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There is an island nation off the southeastern coast of China where public health officials saw the pandemic coming—and took action before China did. Nearly three months after reporting its first confirmed case of Covid-19, this country has only reported 348 positive diagnoses and five deaths. It was one of the earliest countries to be hit and has one of the lowest infection rates.
But you wouldn’t know any of this if you got your information from the World Health Organization. The country is Taiwan, which the WHO refuses to recognize as a sovereign state.
Despite early warnings from Taiwanese officials, the organization kept the island cut off from its global information networks. Now, it may be the rest of the world that’s paying the price.
For nearly half a century, the People’s Republic of China has effectively blocked Taiwan from joining the WHO. Despite never having exercised authority over the island, the Chinese Communist Party officially considers Taiwan part of its territory, and forces international organizations—including the United Nations and its agencies like the WHO—to affirm its view.
Last weekend, the absurdity of this geopolitical paradox was laid bare in a news broadcast that quickly went viral. In a Skype interview, journalist Yvonne Tong of Hong Kong public broadcaster RTHK asked Dr. Bruce Aylward, a senior WHO official, if the global health body would reconsider Taiwan’s membership.
On Tong’s laptop screen, Aylward’s face twitched. He blinked for several seconds. Then he said he “couldn’t hear the question.” When Tong offered to repeat herself, Aylward cut in: “No, that’s OK, let’s move on to another question then.”
“I’m actually curious to talk about Taiwan as well,” said Tong. Aylward’s face disappeared—he had ended the call.
When Tong called back and repeated her question, Aylward replied, “Well, we’ve already talked about China. And when you look across all the different areas of China, they’ve actually all done quite a good job.” He thanked Tong and ended the call again.
The surreal exchange lasted all of one minute. But for Taiwanese people, it summed up a lifetime of gaslighting. During this outbreak alone, the WHO has kept changing how it refers to this country of nearly 24 million, going from “Taiwan, China,” to “Taipei” to the newer and bizarre “Taipei and its environs.” It also allowed China to report Taiwan’s coronavirus numbers as part of its own total, instead of reporting Taiwan’s numbers alone—a conflation that created headaches for the smaller nation. Some other countries enacted travel restrictions on Taiwan along with China, despite the former’s drastically lower infection rate.
When geopolitics dictate health policy, however, the most serious effects are rarely just economic. The WHO’s distortion of Taiwan’s reality has consequences that should be measured in human lives.
Soon after the RTHK video was released, a WHO spokesperson e-mailed a statement to reporters, a rare instance of using Taiwan’s preferred name: “The question of Taiwanese membership in WHO is up to WHO Member States, not WHO staff. However, WHO is working closely with all health authorities who are facing the current coronavirus pandemic, including Taiwanese health experts.” Taiwan says that cooperation has not occurred. According to the country’s officials, on December 31—the same day that Wuhan health officials announced the discovery of a viral pneumonia with “no clear evidence of human-to-human transmission”—Taiwan wrote to the WHO to request more information about the disease’s potential to pass between humans. They say that the WHO acknowledged receipt of the letter, but did not otherwise respond or share it with WHO member states.
Taiwan took action anyway. Before nightfall on December 31, the country decided to begin health inspections for all passengers arriving on flights from Wuhan. Two weeks later—amid continued reassurances from Chinese and WHO officials that there was no need for alarm—Taiwan dispatched two of its health experts to the city in Hubei province, where they found significant likelihood that the coronavirus was capable of human-to-human transmission. This virus, they reported on January 16, could be far more dangerous than initially assumed, noting that Wuhan’s local doctors were taking the disease very seriously as well.
It would be four more days before the Chinese government officially acknowledged that the virus could be transmitted between humans, on January 20. In the meantime, Wuhan had hosted a 40,000-household dinner to celebrate Lunar New Year and millions of people had left the city for the holiday, dispersing across the country at the worst possible time.
By the time Taiwan confirmed its first case of Covid-19 on January 21, the country was arguably more prepared than any other place in the world. It mobilized its Central Epidemic Command Center—a rapid-response agency formed in the wake of the 2003 SARS outbreak—to implement quarantines and conduct drills at hospitals. Citizens were asked to stay calm and assured that they would all be able to buy surgical masks, as production of the masks ramped up into millions per day. Soon after, Taiwanese masks were temporarily banned from export.
By contrast, Hubei did not begin its own emergency measures until the day after, when the Chinese health authority was already reporting 440 cases and nine deaths across mainland China.
In spite of its decisive response, Taiwan was shut out of the WHO’s emergency meeting on January 22, where representatives from 16 countries—including the PRC, Japan, South Korea, and the United States—opted to delay declaring the coronavirus a global health emergency.
When the Taiwanese CDC deputy director general, Chuang Jen-hsiang, gave his own press conference in Taipei, a local reporter asked him whether Taiwan was coordinating with the WHO. “We’re not like other countries,” replied Chuang with a pained smile. “We weren’t invited to the meeting. There’s no way for us to get firsthand information.”
By the time the WHO finally declared a global health emergency on January 30, nearly 8,000 cases had been confirmed by Chinese authorities, hundreds of people had died, and the virus had surfaced in at least 18 countries outside of China. Still, the WHO struck a deferential tone. “This declaration is not a vote of no confidence in China,” said Director General Tedros Adhanom Ghebreyesus. “On the contrary, the WHO continues to have confidence in China’s capacity to control the outbreak.”
People line up to buy face masks at a pharmacy in Taipei, February 3, 2020. Taiwan’s government made masks available to all, but limited the number that each person could buy per day. (Gene Wang / Getty Images)
Taiwan, Italy, and the United States all confirmed their first cases of Covid-19 within days of one another. But unlike the other two countries, Taiwan has so far avoided mass deaths—so much so that on Wednesday, President Tsai Ing-wen announced that Taiwan would donate 10 million surplus masks to places including Italy and the United States.
There is no real altruism to this, or to any of the other rapid aid deals crisscrossing the globe since the outbreak began. Nations that give aid to others project an image of power, to both domestic and international audiences. Even countries whose own outbreaks are far from contained, such as Russia and Australia, are using this moment to score points.
For Taiwan, this is an opportunity to press the case for greater recognition.
The country was a founding member of the United Nations under its formal name, the Republic of China (ROC), in 1945. But it was ejected in 1971, when the UN gave its seat to the PRC. The Chinese Civil War has never legally ended, and the PRC still seeks to eventually gain full authority over Taiwan. That’s why Beijing has kept up the diplomatic pressure by forcing other countries to disavow Taiwan’s sovereignty, while paving the way for Taiwanese firms such as Foxconn—the world’s largest electronics manufacturer—to do business on the mainland.
How to respond to this dilemma is the central issue in Taiwanese politics. Positions range from hard pro-unification to hard pro-independence, with politicians and activists representing every gradation in between.
In 2009, Taiwan’s then-president, Ma Ying-jeou, managed to negotiate a backroom deal with authorities in Beijing for Taiwan to gain observer status in the World Health Assembly (WHA), the committee of states that governs the WHO. A member of the pro-unification Kuomintang party, Ma agreed that Taiwan would reaffirm Beijing’s “One China” principle and use the name “Chinese Taipei” at the assembly. In practice, Taiwan’s participation was limited: A leaked WHO memo from 2010 revealed strict instructions for the agency to use the name “the Taiwan Province of China” in its publications, and explicitly excluded Taiwan from the International Health Regulations, which enables WHO member states to rapidly share information and resources during global health emergencies.
Any sense of détente was undone when President Tsai was elected in 2016. The PRC, enraged by her pro-independence position, retaliated by ordering “Chinese Taipei” ejected from the WHA. Taiwan has unsuccessfully lobbied for reinclusion every year since.
But perhaps debating Taiwan’s inclusion in the WHO misses the point. What if the legitimacy in question here were not Taiwan’s—but that of the system that the WHO represents?
A medical worker collects a sample for coronavirus testing during a drill organized by the New Taipei City government on March 14, 2020. (Sam Yeh / AFP via Getty Images)
The WHO is ostensibly a sober, disinterested moderator, a corrective to the self-interest of nation-states. The PRC’s initial cover-up of the 2003 SARS epidemic—which led to deaths in two dozen countries, including 73 people in Taiwan—is a classic example of what the WHO should help prevent. Yet in the case of the coronavirus pandemic, the agency has again acquiesced to PRC policy, raising critical questions about whether this system is working at all.
The WHO has never operated free from state interests. Like other international agencies founded under the UN in the wake of World War II, the agency originated as a tool of the 20th century US-led world order. In 1954, Republican Representative Frances P. Bolton articulated the US interest in the WHO in a speech on the anniversary of the agency’s founding: “In our global struggle against communism, one of our principal endeavors is to keep the free world strong. Disease breeds poverty and poverty breeds further disease. International communism thrives on both.” Health was a means to a geopolitical end.
Today, the WHO remains submissive to American politicians and corporations. In 2018, the Trump administration pushed the WHO to nix a campaign advocating breastfeeding and blocked a WHO resolution to tax sugary drinks, in both cases to satisfy US lobbyists and manufacturers. The United States pays by far the largest share of the WHO’s budget out of any member state. But its yearly contribution—which Congress approved at nearly $123 million this year—is paltry in the grand scheme of global health; the WHO’s largest nonstate sponsor is the Bill & Melinda Gates Foundation, which has pledged $100 million to the WHO and other organizations to fight Covid-19 alone. The WHO considers itself perpetually underfunded, with a $4.4 billion budget that is smaller than that of some American hospitals. Trump has only exacerbated the agency’s feeling of financial insecurity since taking office, threatening every year to slash US contributions to global health.
That could explain why the WHO is looking to China. This dynamic is especially apparent within the WHA, which elects the WHO’s director general every five years. Competition for the post is fierce, and countries with more leverage lobby other countries into forming voting coalitions, in a secretive process that has included accusations of “rampant” bribery. Beijing has proved especially adept at this game: In 2006, it successfully pushed through its pick, the Hong Kong bureaucrat Dr. Margaret Chan, and in 2017 backed the current chief, Ethiopia’s Dr. Tedros, who courted the CCP for months by praising China’s growing trade with African countries. (And reiterated his support for the “One China” principle after being elected.)
This international horse trading discourages the WHO from antagonizing its member states, even when doing so could save lives. The organization was panned by experts for its slow response for the Ebola outbreak in 2013; leaked documents show that WHO officials delayed declaring an emergency for as long as two months, for fear that it would be seen as a “hostile act” by Guinea Bissau, Ivory Coast, and Mali, and that it would hurt those countries’ mining interests.
To be sure, the WHO has a significant record of accomplishments, not least of which was the global drive that eradicated smallpox by 1980. Still, the contradiction at the heart of its cross-border mission—that it has always depended on rigid notions of sovereignty—is revealing its limits. Dr. Tedros may say that the coronavirus “knows no borders.” As post–Cold War globalization fractures and right-wing nationalisms harden, the WHO’s deference to individual countries’ interests only risks widening divisions.
The stakes have never been higher for us to rethink the question of national sovereignty. Cases like Taiwan’s show how border disputes have powerful, distorting effects upon how we understand and respond to health and disease. In both the United States and China, state-led nationalisms fueled by anger over the coronavirus threaten to plunge us headlong into a new Cold War. Is it mere coincidence that at least two of the societies that have responded most ably to the virus—Taiwan, Hong Kong—are ones that the WHO doesn’t consider to be sovereign places at all?
The coronavirus pandemic is already a profound tragedy. We can avoid further heartache by ending our reliance on a global health system that sees the world as competing states. Instead, we need to focus on creating bottom-up, transnational mutualism between health workers, researchers, and communities.
At this point, sovereignty can’t save us—but solidarity might.