Almost 18 years ago, on Dec. 18, 1999, in an editorial titled “Taiwan: time to end the exile,” the Lancet argued: “Western pressure to change China’s position on Taiwan’s status is necessary but, alone, is unlikely to be successful” and defended the idea that the Chinese Medical Association (CMA), accepted to the World Medical Association (WMA) in 1997, would defend the rights of colleagues in Taiwan who wish to re-enter the arena of international medicine and to improve the health of their people.
In April, the CMA officially proposed the WMA during its 206th council meeting in Zambia to change the name of another constituent member, the Taiwan Medical Association (TMA).
The proposal was turned down, as it was against the practices of any international professional organization toward another member, including the TMA, a member of the WMA since 1930.
The vain political attempt by the CMA, if guided by the Chinese government, would be no surprise to the Lancet.
It shows that politics are the more important value of the quasi-governmental CMA.
The serial attempts started early this year when the CMA drafted a resolution to urge the WMA to agree on a proposal, which coincided with the internal communication between Chinese Communist Party General Secretary Xi Jinping (習近平) and WHO Director-General Margaret Chan (陳馮富珍), to change its policy not to invite Taiwan’s health authority to the annual World Health Assembly, as had been the practice since 2009.
Unexpectedly, the WHO director-general openly resonated the “one China” principle from Xi in her press statement when Xi visited the WHO in Geneva, Switzerland, in late January.
This was a surprise to many in the UN and other international bodies as staff of UN organizations are to adhere to multilateralism and refrain from acting unilaterally.
However, it was not the first signal from Chan as head of the leading global health organization. Fully supported by the Chinese government in her accession to the post of WHO director-general in 2006, Chan strongly endorsed and implemented a memorandum of understanding (MOU) signed on July 12, 2005, by former WHO acting director-general Anders Nordstrom.
The MOU between China and the WHO secretariat was disseminated widely within WHO secretariat offices around the world.
The MOU dealt with issues regarding the participation of Taiwanese medical and public health experts in technical activities organized by the secretariat, the dispatch of staff members or experts to Taiwan to investigate the public health and epidemiological situations, as well as the provision of medical and public health technical assistance to Taiwan by the secretariat.
Apparently, direct contact by WHO staff on any technical issues with their counterparts in Taiwan was allowed only after consultation between the WHO and China’s permanent mission in Geneva.
A similar MOU related to a new International Health Regulation (IHR) was issued on Sept. 14, 2010, when the newly revised IHR2005 was validated by WHA resolution WHA58.3 in 2005, which stated that, in accordance with Article 54 of IHR2005, states parties and the director-general would report annually to the WHA on implementation.
As the Chinese delegates were not in any capacity to report the health and IHR-related activities in Taiwan, the Chinese Permanent Mission in Geneva worked with the WHO director-general to develop an “alternative mechanism” to collect health activities in Taiwan to facilitate the implementation of IHR2005.
This confidential IHR arrangement document was allowed to be circulated only “when needed,” and was “not circulated to non-WHO members” and “outside of the WHO.”
Although it allowed certain interactions and communications between the WHO secretariat and the technical health authorities in Taiwan, these interactions and communications remained extremely limited and restrictive, according to the Centers for Disease Control, which acted as the contact point.
The last WHA during Chan’s term started on May 22 and a change of leadership as well as major institutional reforms were addressed by global leaders. The forthcoming main challenges for the organization, the global health community and Taiwanese authorities will be to work together for Taiwan to attend the next WHA as an observer.
Not only would they thus live up to regulations of the IHR and other global health conventions, like the Framework Convention on Tobacco Control, but they would also follow the ethics and the principle of “health for all” that were set forth in 1978 in the Alma Ata Declaration.
Peter Chang is a medical doctor, a public health professor and a former health official.
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