China has kept Taiwan out of the United Nations, tried to limit its participation in the World Trade Organization, and stopped all but a handful of countries from having diplomatic relations with Taipei.
While clearly unjust, no one is going to die because Taiwan isn’t a member of the UN. Not so the island’s isolation from the international health regime, the latest chapter of which was played out in Geneva this week.
For the last decade, Taiwan has pursued ties with the World Health Organization, whose governing body, the World Health Assembly, is wrapping up its annual meeting in Geneva (May 22-27). The democracy of 23 million (larger than three-fourths of WHO members) is asking for observer status as a "health entity," which would allow it to attend planning meetings and have access to international experts and data.
Once again, due to China’s relentless campaign to isolate Taiwan, Taipei’s bid for WHO status never came to the floor.
But Taiwan isn’t the only victim of China’s intransigence here. Its exclusion from the international health network makes all of us more vulnerable to a looming disaster.
The catastrophe-waiting-to-happen is a virus designated H5N1, popularly known as the bird flu (or avian flu) and prime candidate for the next pandemic.
· We’ve been here before. In the 14th century, the Black Plague wiped out one- to two-thirds of Europe’s population in a few years. In just a few months, the Influenza Epidemic of 1918 killed an estimated 40-50 million worldwide – four times the battlefield deaths in World War I. Then there was the "Asian Influenza" of 1957 (2 million dead) and the "Hong Kong Flu" in 1968 (1 million fatalities).
- Currently, H5N1 is contracted by exposure to infected poultry. Last year, there were 122 reported cases in 16 countries. The mortality rate was a staggering 50 percent. In the first four months of 2006, the disease spread to 42 countries. Of 186 who were infected, 105 have died.
- International health experts believe the disease eventually will mutate in such a way that it’s spread by human-to-human contact. Margaret Chan, chief of influenza pandemic preparedness at WHO warns "The only question is when" H5N1 mutates into a human-to-human strain. former WHO Director General Lee Jong-Wook agreed, "It is only a matter of time before an avian flu virus – most likely H5N1 -- acquires the ability to be transmitted from human-to-human, sparking the outbreak of pandemic influenza."
- As the World Health Assembly was meeting in Geneva, Indonesia reported six bird-flu deaths in one family. While WHO says there’s no hard evidence that the virus has "evolved," it certainly looks suspicious.
- If (or, rather, when) the mutation occurs, says Nancy Cox, head of the Centers for Disease Control, "emergency rooms would be overflowing, doctors’ offices would be overflowing, and hospitals would be overflowing."
- With international air travel, the virus could spread to every continent in three months. Global economic losses could add up to $4.4 trillion.
- WHO estimates deaths worldwide at 5 million (on the low side) up to a mind-boggling 150 million – compared to 22 million who’ve died of AIDS since the 1970s.
Where does Taiwan fit in this alarming picture?
- It’s next-door to Southeast Asia, hot zone for the coming pandemic. Taiwan has substantial ties with the region, including 315,000 foreign workers from the area. Each year, 1.43 million Taiwanese visit Southeast Asia, and 570,000 from the region come to Taiwan. Its trade with ASEAN countries equaled $43 billion in 2004, and its investments there amounted to $45.82 billion.
- Taiwan is a regional transportation hub. In 2004, 175,230 flights arrived in and departed from Taiwan, carrying 20.75 million passengers. In other words, if a mutated bird flu reaches Taiwan, it could spread rapidly.
- Speaking of birds, roughly 1.25 million of the migratory varieties (all potential carriers of the virus) visit Taiwan each year. They represent 351 species. The transients come from various locales in Asia, and pass through Taiwan on their way to Indonesia, Malaysia, the Philippines and Australia.
Taiwan has already suffered from being ostracized by WHO. In 1998, the enterovirus spread to Taiwan from Malaysia. Without international support, the disease took its toll – 400 were hospitalized and 78 died.
In 2003, when SARS cases first appeared on the island (one of China’s many gifts to the Taiwanese), Taipei promptly requested assistance from WHO – especially access to SARS experts, video-conferences and disease-control information.
As Taiwan isn’t a member (and China opposes any official contacts with the island), WHO dragged its feet for 7 crucial weeks. By the time it decided to cooperate, what could have been a mild and containable outbreak became a tragedy resulting in 73 deaths.
Will history repeat itself with the bird flu? If so, Taiwan won’t be the only victim. It’s impossible to contain a virus originating in the region if Taiwan isn’t part of the equation.
Moreover, the island brings a wealth of experience and expertise to the table. It has a First World medical system. Communicable diseases like smallpox and cholera were eradicated decades ago. It was the first Asian nation to eliminate polio and the first to provide children with free hepatitis B vaccinations. Taiwan has one of the highest life expectancies in Asia.
Despite it’s isolation from WHO, Taipei has time and again demonstrated its commitment to improving health conditions in the Third World. Between 1995 and 2004 it donated $233 million in medical support and humanitarian relief to 78 poor countries. As of March 2005, it had 36 long-term technical missions and four medical teams stationed abroad.
Tamiflu is a medicine which counteracts certain influenza viruses. Recently, Taiwan contributed 600,000 Tamiflu capsules to Vietnam, one of the nations most seriously threatened by H5N1.
Taiwan’s advanced research facilities, location and transportation and communications networks would make it an ideal regional hub for tracking and counteracting an avian flu outbreak, if only the World Health Organization could overcome its political hang-ups, and put the emphasis where it properly belongs – on health not appeasement.
Recognizing this reality, in 2004, the European Union called on "the Secretariat, and others organizing technical meetings and working groups under the WHO auspices" to "show flexibility in finding mechanisms to allow Taiwanese medical and health officials to participate in these activities." The government of Canada expressed the hope that WHO will "take all measures possible to ensure that Taiwan is provided with all the ongoing benefits of its advice and assistance."
And in 1998, almost a decade ago, the U.S. House of Representatives unanimously resolved that, "Denying Taiwan the knowledge and expertise of the World Health Organization is a fundamental violation of its human rights."
While the World Health Assembly is almost over, the incoming director general will have the authority to unilaterally grant the observer status Taiwan is requesting.
In preparing for a possible pandemic, Lee had cautioned, "We cannot afford any gap in our global surveillance and response network." Let’s hope WHO takes that advice to heart.
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