Nature | Editorial

Clock is ticking for WHO decision over Taiwan

The World Health Organization shouldn’t allow regional politics to hamper public health.

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Richard Chung/Reuters/Alamy

Taiwanese health researchers could be left in the dark if Taiwan does not attend the next WHO summit.

A showdown is looming at next week’s annual meeting of the World Health Organization (WHO) in Switzerland. For almost a decade, Taiwan — despite not being a member of the United Nations — has been permitted to attend WHO events as an observer. But, so far, its invitation for this year’s event in Geneva has not arrived.

That’s because of the rising political tensions between Taiwan and the Chinese government in Beijing. China does not recognize Taiwan as a state, and Taiwanese officials were previously invited to the WHO meeting with the approval of Beijing. The hard line from the Chinese mainland towards the island’s latest government, which took office last May, has placed the WHO between a diplomatic rock and a hard place.

It is not surprising that global health has become ensnared in world politics in this way, but it’s still disappointing — particularly given that it deflates the mood of cooperation that had allowed Taiwan to participate since 2009.

That arrangement followed Taiwan’s 2003 exclusion from WHO discussions on how to contain the outbreak of the SARS virus — which roamed across both the island and the Chinese mainland. Taiwan raised a fuss about that decision. There is no way to know whether the exclusion hampered its efforts to control the virus. (The epidemiologist Chen Chien-Jen, who was Taiwan’s health minister at the time, says that this was the case.) But despite being one of the last places to be hit by the outbreak, the island struggled to limit the damage — 181 people there died (K.-T. Chen et al. Int. J. Infect. Dis. 9, 77–85; 2005).

The WHO recognizes the UN’s 1971 decision that Taiwan is part of the People’s Republic of China, led by Beijing. Nature also recognizes that decision.

In the wake of SARS, however, tensions eased and business, as well as scientific collaborations, boomed across the strait. Taiwan was given its observer status in 2009. It has made clear that it plans to continue the tradition and show up at the meeting next week, regardless of whether or not it has an invitation. The WHO says that it has not yet made a decision, but it is running out of time.

The irony is that Beijing’s harder attitude towards Taiwan is partly a product of work on public health. The president of Taiwan, Tsai Ing-wen, picked the epidemiologist Chen — now vice-president — to be her running mate in last year’s election. It was Chen, as health minister, who helped to stem the SARS crisis in 2003, and his celebrity status for doing so is credited as a factor in Tsai’s landslide victory.

Tsai is from the Democratic Progressive Party. Although the party has historically been in favour of independence, Tsai and Chen have both pledged not to upend relations with China. That doesn’t seem to have placated the mainland. Next week’s WHO event is merely the latest in a series of international meetings for which an invitation to Taiwan has been withheld or withdrawn.

As the WHO meeting approaches, so the rhetoric about what is at stake increases. Microbes, as the cliché goes, carry no passports and respect no boundaries. Collaboration is one way to tackle the threat of infectious disease — a threat that is increasing. So, this logic argues, any obstacle to collaboration worsens the outlook. Media coverage of the political stand-off dutifully warns that the exclusion of Taiwan would be a disaster for public health — there and elsewhere.

Several prominent epidemiologists and infectious-disease experts contacted by Nature were adamant that Taiwan should be allowed to attend next week. “Politics should not get in the way of infectious disease, which knows no boundaries,” said one. Because Taiwan is a node for international trade and travel, isolating it “is both risky and dangerous”, said another. Some also commented on the contributions being made by Taiwan’s impressive public-health and biomedical-research infrastructure: “Isolating it would be counterproductive to global health.”

But others said that the meeting is purely symbolic. One said that the research in the area goes through publications and informal networks, not the WHO. “WHO meetings play an insignificant role in international research activities.” Another agreed: “Researchers will work together regardless of whether Taiwan is allowed to attend.”

Some were confident that, in a similar way, the health community can also overcome barriers erected by politicians. “I expect the WHO officials will have back-door channels with Taiwanese health officials to find out urgent information, for example about outbreaks of avian influenza or other emerging infectious diseases.”

As China seems to have recognized in years past, in public-health terms Taiwan’s presence at WHO meetings is good for everyone. If politics disrupts that, then people on both sides of the divide and the strait must hope that faith in the informal global infectious-disease control network is not misplaced. And when (not if) a new health emergency comes, China must ensure that Taiwanese health officials and researchers are not kept out of the loop.

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