"China" was one of the founding members of the United Nations. Whatever you mean by "China," anyway. When the UN was formed in 1945 there was only one China. After the Revolution of 1949 the losing side retreated to Taiwan and claimed the title of Republic of China. The US and its allies stupidly continued to recognize them as "China" to keep another communist country from the Security Council, but by 1971 the absurdity of denying mot Chinese a seat in the UN was patently obvious and the People's Republic of China took the place of the ROC. At the time I was strongly in favor of this and I still think it the only logical and reasonable option. But the two continue to squabble about which one represents "China." It is tiresome. Meanwhile there are 23 million people on Taiwan without representation or voice in critical UN agencies, like WHO, and WHO's Secretariat has once again rejected Taiwan's bid for membership because of objections from Beijing. The excuse is that Taiwan isn't a sovereign state.
Maybe that's true. I don't really care. While the two macho pygmies of international relations continue to argue about whose sovereignty is longer, WHO can't have effective relationships with health professionals in a community of 23 million people near one of the globe's great geographic viral incubators. The battle is being joined in the most inappropriate terms, naturally:
Taiwan's President Chen Shui-bian on Sunday protested against the World Health Organisation's rejection of the island's latest bid for membership which had angered rival Beijing.
Chen on April 11 wrote to WHO director general Margaret Chan but the WHO secretariat insisted the island was not a sovereign state and not eligible to apply for membership of the international body.
"Taiwan is a independent sovereign state and has the right to join the WHO. Neither the WHO nor its director general have the right to deny or strip the human rights of 23 million people," Chen told a seminar on the island's WHO efforts.
"The WHO secretariat has no right to unilaterally decide if Taiwan is a sovereign state or if it is entitled to apply for WHO membership," Chen said.
"Therefore, I, on behalf of the government and 23 million people, am filing the strongest protest to the WHO secretariat." (ChannelNewsAsia)
Whether China is a sovereign state is different than whether 23 million people should be brought under the umbrella of the international health system. It would seem reasonable to say (not that reason has much to do with this) that Taiwan can have WHO observer status without making a judgment whether it is a sovereign state. Maybe there is some legal nicety here, but legal niceties are violated all the time. The only two parties that care about who is called what are the two idiot governments squabbling over this. Those that have a stake in global public health include all the rest of us, too. We are better off including Taiwan in the international health system. It is a sign of weakness that the PRC is so threatened by this symbolic issue.
WHO Director Chan could and should cut the Gordian Knot by working with the upcoming World Health Assembly (WHO's governing body) to grant Taiwan observer status, thus allowing them to participate in the international health community. She doesn't have to call for this publicly. She can do it quietly, by not actively opposing it or opposing it in a pro forma fashion.
She could. If she had the courage.
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If THEY have samples, I wonder who they really belong to? Will they try to hold us all for ransom and hostage as Indonesia is?
I'm actually undertaking an Honours thesis in the general area of International Relations and bird flu. IMO, global health governance is suffering from the same challenges that plague the Security Council. Namely, the focus is on relative, rather than absolute, health gains.
In fact, by turning issues such as pandemic influenza into a question of 'security', we trigger the realpolitik chip in every foreign affairs and defence policymaker. You'll see it again and again as the more broadly humanistic goals of the public health community get swamped by the strategic concerns of the nation state. It's one of the under-appreciated problems that come with turning health into an issue of security.
Jon: You might be interested in a series I did on the old site:
http://effectmeasure.blogspot.com/2006/06/who-part-i-300-years-old-at-b…
http://effectmeasure.blogspot.com/2006/06/who-part-ii-westphalian-publi…
http://effectmeasure.blogspot.com/2006/06/who-part-iii-world-changes.ht…
http://effectmeasure.blogspot.com/2006/06/who-part-iv-one-door-closes-a…
http://effectmeasure.blogspot.com/2006/06/who-part-v-end-of-beginning.h…
Cheers Revere, that was enlightening. The Westphalian System's inability to cope with the current global situation is a topic of immense discussion in the bowels of International Relations departments everywhere.
On the topic of health, there is considerable scholarship on the issue in the political science disciplines. In particular, some work which Colin McInnes and Kelley Lee did for the Nuffield Trust in 2003-2005 is one of the more solid accounts I've seen:
http://www.nuffieldtrust.org.uk/research/index.asp?id=39
Also check out the new Biosecurity Centre at the Australian National University which is bringing ethicists, political scientists and public health researchers to do some good interdisciplinary research. (http://biosecurity.anu.edu.au)
Public health HAS to be aware of its broader political and social environment - for the simple reason that it is dealing with collectivities of fallible humans.
I agree that this is tiresome, and Taiwan should be given observer status. However, this is not some minor squabbling between 2 stupid governments. The current Taiwanese president is a bit of a maverick for Taiwanese independence, which China opposes vehemently. This is an issue where both sides have repeatedly affirmed they will go to war over.
Whatever we think, the reality is China ia unlikely to give an inch over this. In the WHA, if and when a dispute arises, China has huge bloc votes from Third World countries, and no one else except maybe the US and a couple others would spend whatever political capital they have for poor little Taiwan.
This is way too big for Chan. No way she can pull anything off. I wish it was different, but there it is!
Jon is right, we will repeatedly see the intersection where global public health bump into realpolitik. The result is always nastier than the public health community can possibly imagine.
Susan: I don't doubt you are right in the specifics. But it is still worthwhile for someone to say what needs to be said, even if they don't listen. The fact that both sides have elevated this to a matter of life and death doesn't make it a reasoonable for either country to take. Small minds thinking tiny.
Jon/Revere-Here is something you can use.
http://www.rand.org/pubs/technical_reports/TR405/
PDF is downloadable for free about midpage down. Its funding actually goes back to the 1980's when the word "smallpox" was being used as a possibility for an attack. But indeed health and security are intertwined.
A rampant virus or situation that starts to get out of hand that a country cant or wont do anything about gets another country up in arms. Could we get to a military response for a health emergency for something like this? At what point in time do you throw in the towel and use the option? E.g. Tactical nuke strike to sanitize an area or other method.
There is a lot of conjecture and mostly because the situation hasnt really presented itself just yet in our modern world, but it might. H5N1 is specifically discussed but it starts down that slippery slope that we have bumped up on here. Could we do it if we had to? Would we to save the world? Probably not for H5N1 at this stage of the game, but maybe something else. How does one arrive at the military option in a medical situation? "Doctor, first do no harm", plays into this. Is it Dr. Kervorkian, euthanization, or just flat murder? Is it murder if someone knows that the fatality rate ensures the destruction of humankind? Man...lots of things to consider.
I hope we never get presented with the situation but history proves we might someday.
MRK: I've actually come across that RAND report before, it's an interesting read if you want to see the dearth of knowledge about disease in the bureacracy. A more salient one for our present topic is the Brower and Chalk monograph from about 2003:
http://www.rand.org/pubs/monograph_reports/MR1602/
Good discussion on what disease means for 'national security' types.
Susan and Revere: While the current situation seems to inspire hopelessness, it is encouraging to note that countries such as Vietnam have decided to reverse their "traditionally-Soviet" stance on sovereignty in the face of bird flu.
It would be interesting to see what sort of regional or bilateral public health initiatives Taiwan is participating in. If only because there has been traditionally less hostility to the idea of Taiwanese involvement in non-Westphalian bodies. I'll do some digging...
Here's an interesting website from the Taiwanese govt:
http://english.www.gov.tw/WHO/index.jsp?categid=247&recordid=93170
All Revere's reasons plus more for letting Taiwan join as an WHA Observer. If only the Taiwanese President would agree...
Jon, thanks for the link to the Nuffield article (unfortunately the link to the .pdf would not work) but the link to the follow up article Health, and foreign policy in the UK: The experience since 1997 did.
I argued for a WHO with teeth, in the discussion after the Westphalia posts, and blamed the position the WHO is in on a failure by the Nation States to divest any power in the IHR(2005) negotiations. I was saddened to see in the Nuffield paper that Colin McInnes attributed this, at least in part, to a reaction by the states to the WHO attempts to act over SARs.
Such cooperation however is fragile, and a reaction to WHOs assumption of a more proactive stance appears to have set in. Not least, negotiations on revising the International Health Regulations (IHRs) saw member states reasserting their sovereignty and demonstrating an unwillingness to allow WHO a greater role in the control of disease.
revere,
Agree. I just wanted to point out that this is not a trivial matter. ie it's not small-mindedness in and of itself, but that the public health issue got caught in the cross-fire, as happens in, well, disputes.
And, FYI, a lot of people have already said what needs to be said, for some years. Still needs to be said though, but, I'm not holding my breath..
US backs limited health body rolebut how?
http://www.taipeitimes.com/News/front/archives/2007/05/13/2003360617
Bush is officially opposed to a vote on observer status for Taiwan in the upcoming WHA meeting.
"Meaningful participation," as currently used, is a term that applies to the inclusion of Taiwan experts in a non-official capacity in such activities as the Global Outbreak Alert and Response Network and the International Health Regulations adopted in 2005 governing notification of diseases and health emergencies of international concern
.but the countries holding technical meetings are pressured by China not to give TW medical experts entry visa.
So, Mr. Bush wants WHOs head, Margaret Chan, to help push TW into true meaningful participation, but how?
Margaret Chan was voted in because China helped buying votes for her by holding a China-Africa summit right before (less than a week) the WHO Director Generals election in November, China exchanged the favor by forgiving the debts of these African nations. If someone helped you get into a post, how do you go against him? Besides, the secret MOU (memorandum of understanding) which sought to provide TW meaningful participation is still not an open document, does WHO official have right to sign a secret document?...help me on this
about the MOU: portion of the secret leaked http://www.economist.com/daily/columns/asiaview/displaystory.cfm?story_…
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 Chinas delegation in Geneva (the WHOs 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.
Besides, is there a lack of regional representation when we have a DG of WHO from China, and an advisor to the Director-General, Liu Peilong, http://www.who.int/dg/office/peilong/en/index.html also from China?
It was laughter when a registered letter from TWs President representing 23 million peoples wish to join the WHO was found returned after dark, slipped under the door of Taipei representative office in Geneva, WHOs who is behind this?...finger print is required?
Should there be a new IHO, International Health Organization, which will accept TW to counter the WHO? If and only if TW doesnt get even the observer status this year. So the little citizens of the world will not be worried about the missing hole on the little island, their people travel a lot, and I am using their product to get this message done. http://english.www.gov.tw/WHO/index.jsp?categid=181&recordid=103138