One Global Health Future

							CONCEPT PAPER #1

THE LEGALITY OF TAIWAN’S PARTICIPATION IN THE WHA
 AS AN OBSERVER IN THE CAPACITY OF HEALTH ENTITY

                         [Executive Summary]

    Taiwan seeks the support of the international community for a
proposal to this year‟s World Health Assembly (WHA) to invite Taiwan
to participate in WHA as an observer. The WHA should respond
positively such a proposal for the following reasons:

 Admitting Taiwan as an observer to WHA is clearly in the
  enlightened self-interest of WHO Member States in protecting and
  promoting global health and health security.
 Granting Taiwan observership as a “health entity” is consistent with
  WHO law, principles and practices of the vital health work of the
  Organization and other international organizations.
 According Taiwan observer‟s status as a “health entity‟ does not
  impinge on the question of sovereignty or the “one-China” policy.
 Excluding Taiwan from WHA is a deadly form of discrimination, it
  creates a gaping hole in international health efforts under WHO
  auspices which may open a potential threat from bioterrorism.

    Taiwan is a beacon of democracy and a champion of human rights.
As a central nexus of trade and travel in Asia, Taiwan enjoys solid
financial and human resources and an advanced public health system. Its
government has a concrete and admirable record of working
cooperatively with the international community to advance global public
health and contributing to international medical assistance and health
development programmes. However, Taiwan remains the only major
health entity totally excluded from WHA and participation in the critical
health programmes of the World Health Organization (WHO). Today,
more than ever before, there is an urgent need to reexamine the
inequitable treatment of the Taiwanese people and grant Taiwan
observership at WHO.

     The exclusion of Taiwan from WHA creates a critical and
unsustainable gap in the global health system established under WHO
auspices. In this era of rapid global integration, Taiwan‟s isolation from
the global health body and its international networks poses significant and
tangible risks to the health of the people of Taiwan and the rest of the

                                    1
global community. Consequently, admitting Taiwan as an observer to
WHA should be recognized as vital to collective efforts to protect global
public health and advance global health security. At the same time, by
endangering the health of the twenty-three million Taiwanese, Taiwan‟s
continued exclusion from WHA should also be recognized as a dangerous
and deadly form of discrimination against the people of Taiwan in
violation of core human rights principles.

     In the past, states opposed to Taiwanese participation in WHA have
primarily contended that granting Taiwan observer status is contrary to
the law and policy of WHO and/or the „one China policy‟ adopted by a
number of WHO Member States. As this concept paper shows, these
objections are groundless. In order to protect the health of its populace,
Taiwan is seeking to put aside the politically charged issue of sovereignty
in its application to WHA and be granted admission as a „health entity‟
observer and not as a WHO Member State. As recognized by many
existing WHO Member States, granting Taiwan observership as a “health
entity‟ does not impinge on the question of sovereignty, the “one-China”
policy or WHO‟s Constitution. Moreover, as Taiwan is an important
player in global public health efforts, it is increasingly recognized that
granting Taiwan admission as an observer to WHA is in fact consistent
with WHO law, principles and practices of promoting universal
participation in the vital health work of the Organization.

     This concept paper will explain why granting Taiwan WHA
observership as a “health entity” is a reasonable adjustment to existing
policy that is requisite to meet the public health needs of the Taiwanese
people and the rest of the global community. In this era of rapid
globalization, Taiwan is a vital and indispensable global partner in
international efforts to promote and protect public health. It is time to
grant Taiwan‟s application for WHA observership for the sake of
everyone‟s health.




                                    2
CONCEPT PAPER #1



 THE LEGALITY OF TAIWAN’S PARTICIPATION IN THE WHA AS
    AN OBSERVER IN THE CAPACITY OF HEALTH ENTITY



     Taiwan seeks the support of the international community for a proposal to
this year‟s World Health Assembly (WHA) to invite Taiwan to participate in
WHA as an observer. Taiwan is a beacon of democracy and a champion of
human rights. As a central nexus of trade and travel in Asia, Taiwan enjoys
solid financial and human resources and an advanced public health system, The
government of Taiwan has a concrete and admirable record of working
cooperatively with the international community to advance global public health
and contributing to international medical assistance and health development
programmes. However, Taiwan remains the only major health entity totally
excluded from WHA and participation in the critical health programmes of the
World Health Organization (WHO). Today, more than ever before, there is an
urgent need to reexamine the inequitable treatment of the Taiwanese people and
grant Taiwan observer status in the WHA.

     The World Health Organization, the 192 Member State specialized agency
of the United Nations in the field of health, leads the world alliance to improve
the quality of human life for all of mankind. WHO has wide-ranging functions
in the global community covering every aspect of public health and is the key
global player in fighting infectious diseases, establishing global health
networks, strengthening national health care programs, promoting primary
health care, delivering essential drugs, making cities healthier, and promoting
healthy lifestyles and environments to achieve health for all.

    Although the government of Taiwan is the sole legitimate authority over all
health matters in Taiwan, it has been excluded from participation in the World
Health Assembly and the activities of WHO since 1971 for purely political
reasons. Taiwan health officials cannot participate in global health conferences

                                       1
and deliberations with experts and specialists from other countries and virtually
all channels of communication with WHO‟s technical services are non-existent.
As Taiwan does not have observer status, its public health officials and medical
experts have no access to real-time public health information or the latest
disease control expertise. Even Taiwanese medical and health professionals
from the private sector and non-governmental organizations are frequently
blocked from participating in global conferences and networks sponsored by
WHO.

     This concept paper will explain why granting Taiwan observership in WHA
as a “health entity” is a reasonable adjustment to existing policy that is requisite
to meet the public health needs of the Taiwanese people and the rest of the
global community. Section 1 of this paper sets forth how the exclusion of
Taiwan from WHA creates a critical and unsustainable gap in the global health
system established under WHO auspices. As described in this section, the
complete exclusion of Taiwan from the global health body and its international
networks in this era of rapid global integration poses tangible and unacceptable
risks to the global community and the people of Taiwan. The emergence of
global epidemics such as SARS and the Avian Flu as well as the continuing
threat of global bioterrorism underscores that the continued isolation of Taiwan
is also a threat to global health security. This section further establishes that
admitting Taiwan as an observer to WHA is in the direct health interests of
WHO Member States as precedent establishes that Taiwan is a constructive and
contributing global public health partner.

    In the past, states opposed to Taiwanese participation in WHA have
primarily contended that granting Taiwan observer status is contrary to the law
and policy of WHO and/or the „one China policy‟ adopted by a number of
WHO Member States. As this concept paper shows, these objections are
groundless. In order to protect the health of its populace, Taiwan is seeking to
put aside the politically charged issue of sovereignty in its application to WHA
and be granted admission as a „health entity‟ observer and not as a WHO
Member State.


                                         2
     Section II sets forth that granting Taiwan admission as an observer to WHA
is consistent with WHO law, principles and practices of promoting universal
participation in the vital health work of the Organization. The principle of
universal participation is at the heart of the international health system
established by the WHO Constitution and, in practice, WHA has broadly
interpreted its mandate by granting observership to different types of entities.
Section III further describes how granting Taiwan observership as a “health
entity‟ has noting to do with the alleged “one-China” policy of those countries
having diplomatic ties with the PRC and is, in fact, consistent with the practices
of other international organizations in supporting membership or participation
of both Taiwan and China.

     Finally, Section IV of this concept paper discusses how admission of
Taiwan as a WHA observer is not only a public health necessity, but also
human rights imperative. By endangering the health of the twenty-three million
Taiwanese, the continued isolation of Taiwan from the global public health
community constitutes a dangerous and deadly form of discrimination against
the people of Taiwan in violation of core human rights principles.

     In this age of the rapid globalization of public health, Taiwan is a vital and
indispensable global partner in international efforts to promote and protect
public health. Admitting Taiwan as an observer to WHA is clearly in the
enlightened self-interest of WHO Member States. The global community should
not allow itself to be politically pressured to endanger world health by isolating
Taiwan.

                                     I
       Protecting and Promoting Global Health and Health Security:
       The Core Rationale for Including Taiwan as a WHA Observer

     This section will illustrate how Taiwan‟s WHA participation is a vital
component of effective global efforts to protect and promote public health. In
particular, the globalization of public health and the emerging demands of
health security, including global infectious diseases and the threat of biological

                                        3
weapons, mandate the widest possible participation in WHA. In addition,
Taiwan has a proven track record in global public health cooperation and is
ready and willing to be a constructive participant in WHA. Consequently,
granting Taiwan WHA observership is fundamentally a matter of enlightened
self-interest – the direct health interest – of every WHO Member State.

(1) Taiwan is an Indispensable Global Health Partner in This Era of the
Rapid Globalization of Public Health

     A dominant characteristic of contemporary globalization is that it has
introduced or expanded risks to health that transcend national boundaries. The
growing laundry list of globalized health problems includes, among other
things, emerging and re-emerging infectious diseases, food safety and trade in
unhealthy products, such as tobacco.

     It is widely recognized that the globalization of public health has
dramatically expanded the need for effective international cooperation and
collective action. For example, global surveillance and collective action are the
best means of reducing the globalized threat of emerging and re-emerging
infectious diseases. To respond to infectious disease threats, communities must
be able to identify infectious disease outbreaks and respond rapidly with
international support. Today, the most important initiative for global
surveillance of infectious diseases is WHO‟s Global Outbreak and Disease
Response Network. This highly sophisticated international collaboration led by
WHO involves a network of over 100 laboratory and disease reporting systems,
providing up-to-the minute reports of infectious disease outbreaks, specialized
investigations and direct technical assistance to WHO Member States.

     Taiwan has been completely left out of this critically important global
network. In today‟s rapidly shifting and globalized context, focusing
international health policy on states alone entirely misses the dynamics of
globalization and health. It is not individualized states that require specific
attention, but health issues themselves which have transborder qualities that
cannot be confined to specific countries. Tackling global health problems

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comprehensively requires the broadest possible participation in the Global
Outbreak and Disease Response Network in particular and WHA in general. It
is in the clear self-interest of WHO Member States that all communities,
whether states or other entities, are active partners in the global health network.
Protecting health anywhere improves health everywhere.

     In the contemporary battle against globalized diseases, Taiwan is
particularly significant as a global public health partner. In fact, recent global
outbreaks of infectious diseases powerfully evidence the importance of
including Taiwan in the global health system and the danger that excluding it
can pose to the international community. Several severe outbreaks of infectious
diseases, including SARS and Avian Bird Flu, have been linked with China.
Because of Taiwan‟s strategic location across the Strait of Taiwan from China
and the large numbers of Taiwanese people traveling to and from China and
Hong Kong, Taiwan is likely to be more susceptible than any other Asian
country to an infectious disease originating in that country. Taiwan also is a
likely international gateway for the globalization of infectious diseases
originating in China because of its status as a key international travel, trade and
transportation hub in Asia.

(2) The Global Health Village: Isolating Taiwan from WHA Undermines
Global Public Health by Endangering the Health of the Taiwanese
Population

     Intentional efforts to cut off Taiwan from the global public health
community also endanger international health because they damage Taiwan‟s
capacity to protect the public health of its population of 23 million. An essential
corollary of the globalization is that increasing global integration has severely
restricted the capacity of governments to protect domestic health through
unilateral action alone. Consequently, efforts to marginalize Taiwan seriously
impinge on the capacity of the government to protect the health of its domestic
population. In the SARS epidemic, for instance, Taiwan had the largest per
capita death rate of any country in the world. This situation is not only morally
intolerable, but it also poses a grave danger to international public health. In the

                                         5
era of increasing global health interdependence, a new geography of
international health is emerging in which it is increasingly understood that we
are living in a “global health village.” Ignoring the health of populations in one
corner of the globe may quickly create health risks to populations in other
corners. Given Taiwan‟s highly strategic position in Asia, undermining the
health of the Taiwanese population through isolation from WHO poses an
unacceptable public health and moral risk to the international community.

     The SARS epidemic, which originated in China, provides ample proof that
Taiwan‟s exclusion represents a serious threat to the health of communities
worldwide. As is well known, Chinese authorities undermined global health by
covering up the emergence of the disease for several critical months. In contrast,
Taiwan promptly reported its first SARS case to WHO in March 2003 and
requested international assistance from WHO. Despite the potential of a global
pandemic, WHO did not respond for almost 7 weeks to the request for help
from Taiwan. During the outbreak, Taiwan was prohibited from participating in
WHO expert meetings and video-conferences and did not have access to real-
time disease control information. Thoroughly isolated, Taiwan was forced to
rely on out-of-date disease control guidelines published on the WHO website.
Taiwan quickly became one of the most SARS endemic communities in the
world. Finally, in mid-May 2003, WHO began to respond to Taiwan‟s requests
for international disease control assistance. In the same month, Taiwan was
allowed to take part in a WHO SARS- related meeting for the first time.

     Taiwan is a valuable partner in the global disease control network and
politics should not inappropriately complicate the collective global battle
against infectious diseases. The admittance of Taiwan to a SARS related
meeting, despite the health entity‟s initial isolation from the global disease
control community, reflects the fact that WHO officials ultimately appreciated
the practical reality that the Organization needs to cooperate with all
communities, including states as well as other entities, to control the
globalization of infectious diseases. SARS proved that we truly live in a global
health village: that the worst-case scenario epidemic predictions cautioned by
disease experts can come true in this era of rapid international travel.

                                        6
Importantly, the SARS epidemic also showed that aggressive disease outbreaks,
for all their speed and force, can be contained and even stopped if there is
effective and comprehensive global cooperation.

     This central lesson from the SARS epidemic of the need for truly inclusive
global cooperation to protect international health has not, unfortunately, been
learned by the world community. In early 2004, WHO warned the global
community that Avian Flu could emerge as a dire threat to global health. As
described further herein, despite the grave predictions of the global public
health implications of this influenza and calls by WHO for international
coordination to fight the virus, Taiwan has once again been excluded from
meetings and conferences in which bird flu experts are devising and instituting
plans to fight the virus. Excluding Taiwan, a key country in global disease
control efforts, from WHO disease control activities leaves a gaping hole in
international health efforts.

(3) Excluding Taiwan from WHA is a Threat to Global Health Security:
Case Studies of Infectious Diseases and Bioterrorism

     The emergence of global epidemics such as SARS and Avian Flu
underscores the grave danger posed by the continued isolation of Taiwan from
the global public health community through the inappropriate politicization of
international health. Excluding Taiwan from WHA is not, however, simply
unsound policy, it is also a threat to global security.

    There is widespread recognition that health and human security are
inextricably linked in this era of rapid globalization. An increasing number of
health challenges stand out as closely connected to human security, including
global infectious diseases as well as bioterrorism.

     The challenge of infectious diseases has changed remarkably over the last
several decades and the globalization of disease now stands out as a vital threat
to global human security. The world is more mobile and interconnected today
then ever before as transportation has become rapid and international trade and

                                        7
travel more widespread. The epidemiology of infectious disease has also
changed rapidly, with the discovery of over two dozen new microbes and
increasing drug resistance.

     The threat that infectious diseases pose to human security has been
forcefully validated by recent epidemics. The scale and intensity of the
devastation wrought by the HIV epidemic is so vast that it has widely been
recognized as a threat to global security, including by the United Nations
Security Council. The SARS epidemic was the first disease to show the
tremendous potential for swift damage that infectious disease can cause in a
globalized world. It took HIV/AIDS two decades to cover the globe. SARS
reached 30 countries in less than a year, generating enormous panic, fear and
disruption, with an estimated cost to the global economy of 60 billion dollars. In
February 2005 WHO announced that a bird flu pandemic is now imminent –
warning that the world is in the “gravest possible danger” of a deadly pandemic
triggered by the virus. WHO also stated that the world is “now overdue” for an
influenza pandemic since it has been nearly forty years since the last one. A
global pandemic could kill millions.

     Responding to the threat to human security posed by the globalization of
infectious demands the widest possible international cooperation.
Comprehensive surveillance, cooperation and information sharing are the key
global public health strategies to restrict the early spread and, perhaps, prevent a
global pandemic.

     Taiwan is at the front-lines in the global battle against influenza. Yet
Taiwan remains outside of the WHO Global Disease and Outbreak Response
Network which can provide the global community with an early warning and
response to a deadly new influenza. The exclusion of Taiwan from the WHA
clearly poses a direct health security risk to the global community.

    The global potential for bioterrorism is another critical threat to global
security that has highlighted the need for comprehensive global cooperation
among diverse global health actors, including Taiwan. The last several years

                                         8
have brought into sharp focus the potential global risks of terrorists wielding
biological weapons. WHO plays a key role in encouraging and assisting its
Member States in strengthening global surveillance and response measures in
the likelihood that biological weapons are used. In the event of a bioterrorist
attack, WHO‟s global network would be a vital ingredient in international
containment efforts. Taiwan‟s exclusion from this WHO network undermines
global public health efforts to prevent and respond to major bioterrorist attacks
and is a direct threat to global health security.

     Health and human security are central matters of human survival in the 21st
century. The current selective approach to health security which seeks to isolate
Taiwan is neither sustainable nor morally acceptable. In this era of
globalization, ignoring Taiwan is a direct threat to health security. The practical
fact is that it is time to grant Taiwan‟s application for observership at WHA for
the sake of everyone‟s health.

(4) Taiwan will be a Constructive and Contributing Observer at WHA

     It is in the direct public health interest of WHO Member States to admit
Taiwan as an observer because the health entity will be a constructive and
contributing global public health partner at WHO. With the active support of
the global community of nations, Taiwan has grown dramatically over the last
several decades. With an economy that ranks 16th in the world, it has
tremendous resources and experience in public health. Taiwan has a concrete
track-record of contributing to global health efforts and can make important
contributions to WHO‟s technical assistance programmes.

     With strong experience in public health and solid resources and institutions,
Taiwan has a keen desire and a manifest capability to serve a responsible role in
WHO. Taiwan enjoys one of the highest levels of life expectancy in Asia and
was the first country in the region to establish a universal health insurance
system Taiwan‟s globally recognized health care system, which covers 99% of
the Taiwanese population, was ranked second in the world in 2000 by the
London-based Economic Intelligence Unit. Taiwan has successfully eradicated

                                        9
numerous diseases, including smallpox, rabies, polio and malaria. It is one of
the few countries of the world to establish an effective nationwide HIV/AIDS
programme, including free medical care and treatment to persons with
HIV/AIDS. Taiwan was also the first in the region to establish a comprehensive
system to provide children with Hepatitis B vaccines.

     Although Taiwan is not a member state of WHO or the United Nations, it
has consistently exhibited its good faith and commitment to WHO‟s objective
of health for all and humanitarian ideals by providing international medical
assistance and other health-related aid. Between 1995 and 2002, the total
government and NGO expenditure on international health cooperation and
medical assistance exceeded US$120 million to 78 countries on five continents.
Taiwan has also actively fostered health and technology exchanges, education,
and training; donated relief materials; and provided medical and humanitarian
aid. Since its founding, Taiwan has steadily expanded its overseas development
assistance as well. As of March 2004, it had 38 long-term technical missions
stationed in 32 partner countries. Taiwan also routinely supports global public
health programmes and initiatives, such as the Global Fund to Fight AIDS,
Malaria and Tuberculosis and international efforts to rebuild Iraq. Taiwan is
also fifth largest donor in the world to Afghanistan.

    Taiwan has also exhibited commitment to WHO policy and programmes by
supporting the promulgation and implementation of the WHO Framework
Convention on Tobacco Control (FCTC), the first treaty developed under WHO
auspices. Although Taiwan is excluded from formal participation in the FCTC
or any other treaty established under WHO auspices, the Taiwanese Congress
(Legislative Yuan) has ratified the FCTC and President Chen Shui-bian has
signed an Instrument of Accession as a tangible symbol of Taiwan‟s good faith
and support for global health cooperation under WHO auspices.

     Most recently, Taiwan has emerged as a leader in providing financial and
other support to tsunami relief efforts. In January 2005 Taiwan donated US$50
million dollars to aid tsunami victims, making it the world‟s eighth largest
donor. It has supplemented this aid with medical teams exceeding 200 doctors

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and relief goods designated for tsunami-devastated areas. The Taiwanese people
and charitable organizations are also doing their part to aid disaster victims. One
of Taiwan‟s major Buddhist charities, the Buddhist Compassion Relief Tzu Chi
Foundation, is working to provide medicine, food and permanent homes to
disaster victims in Indonesia, Malaysia and Sri Lanka. The organization has also
started a global tsunami relief campaign, mobilizing thousands of Tzu Chi
volunteers in 16 countries. Besides the need to raise funds for the relief effort,
this fundraising drive is also an effort to bring the disaster into the
consciousness of others unaffected by the tsunami and to inspire the kindness of
people around the world.

     Taiwan is committed to the moral and ethical imperative involved
advancing global health efforts and is prepared to fulfill its responsibilities to
the world community as an active participant at WHA. It is in the direct public
health interest of WHO Member States to support observership for Taiwan.
Taiwan has the financial resources, the public health expertise and the political
will to participate in and support global public health efforts led by the World
Health Organization.



                                    II
                       Taiwan WHA Observership
     Is in Accordance with the Law, Principles and Practices of WHO

     The first section of this concept set forth why granting WHA observership
to Taiwan is an urgent matter of global health policy and serves the direct health
interests of WHO Member States. States opposed to Taiwanese participation in
WHA have primarily contended that granting Taiwan observer status is contrary
to the law and policy of WHO and/or the „one China policy‟ adopted by a
number of WHO Member States. These objections are groundless. In order to
protect the health of its populace, Taiwan is seeking to put aside the politically
charged issue of sovereignty in its application to WHA and requests admission
as a „health entity‟ observer and not as a WHO Member State. This Section sets
forth that granting Taiwan admission as an observer to WHA is in fact

                                        11
consistent with WHO law, policy and practice of promoting universal
participation in the vital health work of the Organization. Section IV further
describes how granting Taiwan observership as a “health entity‟ does not
impinge on the “one-China” policy and is also consistent with the practices of
other international organizations in promoting the participation of both China
and Taiwan.

(1) The Principle of Universality is at the Heart of WHO’s Constitutional
Mandate to Advance the Health of All Peoples

    Admitting Taiwan as a WHA observer is consistent with the principle of
universal participation which is at the core of WHO‟s constitutional mandate to
advance the health of all peoples. Article 1 of the Constitution of the World
Health Organization provides that the fundamental objective of the Organization
“shall be the attainment by all peoples of the highest possible level of health.”
This self-proclaimed commitment to the principle of universality is at the very
heart of the international health system established at WHO.

     The principle of universality is embodied in several provisions of the
Constitution which clarify that the goal of the Organization is to serve all of
mankind. The Preamble sets for that the universal principle of health and human
rights: “[t]he enjoyment of the highest attainable standard of health is one of the
fundamental rights of every human being….” The Preamble further provides
that the principles of WHO “are basic to the happiness, harmonious relations
and security of all peoples.”

    The broad–based guiding principle of universality is consistent with the
idea that WHO was designed to be a technical organization and not a political
one. Diseases know no borders and the politicization of health undermines the
Organization‟s capacity to protect and promote world health. The founders of
WHO understood that the world body is fundamentally a forum for international
exchange and global cooperation on health.




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     Universality has been the fundamental guiding principle of WHO since its
founding. At the International Health Care Conference in 1946 that established
WHO, the then delegate of Canada who later became the first Director-General
issued a prophetic statement explaining the underlying rationale for the
principle of universality:

      This is not at all an altruistic gesture but a simple matter of enlightened
      self-interest. We cannot afford to have gaps in the fence against diseases,
      and any country, no matter what the 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 world-wide
      question, quite independent of political attitudes in any country in the
      world.

     In this era of globalization, the work of WHO is more important than ever
and the principle of universality has taken on a new, unprecedented urgency. As
this concept paper has illustrated, Taiwan‟s strategic location in Asia means that
the Organization cannot achieve its laudable goals of protecting the health and
the health security of “all peoples” globally, unless it cooperates with Taiwan.
Ignoring Taiwan, a country with a population larger than three-quarters of
WHO Member States, undermines the health and the health security of all.

(2) Granting WHA Observership to Taiwan is Consistent with the Law and
Practice of WHO and Other International Organizations in Promoting the
Widest Possible Global Participation

     In order to implement the principle of universal participation the framers of
the WHO Constitution incorporated a variety of provisions designed to ease the
participation of a wide variety of state and non-state entities. In practice, WHO
and its Member States have also generally adopted an inclusive and pragmatic
approach to representation at WHA in order to ensure the widest possible
political participation and further WHO‟s mandate to protect and promote
global public health.



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     WHO‟s emphasis on the widest possible participation is consistent with the
movement among international organizations, particularly technical
organizations, to organize participation not by the traditional criteria of
statehood but by the principle of universality. The United Nations itself has
granted observership to non-member states and others even though the United
Nations Charter does not contain any reference to observer status. In addition to
WHO, a number of other United Nations specialized agencies have also adopted
the practice of granting observer status to entities that do not qualify for full
membership.

(i) Admission as a WHO Member State: WHA’s Flexible Procedures and
Practices

     With respect to granting admission to WHO as a Member State, the WHO
Constitution strives to facilitate admission by establishing flexible procedural
requirements. Article 6 of the Constitution expressly stipulates that applicants
will be admitted as members “when their application has been approved by a
simple majority vote of the Health Assembly.” During the debates surrounding
the adoption of the WHO Constitution the original constitutional proposal
submitted on this issue was far more restrictive on the vote requirement for
admission, requiring the approval of a two-thirds majority of WHO Member
States. But, during the debates, the lesser requirement of a simple majority
gained favor when it was emphasized that the more restrictive two-thirds
requirement would not facilitate state accessions to WHO and would, therefore,
be directly inconsistent with the proclaimed principle of universality.

     It has been widely recognized that WHO‟s flexible procedural requirements
together without any possible of a membership veto as in the United Nations‟
Security Council is the reason why the Organization has been the first choice
for a number of countries wishing to enter the United Nations family. In
practice, WHO Member States have also interpreted the admissions requirement
very fluidly and have admitted a number of countries as member states in order
to advance the mandate of universality despite the fact that the status of such
entities as sovereign states was uncertain at the time of their application.

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Countries admitted as WHO Member States under this rubric include the
Federal Republic of Germany, Japan and the Cook Islands. Apart from
statehood, factors of importance for the Health Assembly considering
applications has been the capacity of the applicant to participate fully in the
work of the Organization and to exercise the responsibilities deriving from
membership.

(ii) Admission as a WHA Observer: WHA’s Broad Constitutional Mandate,
Legal Authority and Organizational Practice in Promoting Universal WHA
Participation

     WHO has adopted an even more flexible approach for the admission of
observers to WHA. Article 18(h) of the WHO Constitution lists, among the
functions of the World Health Assembly, “to invite any organization,
international or national, governmental or non-governmental, which has
responsibilities related to those of the Organization, to appoint representatives
to participate, without the right to vote, in its meetings….” Article 18(m) calls
upon the Health Assembly “to take any other action appropriate action to further
the objective of the Organization” – the attainment by all peoples of the highest
level of health.

     With this broad mandate to promote universal participation to advance
global health and no further constitutional or other legal requirements on this
issue, the World Health Assembly has broad authority to grant observer status
to any entity. Statehood is not a requirement for observership. In practice, the
WHA has interpreted the constitutional authority to invite observers very
broadly to encompass a wide variety of non-member states, non-governmental
organizations and other entities relevant to WHO‟s public health mandate.
WHA observership has been granted different types of entities, including the
Holy See and Palestine as well as three non-governmental organizations,
including the Order of Malta and two Red Cross affiliates.

    Taiwan clearly meets the legal requirements for admission to WHA as an
observer. The Taiwanese government is the sole legitimate health authority over

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Taiwan and for the 23 million Taiwanese. Hence Taiwan is an entity “which has
responsibilities related to those of the Organization” as mandated by the WHO
Constitution. As an independent “health entity” Taiwan has the capacity to fully
participate in the work of the Organization and to exercise any responsibilities
assigned by WHO. As this concept paper has illustrated, Taiwan is ready to
undertake any and all responsibilities assigned by WHO. It has worked to
advance WHO‟s objective of the “attainment by all peoples of the highest
possible level of health” at home through such means as universal health
insurance and as well as fully cooperating with WHO when permitted to do so.
Taiwan also advances the health objectives of WHO abroad through ever-
increasing international medical and other humanitarian assistance. Legal
precedent establishes that Taiwan meets the legal requirements of observer
status at WHA. Political will of WHO Member States is the sole remaining
factor in Taiwan‟s admission.



                                    III
                       Taiwan WHA Observership
              Has Nothing to Do with the Sovereignty of China

(1) Sovereignty is Not a Requirement for the Admission of WHA Observers

     A major obstacle to Taiwan‟s participation in WHA is the objection of the
government of the People‟s Republic of China (PRC). The PRC fictitiously
claims that Taiwan is one of its provinces and purports that Taiwanese potential
participation in WHO as an observer is in violation of its territorial integrity
and, therefore, its sovereignty. Accordingly, a number of WHO Member States
also object to Taiwan WHA observership under the mistaken argument that
admitting Taiwan as an observer would violate a „one China policy‟ adopted by
some states.

    In fact, Taiwan‟s application to WHA as an observer has nothing to do with
sovereignty or violating the territorial integrity of the PRC. As discussed, for
the purposes of its application to WHA, Taiwan is seeking to suspend

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discussion of the politically charged issue of sovereignty and to be granted
admission as an observer.

     As described above, participation in WHA as an observer does not require
statehood and entities of different natures, including states, quasi-states and
non-governmental organizations, have been granted observer status. By casting
an application for observership as a “health entity” rather than a Member State,
Taiwan is offering a pragmatic and apolitical approach to participation that
entirely avoids the question of statehood in order to protect and promote the
health of the Taiwanese as well as the global community.

    Taiwan, though possessing its statehood, is aware that a number of states
have adopted a so-called “one-China” policy. As statehood is not a requirement
for WHO observers, for those countries without diplomatic ties with Taiwan to
support, Taiwan‟s observership in the WHA as a “health entity” does not
impinge on the question of sovereignty or any “one-China” policy.

(2) Taiwan WHA Observership is Consistent with Taiwan’s Participation
in Other International Organizations

     The PRC‟s claim that granting Taiwan‟s application for observership
violates its sovereignty is also belied by the actual practice of other international
organizations. In reality, Taiwan and the PRC coexist productively and
peacefully in many international organizations. For example, both Taiwan and
the PRC are both full members of major international and regional financial
organizations such as the World Trade Organization, the Asian Development
Bank, and Asian-Pacific Economic Cooperation (APEC), Beijing and Taiwan
have been able to work together cooperatively in these other technical,
functional organizations and dual participation has not implicated the „one
China‟ political question.

    Following its successful bid to become a member of the World Trade
Organization in the capacity of a “separate Customs Territory” in January 2002,
Taiwan has been a member of the Advisory Centre of the WTO Law (ACWL)

                                         17
since 2004, also in the capacity of “separate Customs Territory”. In addition,
Taiwan has recently become member of several regional fisheries management
organizations in the capacity of “fishing entity” such as the Central and Western
Pacific Fisheries Organization (WCPFC), the Extended Commission of the
Commission for Conservation of Southern Bluefin Tuna (CCSBT), and will be
entitled to become a member of the Inter-American Tuna and Tuna-like
Commission (IATTC) when its newly-drafted Antigua Convention comes into
force in the near future.

     Notably, the world‟s trading nations have adopted a pragmatic approach to
ensure that Taiwan, an economic powerhouse, has representation in the critical
international economic organizations. Taiwan‟s membership in APEC, the
Asian Development Bank and the WTO is tangible evidence of this mutual
interest in international economic cooperation. This progress made in promoting
universal participation in economic organizations should surely be matched in
the field of health which is fundamental to human survival.

    Admitting Taiwan as an observer to WHA as a „health entity‟ is a creative
way for the world community to ensure that Taiwan‟s public health significance
and medical expertise can be properly represented in the global health
community while being consistent with the existing political realities on state
recognition. To grant Taiwan the status of observer will not jeopardize the „one
China policy‟ adopted by many WHO Member States or the peace process
between Taiwan and the PRC. Notably, a number of WHO Member States
have recognized that Taiwan‟s participation as an observer at WHA does not
impinge on any “one China policy.‟ For example, in 2004 the United States
promulgated legislation to endorse observer status for Taiwan at the annual
meeting of WHA every year and publicly expressed its firm support for Taiwan
observer status while pointing out that such support for Taiwan observership is
consistent with the longstanding “one China policy” of the United States.

    WHA can authorize Taiwan‟s observer status without impinging on the
“one China‟ issue by making it crystal clear that observership for Taiwan is in
no way a first step towards full membership. Observers at WHO fall into

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different categories and, in practice, the Organization has adopted subtle
distinctions surrounding their designation in its list of participants at WHA. The
Holy See appears under “Observer from a Non-Member State,‟ the three non-
governmental organizations under “observers” and Palestine, under „Observers
invited in accordance with Resolution WHA27.37.” In the case of Taiwan,
WHO Member States could adopt an authorizing resolution for Taiwan‟s
admission to WHA as an observer in the capacity of “health entity”. Such an
authorizing resolution would represent a sensible policy shift from a political
approach to a humanitarian one. Such a practical policy shift is essential to meet
the health needs of the global community, including Taiwan.

                                   IV
                      Excluding Taiwan from WHA
        Violates the Human Rights Principle of Non-Discrimination

     This concept paper has described how the admission of Taiwan as a WHA
observer is a public health necessity and consistent with the law, policy and
practice of WHO and other international organizations. This final section will
discuss how Taiwan‟s WHA admission should also be recognized as a human
rights imperative. By endangering the health of the twenty-three million
Taiwanese, the continued isolation of Taiwan from WHO constitutes a
dangerous and deadly form of discrimination against the people of Taiwan in
violation of the core human rights principle of non-discrimination.

(1) The Exclusion of Taiwan from WHA Jeopardizes the Health of the
Taiwanese People

     As described above, Taiwan‟s exclusion from WHA and, thereby, the
global public health community, seriously damages Taiwan‟s capacity to protect
the health of its population. An essential corollary of the globalization is that
increasing global integration severely restricts the capacity of governments to
protect domestic health through unilateral action alone. Increasingly, effective
international cooperation is becoming an indispensable ingredient in protecting
domestic health.

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     Even though Taiwan has one of the world‟s foremost domestic public
health care systems, its marginalization from the global public health
community profoundly affects the capacity of the government to protect the
health of the population and, ultimately, undermines the health of the Taiwanese
people. Taiwan cannot begin match the resources marshaled by WHO through
its global network of regional offices and country offices as well as national
collaborating centers and other cooperative arrangements with WHO‟s 192
Member States.

     The health risks to the Taiwanese population posed by exclusion from
WHA are not simply rhetorical. The following examples illustrate that the
willingness of WHA Member States to submit to the PRC‟s efforts to isolate
Taiwan from the global health community have had a profound impact on the
public health of the Taiwanese population.

    As described in the discussion of the SARS epidemic above, WHO
     ignored Taiwan‟s early calls for international assistance and fully
     excluded Taiwan from the global disease network until late into the
     epidemic when the disease was endemic in Taiwan. WHO‟s failure to
     provide timely intervention in the face of the imminent threat had deadly
     consequences: in just a few weeks 346 people were afflicted by the
     disease and 73 died in Taiwan. Taiwan had the second highest death toll
     from SARS in the world and the highest death toll on a per capita basis.

    Because Taiwan is not an observer at WHA, the Organization did not
     provide any assistance during a 1998 outbreak of Type 71 enterovirus in
     Taiwan. The outbreak affected the astonishing number of 300,000
     children and killed 80.

    WHO did not render any international assistance in the aftermath of a
     massive earthquake in Taiwan that killed nearly 2000 people.




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(2) Excluding the Taiwanese Population from WHO Violates the
Fundamental Human Rights Norm of Non-Discrimination

     Despite Taiwan‟s earnest efforts to become a responsible observer at WHA,
the Member States of WHO have continued to exclude the Taiwanese
population from any representation or participation at WHA largely because of
underlying political tensions surrounding the national status of Taiwan. As this
concept paper has shown, this exclusion of the Taiwanese populace from the
world‟s foremost public health body directly endangers the health of that
population. The inequitable treatment of the people of Taiwan by the world
community is contrary to sound public health policy. It also constitutes an
insidious form of discrimination against the people of Taiwan in violation of the
fundamental human rights norm of non-discrimination.

     The cardinal principle of non-discrimination is among the most frequently
declared norms of international law. Article 2 of the Universal Declaration of
Human Rights states the principle of non-discrimination as follows: “Everyone
is entitled to all the rights and freedoms set forth in this Declaration, without
distinction of any kind, such as race, colour, sex, language, religion, political or
other opinion, national or social origin, property, birth or other status.” The
principle has been restated in all of the major human rights instruments. It is
also a cornerstone of the preamble to the WHO Constitution which states that
“[t]he enjoyment of the highest attainable standard of health is one of the
fundamental rights of every human being without distinction of race, religion,
political belief, economic or social condition.”

     It is generally accepted that the principle of non-discrimination prohibits
any distinction, exclusion, restriction of preference having the purpose or effect
of impairing or nullifying the recognition, enjoyment or exercise by all persons,
on an equal footing, of all rights and freedoms. The principle of non-
discrimination is a powerful command to states to treat people equally.
Precluding the Taiwanese people from representation at WHA constitutes
discrimination in violation of international human rights norms. This distinction
and exclusion of the Taiwanese people simply because they are from Taiwan is

                                        21
an undeniable impediment to the achievement of equal human rights for the
Taiwanese populace. This concept paper has illustrated that such discrimination
directly affects the capacity of the Taiwanese people to achieve the right to
health on an equal basis with the rest of humanity.

     The discrimination against the Taiwanese people is particularly insidious as
it is being practiced at the world body charged with the “attainment of the
highest level of health of all peoples” without discrimination. In other contexts,
such as the plight of the Palestinians, the world community has recognized that
political circumstances should not constitute a bar to equitable access of all
peoples to WHO cooperation. Fundamental principles of human rights require
that the Taiwanese people should be treated on an equal footing with the rest of
mankind when it comes to participation in the world health body.



                                    V
                                CONCLUSION

     The international community needs to work cooperatively together to
address present, anticipated and unexpected health challenges that will arise in
the 21st century.

    Taiwan humbly seeks the support of the WHO Member States for its
application as a „health entity‟ in order fulfill its responsibility to protect the
health of the Taiwanese population. In response, WHO Member States should
adopt an authorizing resolution to grant Taiwan as an observer in the capacity of
“health entity” to WHA. Such an authorizing resolution would represent a
sensible policy shift from a political approach to a humanitarian one. Such a
practical policy shift is essential to meet the health needs of the global
community, including Taiwan.

     In the present age of far-reaching health challenges to global security,
enlightened self-interest mandates that WHO fulfill its founders‟ vision of


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universal participation in global public health policy and programmes. The
health of the world community depends upon it.




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