[轉載] Diseases without borders
Taiwan’s unhealthy exclusion from the WHO
A TINY island-nation in the Lesser Antilles, with a population of about 170,000, St Lucia is not a big force in international politics. Yet Taiwan’s government has been celebrating as a triumph its decision on April 30th to reopen diplomatic relations with the island. Since China’s government regards diplomacy as a zero-sum game—and duly severed its own ties with St Lucia on May 5th—this was a minor victory in a six-decade-old war of diplomatic attrition between Beijing and Taipei. It brings the number of Taiwan’s diplomatic partners to 25—most of which are similarly small and poor countries, their allegiance bought with promises of aid.
Yet Taiwan last month suffered a far more serious defeat in this tiresome diplomatic set-to. Its application for readmission to the United Nations’ World Health Organisation (WHO) was dismissed. Few people around the world paid much attention: after all, Taiwan, evicted from the WHO in 1972, had since 1997 made annual bids to secure merely “observer” status at the WHO. Its application for full membership seemed not so much quixotic as provocative: of course China was going to block it.
Doomed anyway, the application was calculated to heighten Beijing’s ire, since it was made in the name not of some euphemism designed to spare China’s blushes (such as “Chinese Taipei”, the nomenclature to be used by Taiwan’s team at next year’s Beijing Olympics) but of Taiwan itself. This hints at the wish of many in Taiwan’s ruling party to move towards de jure as well as de facto independence.
From Beijing’s point of view, Taiwan is exploiting global-health concerns to build political capital. It has a point. But Taiwan has a bigger one: its exclusion from an organisation whose aim is to safeguard and promote global health is outrageous. In recent years, epidemics such as severe acute respiratory syndrome (SARS), which ravaged China and its environs in 2003, have demonstrated the need for the swift and full exchange of information. The continuing threat of avian influenza gives the issue urgency.
Yearning to become a member
Exclusion from the WHO does not mean that Taiwan is a no-go zone for the organisation. But a leaked memorandum of understanding that the WHO and China agreed on in 2005 shows appalling discrimination against it. According to Martin McKee and Rifat Atun of the London School of Hygiene, writing in the Lancet, the memorandum requires all possible WHO contacts with Taiwan to be cleared with China’s delegation in Geneva (the WHO’s headquarters) at least five weeks in advance; China decides which Taiwanese individuals will be contacted; communications should identify not Taiwan, but just the city from which the expert to be contacted comes, etc.
This is dangerous as well as humiliating stuff. In mid-April Margaret Chan, the WHO’s director-general, who is from Hong Kong, defended the organisation’s refusal to consider Taiwan’s membership by saying its policies are set by its 193 members who “hold on very strongly to the ‘one-China’ principle”.
But this argument does not make sense. Not only does it ignore the 25 (24 at the time) countries that recognise Taiwan, it also assumes that members could not be persuaded to make an exception for an issue so important as public health. Japan and America, for example, have in the past backed Taiwan’s bid for observer status. The European Union, in a rare instance of foreign-policy commonality, has not.
Some Taiwanese spokesmen overstate the importance of WHO membership, making it sound as if a callous world is exposing Taiwan to horrible risks at China’s behest. They blame the WHO, for example, for the loss of nearly 40 lives in Taiwan to SARS, although membership could not help China and Hong Kong avoid 650 deaths between them from that epidemic.
Yet there is the danger of unnecessary bureaucratic or political delays, and Taiwan is surely right that any such risks taken with people’s lives are unacceptable. In this instance, it would be better to help Taiwan—and benefit from its own quite impressive public-health experience—without insisting it be humiliated first.