS started to spread across the Pacific Ocean to North America, the WHO slapped unprecedented travel advisories on China, Hong Kong, Taiwan and Toronto, Canada. Within weeks, airline traffic to affected areas dropped more than 50 percent and hotel occupancy in most Asian countries plummeted by more than half.
This epidemic took a major economic toll on East and South Asian economies, estimated at some US$18 billion in nominal GDP terms for 2003 — or about US$2 million per person infected by SARS.
Taiwan is also vulnerable to the spread of the H5N1 strain of avian flu. Of the 378 reported cases of avian flu globally, 80 percent were in six countries — China, Indonesia, Vietnam, Thailand, Cambodia, and Laos. Taiwan’s proximity to those countries, in addition to the frequency of airline travel between them and Taiwan, puts this country at great risk of an outbreak of this disease.
The outbreaks of SARS, avian flu and enterovirus 71 highlight just how damaging unexpected, and seemingly uncontrolled, transnational health threats can be in our globalized world. Since such diseases have no boundaries, the outbreaks also reveal the importance of ensuring that no gap or weak spot exists in our global village’s disease prevention network.
There is a weak spot in the global disease prevention network because Taiwan is not a member of the WHO. Taiwan, whose status as a de jure sovereign state has been in question since 1971, has been unable to attain WHO membership.
If there is a time to make the case for Taiwan’s membership in the global health regime, it is now. With the incoming Chinese Nationalist Party (KMT) government planning to significantly increase cross-strait direct charter flights between China and Taiwan, the calls for Taiwan to become a member of the WHO will become louder.
There is no reason why Taiwan should not be invited to become a full-fledged member of the WHO. But failing that, it ought to be considered, at the very least, for observer status in the World Health Assembly (WHA).
There is precedent for the latter. Palestine is not yet a state, yet it is a WHA observer. Similarly, the Holy See, along with a number of non-governmental organizations such as the International Committee of the Red Cross (ICRC), the International Federation of the Red Cross and Red Crescent Societies and the Inter-Parliamentary Union are WHA observers. Even the Sovereign Military Order of Malta is an observer.
Taiwan has a modern healthcare system. It has eradicated a number of communicable diseases such as malaria, smallpox and polio. It shares its advanced medical knowledge and technology with several developing countries that have poor or non-existent medical institutions. It has provided medical humanitarian assistance to places like Haiti, Guatemala, Fiji, the Marshall Islands and Kenya.
Taiwan was also one of the first countries to provide emergency humanitarian aid to countries affected by the 2004 tsunami. Taiwan has also been at the forefront in helping to prevent the spread of avian flu by sending advanced medical experts in 2006 to Burkina Faso, Indonesia and Chad, and by donating 600,000 doses of Tamiflu in 2005 to places like Vietnam. It is also willing to provide humanitarian assistance to the victims of the recent cyclone in Myanmar.
These acts demonstrate that Taiwan is a good global citizen, especially when it comes to health-related issues. One can only imagine how much more this country could contribute if it were allowed to be a member of the global health regime.
Last March I was part of a Canadian team that observed Taiwan’s presidential elections. The smooth election process and democratic vibrancy exceedingly impressed our observer team. More than 250,000 Taiwanese living abroad flew into the country just to cast their vote. It became evident to us that Taiwan is a fully functioning independent state with a greater capacity to realize the obligations of WHO membership than many countries that are WHO members. For instance, Taiwan’s strong economy and vibrant democracy puts countries like Zimbabwe to shame. And Zimbabwe is a member of the WHO.
If the WHO is serious about universalizing its international health regulations, then it has to seriously consider Taiwan’s bid to become a member of its august body when its assembly meets today. In doing so, it would help to prevent a gap in its global disease prevention efforts and ensure that the 23 million people of Taiwan are able to actualize their fundamental human right to life and health.
W. Andy Knight is professor of international relations and director of the Peace and Post Conflict Studies program at the University of Alberta, Canada.
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