A Healthy Choice For China: Taiwan And The Who

Publication: China Brief Volume: 4 Issue: 12

The World Health Organization’s (WHO) annual meeting at the World Health Assembly (WHA) in Geneva has increasingly become entangled in Taiwan’s effort to carve out international space for itself in multilateral organizations. The United States has consistently supported Taiwan’s push to join the WHO as an observer since Taiwan started its campaign in 1997. This year, however, the heightened political atmosphere in both Taipei and Washington contributed to a more vigorous and visible effort to bring Taiwan’s membership to a vote, resulting in greater tension between Washington and Beijing. But China’s current policy to contain Taiwan and prevent the island from joining the WHO does not serve its ultimate goal of reunification or advance the “one China” principle. Rather, China’s endeavors to keep Taiwan out of the WHO drives the wedge deeper between China and the people of Taiwan, making it all the more difficult for Beijing to cast itself as a peaceful member of the international community. Additionally, China’s stance strengthens the hand of President Chen Shui-bian and his pro-independence supporters. China can begin to reverse the trend towards independence by supporting Taiwan’s proposal to join the WHO as a non-state observer. To do so would not forfeit China’s claim to sovereignty over Taiwan but would improve its standing amongst the Taiwanese people. This new approach could also encourage increased international support for China’s own fragile public health system.

On May 18, the members of the WHO voted for the first time since 1997 on whether or not the WHA meeting agenda would include a discussion of Taiwan’s application to join the WHO as a “health-entity with observer status” (similar to the Palestine Liberation Organization, the Knights of Malta, and the Vatican). The resulting vote was 133 to 25 against, with the 23 countries that formally recognize Taiwan, the U.S. and Japan voting for the measure. China was extremely upset that the United States voted to include Taiwan on the agenda. Further angered by public statements by U.S. officials in support of the measure, Beijing also took exception to personal contacts between U.S. and Taiwanese officials in Geneva over the course of the assembly.

China’s acrimonious reaction to the events in Geneva and President Chen’s inauguration speech appear to be a retreat from the more flexible tone discernable in the days prior to the WHO vote. The head of the Chinese delegation to the WHA, Executive Vice Minister of Health Gao Qiang, declared that Taiwan’s attempt to join the WHO was an attempt to create “two Chinas,” not to serve the interests of the people of Taiwan. China’s reaction included freezing health-related bilateral cooperation with the U.S., “postponing” a U.S.-China healthcare forum in Beijing scheduled in late May, and canceling official meetings between U.S. and Chinese health officials. On May 23, Xinhua reported that Secretary of State Colin Powell called Foreign Minister Li Zhaoxing to assure Beijing that the U.S. will continue to adhere to the one China principle. While the details of the conversation have not been reported, it can be assumed that the freeze on health exchanges was addressed.

The concern remains that political tensions between China and the U.S. will hinder efforts by the international community to address health issues in a timely fashion. This is particularly worrisome in the event of the emergence of an infectious disease outbreak such as SARS, where a delayed response by the Chinese government in 2003, including the refusal to allow WHO teams to travel from Beijing to Guangzhou for one week, resulted in a regional epidemic.

Broad Support for Taiwan’s Inclusion

U.S. administration officials argue that the level of contact between U.S. and Taiwanese health officials and the U.S. government’s public support for Taiwan’s membership have not substantively altered since 1997. In May, private meetings took place in Geneva between U.S. Secretary of Health and Human Services Tommy Thompson and Taiwan’s Minister of Health, Chen Chien-jen, as they have every year – though this year, the meetings received wider coverage in the Taiwanese press. Chinese ire over overt U.S. support for Taiwan’s inclusion on the WHA agenda arose despite the fact that this is not the first time that Secretary Thompson has raised the issue. The U.S. delegation to the WHA meetings has the outspoken support of the U.S. congress and the tacit support of the administration. Since 1999, both houses of the U.S. congress have introduced and passed bills calling on the U.S. government to seek Taiwan’s membership in the WHO. This year, the bill was passed unanimously in both the house and the senate and contained language referring to SARS and the bird flu. Both the Clinton and Bush administrations have supported Taiwan’s efforts to participate in “appropriate” international organizations. Under the 1994 Taiwan Policy Review, President Clinton stated his intention to preserve the one China policy framework while supporting Taiwan’s membership in international organizations and authorizing cabinet-level officials from economic and technical departments to meet with their Taiwanese counterparts.

China’s Dilemma

Beijing’s uncompromising “one China” stance and its refusal to allow Taiwan any international presence has thus far been relatively successful in “containing” the island. But these successes have been at the expense of alienating many in Taiwan who increasingly identifying themselves as Taiwanese, rather than Chinese. The 2003 cover-up of the SARS outbreak in China and the subsequent spread of the virus to Hong Kong and Taiwan further demonstrated to many Taiwanese the fundamental differences between the mainland and the island, reinforcing the political resolve of some to push for membership in the WHO. China’s effort to keep Taiwan isolated in the international community does serve the purpose of maintaining the “one China” chimera, though in the case of the WHO, it appears hypocritical and thuggish to many Taiwanese. These actions increase support among average Taiwanese for independence-oriented politicians, effectively pulling the mainland into the fray of Taiwan’s domestic politics.

China’s Healthy Alternative

Chinese strategy-makers need to consider new approaches that will improve the mainland’s perception among Taiwanese and encourage Taiwanese leaders to work towards a resolution suitable to both sides. By supporting Taiwan’s participation in the WHO as a “health entity with observer status,” Beijing would lose little strategically, yet gain much in terms of good will and potentially increased support from the international community to help bolster its own failing health system.

Public health represents a core self-interest for China, particularly following the social and economic disruption of the 2003 SARS outbreak, making it a suitable focus for building cross-straits détente. Additionally, as China awakens to its developing HIV/AIDS crisis and addresses endemic tuberculosis and hepatitis challenges, multinational cooperation on public health issues becomes increasingly important, requiring significant capital and expertise from international sources. Mainland, Taiwan and U.S. officials have ample opportunities and incentives to cooperate on public health issues of mutual interest. Key international conferences, such as the biannual International AIDS Conference taking place in Bangkok this July, provide unique venues for officials from both sides of the straits to meet and consider strengthening ties.

By allowing Taiwan to join the WHO as a non-state, the mainland would not give up claims to sovereignty over the island any more than it does with Taiwan’s existing membership as a “separate customs territory” in the World Trade Organization. By extending a tangible olive branch to not only Taiwanese leaders, but the 23 million Taiwanese as well, Beijing would set the tone for renewed cross-straits dialogue and place itself in a better position to expect honest and substantive discussions.


China’s uncompromising approach to Taiwan over the past decade has been unsuccessful in promoting unification. If China wants to reverse the trend towards Taiwan independence accommodating, rather than coercive, tactics seem more likely to produce results at this point. China needs to consider imaginative, flexible, pragmatic and proactive strategies to woo the Taiwanese people, as well as their leadership, into closer cooperation, and ultimately, a peaceful resolution of the issue. While public health cooperation and Taiwan’s membership in the WHO would not solve fundamental sovereignty issues, the policy would represent a step towards resolution.

Most importantly, health issues require considerable cross-straits and regional communication and cooperation. Public health, particularly infectious diseases, respects neither borders nor sovereignty, as was clearly proven by the SARS outbreak. The threat of a future regional health crisis intensifies as China increasingly opens to the outside world and the vibrant, free-flow of commerce expands. Addressing the challenge that public health presents is necessary not only to maintain economic growth and stability for China, Taiwan and the international community, but also presents an important diplomatic opportunity that could contribute to peace and stability in the region.