Does Taiwan’s WHA Exclusion Really Matter? An Insider’s Guide to the World’s Biggest Health Meeting

The 70th World Health Assembly (WHA) is scheduled to convene next week, and Taiwan, for the first time since 2009, has not been invited to join the meeting as an observer because of continued pressure from China to narrow Taiwan’s international space.

Many in Taiwan, including President Tsai Ing-wen (蔡英文), continue to protest the exclusion. Commentators and health experts have said Taiwan’s non-attendance could heighten the risk of the spread of disease in the region.

Why WHA matters

The World Health Organization was founded in 1946 as the specialized agency within the United Nations structure for health related issues. It bears the objective of “the attainment by all peoples of the highest possible level of health.”

Although in the past three decades, the WHO’s dominance in global health governance has gradually been eroded by institutions such as the World Bank, the G8 Group, and the Bill and Melinda Gates Foundation, which have strong financial capacity and political influence, WHO remains at the center of global health arena given its unique mandate in the U.N. system and the democratic legitimacy provided by its General Assembly.

The General Assembly of the WHO, the WHA, is the highest decision-making body of the organization. It consists of delegates from 194 member states and a number of observers, and is where budgets are approved, resolutions are debated and passed, and action plans are authorized.

Apart from being an organizational occasion, the WHA also collects officials and professionals from all over the world in one building, making possible private intergovernmental meetings on topics not necessarily confined to health.

The WHA is also something of a fair for public health opinions. A great number of side events are held by member states or non-governmental organizations on important public health issues. Discussions and exchanges of thoughts are usually much more vibrant in these side events than the main committees.

For a country like Taiwan with limited access to international events and meetings, the WHA serves as a precious opportunity to be exposed to public health discussions and experiences from other countries.

Taiwan’s participation in WHA

After its membership of the United Nations was replaced by the People’s Republic of China in 1971, the government of Republic of China (Taiwan) also lost its seats in all U.N. agencies. It was not until 2009 when the 23 million people in Taiwan once again had a legitimate representation in the WHA, when the Taiwanese government began to receive invitation every year from the WHO Director-General to join the Assembly as an observer under the name of “Chinese Taipei” – a political compromise made with the Chinese government.

This year marks the first year since 2009 that the Taiwanese government did not receive an invitation to join the WHA, once again completely denying Taiwan the above-mentioned benefits offered by the occasion.

This decision of the WHO has already been met with an international response. Among others, earlier this month, Ed Royce, chairman of the Foreign Affairs Committee of the United States House of Representatives, along with Eliot Engel, another member of the Committee, called for support from the U.S executive branch for Taiwan’s meaningful participation in the WHO.

Why WHA does not matter

It should be noted that, within the WHO framework, observer status applies to meetings instead of the entire organization, hence “Chinese Taipei,” as an observer to the WHA, does not also have access to any other WHO regional meetings or technical meetings. For an agency as massive and bureaucratic as the WHO, many discussions and decisions have to already have been made at these lower level meetings, and are brought to the WHA merely for approval.

Therefore, although being granted observership to WHA was one of the most significant breakthroughs for Taiwan’s international participation and does offer multiple benefits, involvement in the WHO is by no means substantial.

Without regular meetings and full access to organizational information, lobbying and intergovernmental partnerships are very difficult to carry out, let alone making an impact on the agenda and policies of the WHO. Taiwan is continuously excluded from numerous data-sharing schemes, cooperation frameworks, and intervention programs available only for member states.

Taiwan’s development of global health, in terms of policy, academia, civil society, and global connectivity, have all been greatly hampered by our absence in the WHO system ever since 1971, and the access to the WHA makes an only minimal amendment to this disadvantage.

This is not to say that the observer status at the WHA is not important, or that the decision to further exclude Taiwan from the global health community should not be rightly condemned for its jeopardy to health as a basic human right.

Nevertheless, this incidence can be seen, rather than as a catastrophe, more as a wake-up call for Taiwan to start formulating a more comprehensive global health strategy that does not overly rely on its unguaranteed status in the WHA.

How can Taiwan still be involved in the global health community

The World Health Assembly is open to not only officially invited delegates. A certain number of visitors possessing a U.N.-recognized identity are also allowed to enter the Palais de Nations – headquarters of the U.N. in Europe and the venue for WHA – and have access to the majority of the committees and events in the WHA.

Every year, a number of people from Taiwan, including NGO representatives and students, manage to participate through this route. This model of participation will be more and more vital for Taiwan if the difficulty of attending WHA continues to increase, and the Taiwanese government must figure out a way to form a closer partnership with these non-official attendees.

The alliance between government and the civil society should also extend beyond the WHA. Academic activities that study global health policies should be encouraged; NGOs and student organizations should be funded to engage in or organize global health events, seminars, and campaigns.

In the past few years, global health community has been experiencing a massive paradigm shift. The sustainable development goals (SDGs) approved by the United Nations General Assembly in 2015 called for intersectional approaches in public policies, and a stronger emphasis on social justice and environment.

However, current policies and public discourse in Taiwan is hardly ever framed through the SDGs. If Taiwan wishes to continue to be an active contributor to the global health community, it must also be capable of adopting frameworks recognized by the global community.

Actively taking part in other non-U.N. global health organizations or platform is another way to expand diplomatic space. As stated at the beginning of the article, the global health arena has never been as decentralized as it is today. New organizations and initiatives that are much more flexible and with more specified objectives are gaining influence and popularity among nations.

For example, Taiwan’s Center for Disease Control has been campaigning for Taiwan to join the Global Health Security Agenda (GHSA), a multinational initiative aiming to increase nations' capacity to prevent and respond to the outbreak of infectious diseases.

Epilogue

Forty-six years have passed since Taiwan was first excluded from the WHO. It certainly matters, and the endeavor to re-enter the WHO as well as the U.N. has to be continued. However, with a more diversified global health strategy, Taiwan can make it matter less.

Editor: Edward White