Taiwan Still Stuck in WHO Waiting Room

When the World Health Assembly (governing body of the World Health Organization) had its annual meeting in Geneva last month, a vital player was excluded.

Absent was a nation more populous than three-fourths of WHO members, a nation that has suffered needlessly from exclusion from the international health network and could be near ground zero of the next pandemic—Taiwan.

Since it lost its WHO membership in 1972 (its place taken by China), Taiwan has been the patient forever stuck in the waiting room. For Taiwan, what has been a tragedy could become a catastrophe. But the island’s ostracism, due to China’s intransigence, puts all of us at risk.

In 1998, the enterovirus spread from Malaysia to Taiwan. More than 400 people were hospitalized and 78 died. Economic losses from the disease were estimated at $1 billion. Without ties to WHO, Taiwan had to go it alone.

SARS first appeared in Taiwan in March of 2003. Taipei immediately requested support from WHO, including access to experts on the contagion and disease-control information. Once again, the patient was kept in the waiting room. It took WHO seven weeks to respond. This delay contributed to the toll the disease took, including 73 deaths.

But worse could be in store. Experts believe the next pandemic will come out of Southeast Asia. The most likely pathogen is a virus designated H5N1—popularly known as the bird flu—which has the potential of exceeding the 1918 flu epidemic, which killed 40 to 50 million in a matter of months.

By the end of 2005, 142 H5N1 cases had been reported in Vietnam, China, Cambodia, Thailand and Indonesia, with a fatality rate of up to 50%. If the bird-flu virus mutates to allow human-to-human transmission, the world will have a crisis on its hands the likes of which has never been seen. With international air travel, the disease could reach every continent in three months. The late Dr. Lee Jong-Wook, former director general of WHO, warned, “We are facing a challenge which is potentially much bigger than SARS.” If the bird flu evolves and goes global, experts are talking about a worldwide death toll of five million to 150 million.

What makes Taiwan’s exclusion from the international health system so dangerous?

l Taiwan is close to Southeast Asia, potential hot zone for the bird flu. Taiwan employs 315,000 foreign workers from the region. Each year, 1.43 million Taiwanese visit Southeast Asia, and 570,000 from the region come to Taiwan.

l Taiwan is a major regional hub for travel and trade, with 13 major international flight routes. In 2004, 175,230 flights arrived in and departed from Taiwan.

l Roughly 1.25 million migratory birds visit the island each year. They come from Siberia, China, Japan and Korea, and go on to the Philippines, Malaysia, Indonesia and even Australia.

l In October 2005, an illegal shipment of 1,037 pet birds from China was seized by Taiwanese authorities. Tests were randomly performed on 46 birds, of which eight tested positive for H5N1.

The foregoing spells trouble for Taiwan and the rest of us. Dr. Lee maintains, “We cannot afford any gap in our global surveillance and response network.” Taiwan isn’t a gap—it’s a breach you could drive a plague through. Trying to contain a future pandemic without Taiwan’s involvement is impossible. If the patient dies in the waiting room, it won’t be the only fatality.