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China's pact with WHO impeding Taiwanese bid

Taiwan's latest attempt to gain observer status at the World Health Assembly (WHA) seems to be stalled because of a memorandum of understanding (MOU) signed by China and the WHO that stipulates China has authority over Taiwan's WHO participation.

Taiwan has failed in every attempt over the last nine years when applying for observer status at the WHA because of China's opposition.

In May last year, the Chinese government signed the MOU with the WHO, claiming the memo serves to facilitate Taiwan's technical participation in the WHO, albeit under the watchful eye of Beijing, which considers Taiwan part of China.

Taiwanese foreign ministry and health officials said it was an extremely difficult task to push the observer bid.

This year, they came up with a "practical" campaign to strive for "meaningful participation," namely to ask for Taiwan's inclusion in the Global Outbreak and Alert Network (GOARN) and recognition as a partner in the International Health Regulations.

In a press conference to launch Taiwan's bid for WHA observer status this week, Vice Minister of Foreign Affairs Michael Kau (高英茂) spoke of the impact of the MOU, which he said had both positive and negative effects for Taiwan.

Despite the memo only offering Taiwan limited access to WHO-related activities, Taiwan was granted a total of 14 approvals to attend WHO technical meetings out of 32 that it requested to join.

But the negative impact of it was that Taiwan had to participate in those meetings under the guise of a province of China; either under the name of "Taiwan, China" or "Taipei, China," Kau said.

Health officials in Taiwan also emphasized that the political issue was not as important as participation as Taiwan was able to engage with the international health community.

A WHO official who was approached by Taiwanese journalists yesterday said the MOU serves to help and facilitate Taiwan's participation. Although, in most cases, Taiwan has to first obtain Beijing's approval, in times of emerging disease threats, like that of bird flu or SARS, the WHO can bypass Beijing and establish direct contact with the Taiwanese authorities.

"It's entirely a political issue," said a WHO official, who wished to remain anonymous, admitting that the WHO does not regard Taiwan's exclusion from the world health body as acute an issue as the medical incapacities facing other developing countries.

However, the signing of the MOU drew criticism from Taiwan that the memo severely undermines the country's status.

Democratic Progressive Party Legislator Winston Dang (陳重信) said he was appalled by the comprehensiveness of the MOU in allowing China to dominate Taiwan's WHO participation.

President of the Medical Professional Alliance of Taiwan Wu Shu-min (吳樹民) said that although it was important to have "substantive participation" in WHO activities, any kind of participation that was not based on observer status or full membership was unsustainable.

Secretary general of the alliance Lin Shih-chia (林世嘉) criticized China for using the MOU as a ploy to allow for Taiwan's technical and substantive participation in WHO in exchange for downgrading Taiwan to the status of a local government.

"The MOU is bait, and China uses `substantive participation' as a lure to exercise its unification campaign," Lin said.

Last year's MOU was a bilateral agreement between the WHO and Beijing and was kept confidential. Up until now Taiwanese officials still do not have access to the exact content of the document.

But a recent publication by British academic Martin McKee from the London School of Hygiene and Tropical Medicine revealed part of the MOU which detailed Beijing's control over technical exchanges between Taiwan and the WHO.

In an article entitled "Beyond Borders: Public-health Surveillance" which was published in the medical journal The Lancet on April 15 this year, McKee used Taiwan as an example to illustrate how political factors have impeded the integration of global surveillance of infectious disease outbreaks.

He said the memorandum of understanding between the WHO and China allows only very limited official communication between the WHO and the Taiwanese health authorities.

"The Chinese authorities have insisted that the highly bureaucratic procedures should not in any way imply independent status for Taiwan. All possible contacts need to be cleared with the Chinese delegation in Geneva no less than five weeks before meetings take place, and the Chinese authorities decide which Taiwanese individuals will be contacted," McKee wrote in the article.

Beijing also demanded that contact between the WHO and Taiwan "should not identify Taiwan, but just the city from which the expert comes from, and Taiwanese citizens are not to be invited to join expert advisory panels," McKee said of the MOU.

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