Implications of Coronavirus Outbreak on Taiwan’s Campaign for the World Health Organization

This article was originally published by Global Taiwan Institute in its weekly newsletter, The Global Taiwan Brief, Vol. 5, Issue 5. Used with permission. To get the Global Taiwan Brief in your inbox every week, subscribe at globaltaiwan.org/subscribe. 

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By I-wei Jennifer Chang, a research fellow at Global Taiwan Institute.

With the outbreak of the novel coronavirus (COVID-19) from Wuhan, China, that has already killed at least 3,800 and infected more than 108,000 worldwide, including 1 death and 45 confirmed cases in Taiwan (as of March 9), Taiwan has gained yet another opportunity to amplify its decades-long campaign to join the World Health Organization (WHO), or at least obtain observer status to join WHO meetings. Taiwan’s government recently renewed its call to participate in the WHO and gain access to WHO updates on the coronavirus. “Like all other countries, Taiwan is currently facing the risk from this global pandemic,” Taiwan’s President Tsai Ing-wen (蔡英文) said on January 30. “We have the capability and the responsibility to do our part for the international community, and we hope that the WHO will not exclude Taiwan for political reasons,” Tsai said. “The WHO must make room for Taiwan’s participation,” she said, expressing gratitude to the United States, Canada, and Japan for their sustained support for Taiwan’s membership in the global health organization.

In a small step forward, Taipei was allowed to join a WHO technical meeting in an online capacity on February 11 to 12. Beijing claimed that it gave permission for Taipei to attend the meeting, though Taipei retorted that the meeting was arranged in direct talks with the WHO, backed by support from the United States and Japan. Amid international criticism over its handling of the coronavirus epidemic that originated inside its borders, Beijing faces mounting challenges on both domestic and international fronts that are testing the leadership of the Chinese Communist Party (CCP) and undermining the country’s image as a responsible stakeholder. The coronavirus crisis also drew unwanted attention to Beijing and the health organization’s cozy relationship, particularly when the WHO’s Director-General Tedros Adhanom Ghebreyesus was widely seen as pandering towards Beijing. The Chinese government will likely be strongly opposed to Taipei’s more extensive participation in the WHO, knowing that giving Taipei more international space would likely boost the popularity of President Tsai, who was re-elected in January 2020 for another four years.

During each global health crisis, Taiwan’s government has repeatedly argued that the island needs to obtain comprehensive information from the WHO on the epidemic in an urgent and timely manner in order to save lives and prevent the epidemic from spreading. During the Severe Acute Respiratory Syndrome (SARS) outbreak in 2002-2003, the WHO, under pressure from Beijing, did not respond in a timely manner to Taipei’s requests for help, recounted Foreign Minister Joseph Wu (吳釗燮). In any case, Taiwan, accustomed to being excluded from the WHO during the past several health crises in Asia, has been tackling the Wuhan coronavirus largely on its own. Taiwan’s Foreign Ministry posted on Twitter on March 2: “Officials in Taiwan are mobilized and determined to protect the country, with or without help from the WHO.” Compared to the more than 7,300 infections including more than 50 deaths in South Korea and at least 397 cases including 7 fatalities in Japan (as of March 8), Taiwan is doing comparatively well in keeping the infection rate and mortality rate on the lower end. [1] Taiwan’s self-reliance and public health measures have served it well even without membership in the WHO, but the island also wants to provide assistance to the rest of the world to fight the coronavirus.

Taiwan’s Campaigns for Participation in the WHO

When the representatives of Chiang Kai-shek (蔣中正) were expelled from the United Nations in October 1971, Taiwan was concurrently ousted from the UN’s specialized global health agency, the WHO. Since 1997, successive Taiwanese administrations have lobbied to either gain membership in the WHO or gain “observer” status at the World Health Assembly (WHA) meetings held in Geneva each May. It was not until a warming in cross-Strait relations under Taiwan President Ma Ying-jeou’s (馬英九) administration that Taiwan was able to dispatch its health minister to attend the WHA meetings as an “observer” under the title of “Chinese Taipei” from 2009 to 2016. However, Beijing later retracted Taipei’s observer status following the 2016 election of Tsai Ing-wen of the opposition Democratic Progressive Party (DPP), who refused to accept Beijing’s “One-China” principle. Subsequently, Taiwan sent delegations to Geneva to meet with foreign officials and experts on the sidelines of the WHA sessions in 2017 through 2019 to protest its exclusion.

Taipei’s level of access to the WHO has been influenced by Beijing’s attitudes towards Taiwanese participation in international organizations. Beijing is most opposed to Taiwan’s involvement in international organizations such as the United Nations, which are potent symbols of state sovereignty that would directly challenge the legitimacy of “one China.” On the whole, Beijing is less opposed to Taipei’s participation in functional organizations such as economic organizations. For example, Taiwan is a member of the Asia-Pacific Economic Cooperation (APEC), the World Trade Organization (WTO), and the Asian Development Bank (ADB). However, Beijing’s criteria for what constitutes an acceptable or unacceptable international institution for Taiwanese participation are not necessarily clear-cut. The WHO is a case in point.

Entry into the WHO, a functional UN agency, has not only been a public health concern but a key diplomatic objective for Taiwan. Taipei’s WHO bid resembles the island’s decades-long unsuccessful campaign to join the United Nations, but on a much smaller scale. Successive Taiwanese governments have, from time to time, shifted the island’s official designation from “Republic of China” and “Taiwan” to later “Chinese Taipei” and “health entity” (衛生實體) in order to increase its acceptability to both Beijing and the WHO. While Taiwan’s goals vis-à-vis the WHO have mostly focused on gaining observer status, for President Chen Shui-bian’s (陳水扁) administration, observer status in the WHA meetings was only a stepping stone towards full membership into the WHO—and not the ultimate diplomatic objective. In 2004, Taiwan’s Foreign Minister Chen Tang-shan (陳唐山) said Taiwan’s nine diplomatic allies requested the WHO to consider Taiwan’s application to join the global health body. In 2007, Taipei unsuccessfully applied for membership in the WHO under the name “Taiwan.”

Chen’s push for WHO membership gave China yet another reason to exclude Taiwan from the UN agency and further constrict Taiwan’s international space and recognition. Beijing continued its tough stance on Taiwan even during the avian flu epidemic in 2005-2006. The WHO and the PRC signed a secret Memorandum of Understanding (MOU) in 2005 that curtailed WHO contact with Taiwanese officials, who could only participate with approval by Beijing. Subsequently, Taiwan’s representatives were allowed to attend only 21 of around 1,000 WHO technical meetings held between 2005 and 2008.

Taiwan Gains Observer Status

During a temporary thaw in cross-Strait relations under the Ma administration, the Chinese government relaxed its notion of state sovereignty regarding Taiwan’s participation in WHO meetings from 2009 to 2016. In 2009, the WHO Secretariat sent an invitation to “the Department of Health, Chinese Taipei” to attend the WHA as an observer without voting rights. Taiwan’s then Health Minister Yeh Ching-chuan’s (葉金川) attendance at the WHA ended Taiwan’s 38 years of exclusion from the body. President Ma cited three factors leading to the WHO invitation: joint efforts of the public and political parties, international support from Taiwan’s diplomatic allies and other friendly countries, and the goodwill of the Chinese government. “There is a clear link between cross-Strait relations and our international space,” Ma said. “We’re not asking for recognition; we only want room to breathe,” he said. Ma shifted Taiwan’s focus towards attending WHA meetings rather than joining the WHO. Ma, however, was criticized for negotiating with Beijing without broader consultations with other political parties or the public. “This came about through black box negotiations,” said Hsiao Bi-khim (蕭美琴), who was then DPP’s international affairs director. “We are concerned that our government has given out political concessions,” she said. There was concern that accepting this gesture from Beijing would actually harm Taiwan’s sovereignty. Subsequently in 2011 and 2012, the WHO informed the Taiwanese delegation that its title would change to “Taiwan, province of China.” In both years, Taiwan’s then Health Minister Chiu Wen-ta (邱文達) attended the WHA meetings in Geneva even with this title change, though he also submitted formal letters protesting the WHO’s designation change for the island.

China Retracts Taiwan’s Observer Status

After seven years of participation as a WHO observer, Taiwan was no longer invited to the WHA meetings beginning in 2016. China used Taiwan’s past observer status to punish the Tsai administration for refusing to accept the “One-China” principle. China’s Health Minister Li Bin (李斌) stated, “Only when the political basis that reflects the ‘One-China’ principle has been confirmed can the regular exchanges across the strait be sustained. And only then can the two sides of the Taiwan Strait resume their consultations regarding the possibility of Taiwan’s participation in the World Health Assembly.” In 2019, Jonathan Moore, acting assistant secretary of the State Department’s Bureau of International Organization Affairs, argued that Taiwan’s past participation as an observer at the WHA is sufficient to demonstrate that “there is no legal barrier to Taiwan’s participation,” and that “because of the results of a free and fair democratic election in Taiwan, China decided to block Taiwan’s further participation, applying pressure on WHO leadership to exclude Taiwan despite the fact that China contributes less.”

Moving Forward

Going into the spring of 2020, Taiwan will likely double down on its campaign for observer status at the WHA meeting in Geneva, drawing from the momentum created by the novel coronavirus. The Taiwanese government will need the support of bigger powers, notably the United States, which has traditionally played a key role in exerting pressure on China over Taiwan’s participation in the WHO. At the same time, China is likely to object to Taiwan’s inclusion as anything but separate from the Chinese delegation and will seek to project a strong and capable international image as it seeks to battle the Wuhan coronavirus domestically. This time around, the WHO will need to decide whether it will continue to acquiesce to Chinese pressure on Taiwan or will actually provide universal health representation for all.

The main point: The emergence of the Wuhan coronavirus has provided a tangible reason not to exclude Taiwan from the World Health Organization. In the past, Taiwan’s WHO campaigns took many different forms but were consistently blocked by Beijing, except for a brief period where Taipei was allowed observer status from 2009 to 2016.

[1] Japan counts its national infections and deaths separately from (1) returnees from China on Japanese chartered flights (11 infection cases) and (2) passengers on the Diamond Princess cruise ship (6 fatalities). These numbers are current as of March 8, 2020.