The World Health Assembly (WHA), the decision-making body of the World Health Organization (WHO), meets 20–28 May in Geneva. Although the WHO promises “better health for everyone, everywhere,” the organization systematically excludes one country from the annual discussions. Taiwan, officially known as the Republic of China (ROC), has one of the world’s best medical systems and can make important scientific contributions. Yet, Taiwan is not permitted to send a delegation to WHA meetings, even with observer status, to share knowledge about urgent health threats.
This situation, like that at all United Nations (UN) venues, is a relic of the Cold War when two governments disputed which could legitimately represent China. Of course, only the People’s Republic of China (PRC) can represent the 1.386 billion people living within its jurisdiction. But what about the 23 million people who live on independently ruled Taiwan, with its Ministry of Health and Welfare entirely under Taiwanese control? What about the entire ecology of microorganisms that spread disease across borders with no regard for political disputes?
The Challenge of Preventing Pandemics
Since viruses know no boundaries and do not discriminate between citizenries, the exclusion of Taiwan is an important gap in the global health system. Taiwan learned this lesson quite painfully in 2003 when an epidemic of severe acute respiratory syndrome (SARS) took 181 lives (27%) out of 668 confirmed cases.
In retrospect, public health experts understood that one obstacle was that Taiwan is not part of the WHO and thus could not access needed epidemiological data and virus samples in a timely fashion. Taiwanese medical professionals, excluded from face-to-face WHO meetings, had to rely on the WHO website and ask other countries (especially the USA) to share data. From 2009 to 2016, Taiwan was permitted to attend the WHA as an observer under the name Chinese Taipei. Since 2017, however, China has taken a hardline stance against Taiwan and blocked its participation.
Nowadays, the greatest threats seem to be zoonotic influenza viruses — viruses that first infect animals and then spread into human populations. Avian influenza, which affects poultry but could potentially mutate and infect humans, has appeared in two strains in Taiwan since 2003. In 2019, the main concerns are Hog cholera and African swine fever. Taiwan takes all possible measures to avoid a pandemic outbreak, including using automated sensors to test incoming air passengers for fevers and strictly enforcing laws on illegally importing meat. To be fully successful, such efforts need the international co-operation that only the WHO can provide.
Democratic Allies Support Taiwan
Political leaders from democratic countries are beginning to express concern about this situation and show support for Taiwanese participation. In 2018, the European Parliament passed a resolution saying that the exclusion of Taiwan from the WHO is not in line with EU interests. On 9 April this year, when questioned by the Senate Committee on Foreign Affairs and International Trade about Taiwan’s participation in the WHA, Canadian Foreign Minister Chrystia Freeland replied that Canada supports Taiwan’s “participation in international multilateral fora where its presence provides important contributions to the global public good.”
Diplomats tasked with maintaining good relations with China, while supporting Taiwan’s bids for international space, make diplomatic somersaults to plead their case. In his remarks at the 40th anniversary of the Taiwan Relations Act, for example, US Principal Deputy Assistant Secretary of State W. Patrick Murphy reiterated the long-standing American policy:
“The United States will continue to support Taiwan’s membership in international organizations where statehood is not a requirement for membership, and its meaningful participation in international organizations where statehood is a requirement.”
Statehood is the Issue
Pretending that there is no independent state on Taiwan overlooks the facts that Taiwan possesses a permanent population, a defined territory, a government, and the capacity to enter into relations with other states. In fact, having all of these characteristics make it a state according to the definition of the 1933 Montevideo Convention.
Technically, Taiwan is not a state, but the ROC is. Taiwan as a society is still debating whether they should maintain the ROC, a constitutional framework that might one day enable the emergence of a larger democratic China. Beijing is impatient with Taiwan’s boisterous democracy, which means that no elected government has moved too quickly toward either independence or unification for fear of alienating voters and losing power. China thus tries to coerce Taiwan through external means, such as vetoing Taiwan’s attempts to enter the WHA.
The refusal of the WHA and other international bodies to recognize ROC statehood has two important consequences. The first is in Taiwan itself. As China succeeds in constraining Taiwan’s international space, Taiwanese people lose confidence in their government to represent them to the world. This destabilizes Taiwan’s hard-won democracy. The second consequence is that diplomats and political leaders learn to perceive Taiwan only in its relationship with China rather than as an independent sociopolitical reality.
Denying the existence of a state on Taiwan begs the question of what Taiwan actually is. Obviously, it is not a non-governmental organization like the Red Cross, which has observer status. Taiwan’s contested status in the international arena more closely resembles Palestine, which has held observer status in the WHA since 1974 and in the UN since 2012, but which is excluded from other international entities due to American opposition. Both Taiwan and Palestine are limited in their international aspirations due to great power politics, but only Palestine gains a seat at the table at the WHA. Taiwan should be no different in terms of prioritizing human health over politics.
Taiwan is already a part of several other international organizations, such as the World Trade Organization (WTO) and the Asia-Pacific Economic Cooperation (APEC) forum. These provide sufficient precedents for pragmatically including both the PRC and the ROC. Surely the existential threat posed by disease is sufficient reason to include Taiwan in the WHA. A change in mindset is needed to make the WHO into the inclusive organization it claims to be.
Scott Simon, Ph.D., is Professor in the School of Sociological and Anthropological Studies, Co-holder of the Chair in Taiwan Studies, and Researcher at CIPS, University of Ottawa. Proficient in both Mandarin Chinese and Japanese, he has conducted research on various social and political issues in China, Taiwan, and Japan. He is the author of three books about Taiwan.