Taiwan and the WHO: A Brief History

Among its countless side effects, the COVID-19 pandemic has reignited an old debate over Taiwan’s inclusion in the World Health Organization. It’s an old manifestation of a long-standing contest that pits China – which claims sovereignty over Taiwan – against the self-governing island, with global organizations generally toeing Beijing’s line.

The saga dates back to the Chinese Civil War between Chiang Kai-shek’s Nationalists and the Communists. In 1949, the defeated Republic of China (ROC) government, led by Chiang, decamped to Taiwan, which had been returned to ROC control in 1945 after 50 years of Japanese occupation. Ever since, both the ROC government in Taipei and the People’s Republic of China (PRC) government in Beijing have each claimed to be the China. Although the ROC’s claim became greatly diluted through the years, as it became obvious it would never retake the mainland, it is still enshrined in the national constitution, which dates back to 1946.

For decades after its overthrow on the mainland, Chiang’s ROC occupied China’s seat in the United Nations, with the support of the United States and its Cold War allies. But by the 1970s, with Washington eager to curry favor with Beijing to take advantage of the Sino-Soviet split, the writing was on the wall. The ROC lost its UN seat to the PRC in 1971. As the WHO is under the United Nations’ umbrella, it swiftly followed suit. The 25th World Health Assembly in 1972 officially decided to recognize PRC representatives “as the only legitimate representatives of China to the World Health Organization and to expel forthwith the representatives of Chiang Kai-shek from the place which they unlawfully occupy at the World Health Organization.”

With the loss of its UN seat, Taiwan was forced to find other avenues for participation in the international community. WHO membership is reserved for states, and not even the United States – which itself severed ties with Taiwan in favor of China in 1979 – advocates for Taiwan to join organizations where statehood is a prerequisite for entry. Official U.S. policy says that “the United States supports Taiwan’s membership in international organizations that do not require statehood as a condition of membership and encourages Taiwan’s meaningful participation in international organizations where its membership is not possible.”

So what would “meaningful participation” in the WHO look like for Taiwan?

One favored approach has been seeking observer status, which is the crux of the current push. U.S. Secretary of State Mike Pompeo recently called “on all nations, including those in Europe, to support Taiwan's participation as an observer at the World Health Assembly and other relevant United Nations venues.” The World Health Assembly (WHA), the annual forum of the WHO, both governs the organization and sets global health policy. As an observer, Taiwan would not be given a formal vote but would at least be in the room where decisions are being made. Both the Vatican and the Palestinian Authority, neither of which is a UN member state, have received permanent observer status at the WHO and other UN missions.

While Taiwan has been granted WHO observer status in the past, it was not permanent. Instead, Taiwan must receive an invitation from the organization’s director-general to participate in the WHA – and must be invited back again each year. That leaves the inclusion of Taiwan up in the air each and every May, when the WHA typically meets.

Taiwan did receive invitations to attend the WHA from 2009 through 2016. In 2008, Taiwan elected Ma Ying-jeou to the presidency. Ma was quick to pursue closer relations with Beijing, including cross-strait economic pacts and formalized political exchanges – underpinned by acknowledging the “1992 consensus” that there is only one China. Alongside these milestone developments, Taiwan was invited to participate in the WHA as an observer for the first time since it lost its formal representation in 1972. Taiwan’s inclusion was essentially bestowed by China as a “reward” for Ma’s warm approach to the cross-strait relationship.  

There were major caveats, however. Taiwan attended under the name “Chinese Taipei,” the same name used for Taiwan’s participation in APEC and the Olympics, which allows for the fiction that the island is functionally a part of Beijing-governed territory. Even then, Taiwanese representatives continued to be excluded from most technical meetings, where the actual work of promoting global health is done. And, without permanent observer status, getting a coveted invitation each year was dependent on staying in Beijing’s good graces – something that became very apparent when Ma finished his second term in 2016 and was replaced by Tsai Ing-wen, of the former opposition Democratic Progressive Party (DPP). 

Tsai and the DPP have never confirmed the 1992 consensus or Beijing’s “one China principle,” making them anathema to the PRC government. After Tsai’s election, Taiwan’s inclusion at the 2016 WHA was thus in doubt. At the last possible minute, Taiwan received an invitation for the WHA that began on May 23, 2016 – just three days after Tsai’s inauguration. But there was a clear warning sign: the letter specified, for the first time, that Taiwan was being invited on the basis of United Nations Resolution 2758 – the 1971 General Assembly resolution that gave control of China’s UN seat to the PRC government – and thus that Taiwan’s participation had to be in accordance with the “one China” principle. Tsai’s government accepted the invitation, but rejected the premise.

Shortly thereafter, Beijing announced it had cut all official cross-strait exchanges with the Tsai administration, citing the new president’s refusal to explicitly endorse the 1992 consensus. Taiwan has not been invited back to the WHA since.

Each year, ahead of the annual WHA meeting, Taiwan’s Ministry of Foreign Affairs (MOFA) makes a push for its inclusion, backed by supportive statements from the United States. A MOFA statement from 2018 argued that “Inviting Taiwan to participate in the WHA would not only conform to the WHO Constitution and universal values concerning human rights, but also allow Taiwan to join the efforts of WHO and countries throughout the world in promoting Universal Health Coverage, and working toward achieving their core objective of raising health standards among all mankind.”

A 2019 MOFA statement was far more blunt: “China’s pressure on the World Health Organization (WHO) to exclude Taiwan from the WHA runs contrary to the WHO Constitution's espousal of health as a fundamental human right, and completely ignores the health and wellbeing of Taiwan's 23 million people.”

This year, in light of the global health crisis brought by the COVID-19 pandemic, Taiwan’s inclusion in the WHO and WHA has gained a new urgency. In a fitting metaphor for the situation, if you visit the WHO’s COVID-19 dashboard, Taiwan is left blank on the map. The pandemic makes clear exactly what it means for Taiwan to be a loophole in the WHO: not only is Taiwan’s data not shared with other countries through the organization’s framework, but there have reports that data have been misreported because the WHO prioritizes China’s reporting on behalf of Taiwan over Taiwan’s self-reporting. 

However, Taiwan’s success at combating the new coronavirus has only heightened calls for the island to gain a seat at the global health table. Taipei has been quick to capitalize on the outpouring of goodwill to demand representation more vocally than ever. Said Foreign Minister Joseph Wu: “Given that pandemics recognize no borders and make no distinctions between nationalities, we think it is irresponsible for the WHO to continue to limit Taiwan’s participation.”

Faced with mounting pressure, the WHO was forced to make a rare statement on Taiwan. “WHO is working closely with all health authorities who are facing the current coronavirus pandemic, including Taiwanese health experts,” the statement said (the emphasis is in the original text).

“With respect to the COVID-19 outbreak, the WHO Secretariat works with Taiwanese health experts and authorities, following established procedures, to facilitate a fast and effective response and ensure connection and information flow.”

Taiwan took issue with that claim. “[T]he reality is that Taiwan unilaterally provides information to WHO… information that is not then shared by WHO with other members. … The health agencies of other nations thus cannot get information through WHO data on the epidemic in Taiwan, or our prevention policies or border quarantine measures,” MOFA said in its own statement.

“From 2009 to 2019, Taiwan applied to attend 187 WHO technical meetings, but was invited to only 57, for a very high rejection rate of 70 percent,” it added.

Despite facing more scrutiny than ever before, the WHO refused to budge. In the lead-up to this year’s WHA, the organization’s top legal officer, Steven Solomon, felt compelled to make a statement on the question of Taiwan’s inclusion. “To put it crisply, director-generals only extend invitations when it's clear that member states support doing so, that director-generals have a mandate, a basis to do so,” Solomon told reporters on May 11. “Today however, the situation is not the same. Instead of clear support there are divergent views among member states and no basis there for – no mandate for the DG to extend an invitation.”

Left unnamed in all the WHO’s comments is the elephant in the room: China. The global health body is hiding behind the pretense that a majority of WHO member states do not want Taiwan to attend without naming the single state that actually has an objection, and alternatively cajoles and coerces its partners into objecting along with it. The truth is that the WHO is not inviting Taiwan because China does not want Taiwan invited – at least not under the Tsai administration.

Chinese Foreign Ministry spokesperson Hua Chunying intimated as much, telling reporters on May 6, “On the Taiwan region's participation in WHO activities, China's position is clear and consistent. It must be handled according to the one China principle.” In other words, a government in Taiwan that does not accept that principle, in the form of the 1992 consensus – say, the Tsai administration – will be shut out of the WHO. Instead, Hua claimed that “China's Central Government has made proper arrangement for the Taiwan region's participation in global health affairs, which ensures that the region can deal with local or global public health emergencies in a timely and effective manner.”

“Since the outbreak of COVID-19, the DPP authorities have been engaging in political manipulation and constant hype-up over the issue of Taiwan's participation in WHO and WHA,” Hua continued. “The real intention is very clear. They are taking advantage of the virus to seek independence. We firmly reject this futile attempt.”

The Taiwan Affairs Office in Beijing piled on, accusing the DPP of “unscrupulously using the virus to seek independence, venomously attacking the WHO and its responsible people, [and] conniving with the green internet army to wantonly spread racist comments.” The last point is a reference to WHO Director-General Tedros Adhanom Ghebreyesus’ claim that he had faced racially-charged trolling spearheaded by Taiwan.

The WHO strenuously denies that it is taking a political approach to Taiwan’s inclusion, and that might be true, as far as the organization itself is concerned. But China, which has effective veto power over the Taiwan question, is undeniably withholding a WHA invitation out of political motives. The specific references to the DPP and its policies make that crystal clear.

The trouble for Beijing is that its stubborn stance has alienated not only the DPP but the more “China-friendly” Kuomintang (KMT), the party of former President Ma. KMT chair Johnny Chiang wrote in a recent op-ed for The Diplomat that “greater international support ought to be given to Taiwan’s 23 million people, whose lives should be no longer put at risk through such international isolation and whose desire to participate in the World Health Organization (WHO) system should be fulfilled by all countries in the world.” 

Taiwan’s bid for WHO inclusion, Chiang added, “is not about politics but about basic human rights, as well as about Taiwan people’s desire of being able to be recognized by and to contribute to the international community.” 

Beijing would like to see Tsai’s administration take the blame for its own exclusion from the WHO, but that narrative has lost traction amid the COVID-19 outbreak and the Tsai administration’s robust response. Taiwanese people of all political persuasions are not likely to forget that their country was shut out of the world’s top health body in the midst of a global pandemic – nor will they forget that Beijing was ultimately responsible.