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.
Similar flexibility was created by NGOs in the field of science. The International Council of Scientific Unions (ICSU), an umbrella NGO encompassing more than 20 international organizations, recommended that all scientific unions adhere to the principle of the universality of science -- extending membership to any community of scientists that effectively represents the scientific activity in a definite territory.
When the Chinese Biochemical Society requested in 1979 that it replace Taiwan in the International Union of Biochemistry (IUB), the IUB realized that political circumstances were threatening to interfere with scientific inquiry and communication. The ensuing discussions within IUB led to agreement on a "one-country, two-adhering-bodies" formula. Very soon, this formula was adopted by the ICSC and followed by all other scientific unions.
By creating a "functional standing clause" to accommodate membership by both China and Taiwan, all these groups succeeded in ensuring universality of participation and maintaining their organizational effectiveness.
Article 1 of the WHO Constitution commits the organization to attaining the highest possible level of health for "all peoples." The preamble describes the enjoyment of the highest attainable standard of health as one of the "fundamental rights of every human being" without distinction of race, religion, political belief, economic or social conditions.
The 23 million residents of Taiwan have been deprived of such fundamental rights since 1972. Taiwan's health officials and experts have been prevented from attending WHO conferences, obtaining information and advice from WHO, or participating in the global outbreak alert and response network.
As a specialized agency of the UN, WHO has long followed the UN political decision that there is only one China and that the People's Republic of China's (PRC) representatives are the sole legal representatives of China. Yet WHO is a functional organization, and its aim of enhancing worldwide health is apolitical. For that reason the US Senate and House of Representatives and the European Parliament have all passed resolutions supporting Taiwan's WHO participation.
China claims that its health administration is attending to the health concerns of Taiwan residents. But the world and WHO are fully aware that the PRC has never exercised jurisdiction over the Taiwan area. To accept the Chinese claim is to engage in self-deception.
Some argue that Taiwan is doing fine without WHO assistance. According to that logic, all health-advanced states might as well withdraw from the WHO.
The current consideration of a new IHR is the time for WHO and its members to close the gap in the system that omits Taiwan. If WHO can be as creative as other organizations in basing eligibility on functionality, such as broadening qualification definition or creating a side track, the beneficiary will be not just the people of Taiwan but the entire world health system.
Cho Hui-wan is an associate professor at the Graduate Institute of International Politics, National Chung Hsing University.
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