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By Jonathan Sun, Director-General, Taipei Economic and Cultural Office in Boston
The 74th session of the World Health Assembly (WHA) concluded on May 31, 2021. Unfortunately, for the fifth consecutive year, Taiwan was barred from participating and contributing to the session due to political considerations of the World Health Organization (WHO).
The WHO claims that Taiwan’s observer status in the WHA requires members’ approval. However, the WHO director-general invited Taiwan to participate in the WHA between 2009 and 2016.
As of June 14, 2021, there have been more than 175 million confirmed cases of COVID-19 worldwide, with more than 3.79 million precious lives lost. WHO Director-General Tedros Adhanom Ghebreyesus, in his opening remarks at the 74th session of the WHA, correctly pointed out that the foundation for a safer world requires a common commitment to solidarity, equality, and sustainability. Tedros even noted that “If anyone is left behind, all are held back.” By excluding Taiwan, with a population of 23.5 million people, the WHO is creating inequality and division within the global health system and endangering health benefits for all human beings.
Taiwan can help: A model for universal health coverage
Universal health coverage remains a strategic priority of the WHO. It is also included in the United Nations Sustainable Development Goals (SDGs). However, after years of discussion, at least half of the world’s population still does not receive the health services they need. About 100 million people worldwide are pushed into extreme poverty each year because of out-of-pocket spending on health. Taiwan’s National Health Insurance (NHI) program, ranked first by the crowd-sourced global database Numbeo, second by CEOWORLD Magazine, and third on the Bloomberg Finance 2020 Health Care Efficiency Index, serves as a model for the world.
The success of Taiwan’s NHI, which covers 99.8% of its population regardless of age and financial or employment status, can be attributed to several key factors. First, the NHI adopted a single-payer model with contributions from individuals, employers, and the government. A supplementary premium is also charged based on a payer’s income level. Second, to control medical expenses, a budget payment system was adopted to set caps on health care costs paid by the government. Under these caps, Taiwan’s medical expenses accounted for only 6.44% of GDP, lower than the Organization for Economic Cooperation and Development (OECD) average. A family of four pays approximately $100 (in U.S. dollars) per month in premiums. The administrative costs have also been controlled at approximately 1% of medical expenses. Third, NHI integrated preventive health care services and pay-for-performance programs have ensured high-quality health care and encouraged the continued improvement of health standards. Fourth, to reduce health inequalities, premium subsidies are provided to disadvantaged groups such as low-income households and the unemployed.
The COVID-19 pandemic proves once again the urgency and importance of achieving universal health coverage for all human beings. Taiwan’s success story in providing low-cost and comprehensive health coverage for its people can serve as a model for the global community.
Taiwan is helping
As a responsible stakeholder, Taiwan has been proactively contributing resources and experience to countries in need to fight against the COVID-19 pandemic. After Taiwan ensured its people had sufficient access to medical resources, it began to donate critical medical equipment and pandemic-prevention supplies to countries in need. So far, Taiwan has donated 51 million surgical masks, 1.16 million N95 masks, 600,000 isolation gowns, and 35,000 forehead thermometers to more than 80 countries, including 13 million surgical masks and 15,000 forehead thermometers to the United States.
Taiwan exchanged information on containing COVID-19 with global public health professionals and scholars through various forums, APEC’s High-Level Meeting on Health and the Economy, the Taiwan-U.S. Global Cooperation Training Framework (GCTF), and other virtual meetings. Taiwan also held nearly 80 online conferences with experts from governments, hospitals, universities, and think tanks in 32 countries.
To improve regional and global disease monitoring and emergency preparedness, Taiwan has cooperated with the United States, Japan, and other like-minded nations to address such significant communicable diseases as MERS, dengue fever, Zika, chikungunya, enterovirus, and drug-resistant tuberculosis, through a series of workshops held under the GCTF. To date, senior medical personnel specializing in epidemic prevention and control and lab technicians from 20 Asian and Caribbean nations have participated, establishing a cross-border network for cooperation in epidemic prevention and control. Furthermore, since its establishment in 2002 by Taiwan’s Ministry of Health and Welfare (MOHW), the Taiwan International Healthcare Training Center has assisted in training more than 1,600 public health personnel from 68 countries. These efforts prove that Taiwan is determined, willing, and able to contribute to cooperation and exchanges in global public health matters.
Taiwan’s contact with the WHO is extremely limited
Viruses and diseases do not stop at the border. Being a regional transport hub with more than 72 million inbound and outbound travelers each year, Taiwan strived hard to seek participation in WHO meetings, mechanisms, and activities to safeguard the health benefits of its people and foreign nationals. After all, it just makes sense. However, due to political obstruction, results have been far from satisfying.
In a recent meeting of the WHA, Eswatini Health Minister Lizzie Nkosi stated that between 2009 and 2020, Taiwan applied to participate in 199 WHO technical meetings but only received invitations to 64. The refusal rate stands at about 70%. Taiwan applied to attend 12 COVID-19 related technical meetings but was invited to only 7. In addition, Taiwan’s continued exclusion from WHO laboratory networks undermines its ability to obtain and exchange surveillance data about infectious diseases with the WHO and other countries to help guide disease eradication, elimination, and control programs.
The WHO Western Pacific Regional Office (WPRO), responsible for public health issues related to Taiwan and other countries in the region, refuses to contact or interact with Taiwan. As a result, Taiwan lacks any means to obtain epidemic and three additional types of information issued by the WPRO and is not allowed to participate in meetings organized by the WPRO. Such action is detrimental to Taiwan’s exchange and interaction with the competent authorities in charge of public health in countries throughout the region.
Although Taiwan has been granted participation in the WHO International Health Regulations (IHR), the IHR intranet (IHR Event Information Site) does not include Taiwan’s IHR National Focal Point information, making it difficult for the IHR National Focal Points of other countries to contact Taiwan directly, which could impact the timeliness and effectiveness of bilateral cooperation in epidemic prevention and control.
It is time to include Taiwan in the WHO
The Constitution of the WHO states that “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.” Therefore, we believe Taiwan’s participation in the WHO is not a political issue but remains a human rights issue. To avoid any loophole or weak spot in the global health system, we believe the WHO director-general and secretariat should refrain from seeking or receiving any instructions from any government while performing their duties, as stipulated in Article 37 of the WHO Constitution. Only by granting Taiwan unfettered access to WHO meetings, mechanisms, and activities can Taiwan share its experience and capacity in health care reform more effectively and make universal health coverage a reality by 2030. Therefore, Taiwan’s inclusion is indispensable to achieve the goal of “Health for All” espoused by the U.N. and WHO. We are grateful to the United States and other like-minded nations for expressing steadfast support for Taiwan’s inclusion in the WHO. We also call on the WHO to pay due attention to the health rights of Taiwan’s people and fully admit Taiwan to its meetings, mechanisms, and activities.
Sponsored by Taipei Economic and Cultural Office in Boston (TECO-Boston)
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