Taiwan Editorial Archive

Global Disease Prevention Network Must Include Taiwan


WHO Secretariat and China Have a Secret Memorandum of Understanding

By Dr. Hou Sheng-mou, Minister of Taiwan's Dept. of Health

The World Health Report 2007 – A Safer Future: Global Public Health Security in the 21st Century, issued by the World Health Organization (WHO), elucidates the importance of cooperation and information sharing among countries in the fight against disease. It emphasizes that more resources are required to establish a seamless global disease prevention network. WHO Director-General Margaret Chan stresses in her message published in the report that “international public health security is both a collective aspiration and a mutual responsibility… The new watchwords are diplomacy, cooperation, transparency, and preparedness.”

We highly approve of the importance the WHO attaches to health security because as one of the main victims of the 2003 SARS (severe acute respiratory syndrome) epidemic, Taiwan had to learn firsthand that once a gap appears in the health security system, epidemics can spread with alarming rapidity and seriously impact the global economy and trade. Given today’s high level of social mobility, maintaining international health security has become more urgent than ever and requires close cooperation between all countries. There is no space for loopholes or lack of transparency in the disease reporting system.

Situated in the West Pacific, Taiwan plays a vital role in disease prevention. Every winter, nearly 1.25 million migratory birds of 351 species fly from Siberia and China to Taiwan, either to stay for the winter or to continue on to the Philippines, Indonesia, Malaysia, or Australia. In the event of an outbreak of a lethal strain of bird flu that is highly communicable between human beings, the exclusion of Taiwan’s 23 million people from the WHO could make it extremely difficult for the global health network to control the international spread of the disease.

Taiwan’s determination to participate in the global health network and the sincerity of its motives have been made abundantly clear to the international community. On its own initiative, it began implementing the revised International Health Regulations (2005) one year before they came into force in 2007, and has now completed all necessary preparations mandated by the regulations. Taiwan continues to be excluded from the IHR (2005) notifiable disease reporting system, however, and is thus unable to immediately access information on disease outbreaks in other parts of the world or report local outbreaks to the WHO.

Regrettably, the WHO Secretariat and China signed a secret memorandum of understanding in 2005, stipulating that the WHO must receive clearance from Beijing before engaging in any interaction with Taiwan. Undeniably, this agreement seriously hampers disease prevention efforts and violates the rights of Taiwan’s people. Following the shigellosis outbreak in Denmark associated with baby corn exports from Thailand in September 2007, for example, the WHO conveyed the news to China, but it took China ten days to notify Taiwan about this health threat. We were lucky this time round: Our Department of Health confirmed that none of the affected corn had been imported. Though infection by the Shigella bacterium is seldom life-threatening in adults, this example underlines the risk incurred by leaving Taiwan out of the global health network.

Since Taiwan is a sovereign and independent nation, its public health system differs entirely from that of China. If an epidemic broke out in Taiwan, China could not replace Taiwan in monitoring it and providing assessments and reports to the WHO.

Such events and considerations demonstrate that the dependence of Taiwan and the WHO on China as a go-between for the transmission of epidemiological information inevitably creates a serious gap in the global disease prevention network. They underscore the necessity and urgency of establishing a direct communication channel between Taiwan and the WHO.

The first Director-General of the WHO, Brock Chisholm, was right when he said, “We cannot afford to have gaps in the fence against diseases, and any country, no matter what its political attitudes or affiliations are, can be a serious detriment to the effectiveness of the WHO if it is left outside. It is important that health should be regarded as a worldwide question, quite independent of political attitudes in any country in the world.” In this era of globalization, the risk to human health and the consequences of the responses we make have long since expanded beyond the boundaries of individual sovereign countries and become issues that must be handled within the framework of a global governance regime. No country can be excluded.

Taiwan is doing everything in its power to engage in constructive cooperation and fulfill its responsibility so that global health security can be guaranteed. Can the same be said of the WHO?