Taiwan’s status could disrupt the most important global health meeting of this pandemic

Taiwan’s former health minister, Yeh Ching-chuan, displays his observer badge at the opening of the 62nd World Health Assembly in 2009—the first time Taiwan was granted observer status by the WHO.
Taiwan’s former health minister, Yeh Ching-chuan, displays his observer badge at the opening of the 62nd World Health Assembly in 2009—the first time Taiwan was granted observer status by the WHO.
Image: REUTERS/Denis Balibouse
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On Monday, May 18, representatives of 194 countries will gather virtually for one of the most important public health meetings in recent memory.

A country thought to have had one of the best public health responses to the coronavirus pandemic—Taiwan—will likely not be in attendance.

At this week’s World Health Assembly (WHA)—the yearly convening of the World Health Organization (WHO)’s plenary body—member states will approve the organization’s budget, fill vacancies in its executive board, and vote on agenda items that include ending tuberculosis and eradicating polio.

Over two days, they will also address a resolution, originally proposed by the EU, calling on countries to jointly develop affordable diagnostics, medicines, and vaccines for Covid-19, and request that the WHO conduct a review “at the earliest appropriate moment” of the global response to this pandemic.

Why might Taiwan—which could potentially emerge stronger from this pandemic than it was before it—not be present? The country is not a member of the WHO, because most governments do not recognize it as an independent state. The Communist Party in China claims Taiwan as its own territory, even though it has never had sovereign control there.

The People’s Republic of China has represented “China” at the United Nations and all its agencies (including the WHO), since 1971. During a brief period of detente between Taipei and Beijing that lasted from 2009 to 2016, Taiwan was invited to the WHA as an observer. That stopped when the island elected a president that Beijing deems unfriendly to its interests.

Now, thanks to Taiwan’s effective response to this pandemic—and against a backdrop of worsening relations between China and countries around the world—the issue of Taiwan’s observership at the WHA has re-emerged with full force.

On Monday, the assembly will vote on whether Taiwan should be invited. The resolution needs the support of more than half of member states to pass. It’s unlikely to get it. Still, the number of countries willing to publicly support Taipei in spite of Beijing’s threats will serve as an indicator of how much damage China’s heavy-handed response to the pandemic has done to its global standing. (A spokesperson for the WHO did not address a procedural question from Quartz about what would happen if the vote went Taiwan’s way.)

Whichever way the vote goes, it will set a standard—for Taiwan’s geopolitical ambitions, for how the world community chooses to respond to China’s rise as a global power, and for the future of the standoff between the US and China.

Taiwan and the WHO: A history

Decades after Taiwan was expelled from the WHO in 1971, its re-inclusion hinged on two words in a wonky 84-page legal document: the revised International Health Regulations (IHR) of 2005.

First promulgated in 1969 as an instrument to prevent the international spread of diseases, the regulations were up for a fundamental revision in 2005. The 2003 SARS epidemic highlighted the danger of excluding Taiwan from the global health network, and the IHR revision presented opportunities to join the new framework. Taiwan lobbied hard to add the phrase “universal application” to the text, which it believed would provide the premise for its participation, even if only as a non-member. With backing from the US and other Taiwanese allies, the revised IHR, passed and implemented in 2007, called for the “universal application for the protection of all people of the world.”

“The wording ‘universal application’ left some space for Taiwan to participate in the IHR,” wrote Che-ming Yang, a former high-ranking official in Taiwan’s health department, in a journal article about Taiwan and the WHA in 2010. “Taiwan used this principle to claim a right to join the IHR framework,” and it used the same appeal in its bid for WHA observer status.

When Taiwan stopped receiving invitations to the WHA in 2017, the then director-general of the WHO, Hong Kong’s Margaret Chan, said she had made the decision on her own volition because Taipei had violated the “One China” policy. The current director general, Tedros Adhanom Ghebreyesus, reiterated his adherence to the “One China” principle as soon as he was elected, suggesting he will be unlikely to break with precedent and invite Taiwan this year. A WHO lawyer has already said that the body has “no mandate” to invite Taiwan to the assembly—a declaration that makes the possibility of Taiwan’s participation all but dead. Scholars have disputed this interpretation of the WHA guidelines, pointing out that the rules have not changed since 2016, when Taiwan was last invited.

The “One China” principle has been center-stage this time around as well. China’s foreign ministry said this week that Taiwan couldn’t participate in the WHA because its government didn’t accept the principle, to which Taiwan’s health minister replied, “I have no way to accept something which does not exist.”

It’s different this time around

The WHO has tied itself into knots trying to distance itself from the messy politics of all of this, but it’s ended up having the exact opposite effect. The weeks leading up to World Health Assemblies are usually the busiest of the year in Geneva, full of back-and-forth negotiations over major health issues. This time, attention has been dominated by questions over why the WHO won’t invite Taiwan, and whether it can even do that if China blocks such a move.

The issue of Taiwan’s participation “is like a boring and annoying ritual that comes up every year at the beginning of the World Health Assembly,” said Andreas Wulf, Berlin representative for the aid group Medico International, who has attended the assembly more than a dozen times to represent civil society. “It’s a political game that is acted out at the WHO, which should not be at the level of WHO.”

Yet politics has always been fundamentally entwined in the WHO’s work, no matter how much it insists that it is an apolitical body. The same goes for every UN agency. For example, the US and Israel cut funding to (and eventually withdrew from) the UN Educational, Scientific and Cultural Organization (UNESCO) after it granted membership to the Palestinian Territories. The WHO “is always confronted with big politics,” argued Ilona Kickbusch, an advisor to the WHO and member of the Global Preparedness Monitoring Board. But this year, Taiwan is “much more demanding than it was in the past.”

Kickbusch argues that territories like Taiwan use international organizations like the WHO “as a testing ground. You take an organization that’s not, per se, political and you sort of test out, who will support you, how far you can go. And based on that, you then consider whether it’s time to take it to New York,” by which she means the United Nations.

Taiwanese officials deny they’re playing politics over this issue. They frame Taiwan’s struggle to participate in WHO assemblies as a global problem. “I think the experience of Taiwan in dealing with this pandemic is worthwhile to share with the international community,” an official from the Taiwanese mission in Geneva, who asked not to be named due to the sensitivity of negotiations around the WHA, told Quartz.

At the same time, however, Taipei is wielding its soft power, publicizing its donation of masks to other countries and holding the rare baseball game. The goal is to build on its public health success—as well as past successes dealing with SARS in 2003 and the H1N1 flu in 2009—to build more ties with international bodies and gain support from prominent countries.

That they have succeeded at doing the latter is clear. More than 20 countries have expressed support for Taiwan being invited to observe the WHA, including the US-led “group of eight,” made up of Canada, Germany, France, Japan, the UK, New Zealand, and Australia, as well as 14 of the 15 countries (pdf) that officially recognize the government of Taiwan. That support might well amount to nothing—but Taiwan seems intent to keep trying.