Michael Richardson: China's world health battleground

At first glance, Taiwan's failure for the ninth consecutive year to gain observer status at the World Health Organisation annual assembly in Geneva is just another manifestation of its never-ending diplomatic tug-of-war with China.

After all, it came just three days after Taiwan scored a small victory by winning back the tiny South Pacific island nation of Nauru as an ally three years after it had switched allegiance to Beijing.

The WHO is a much bigger and more important battleground for China than the South Pacific. Despite some declarations of support for Taipei, the WHO's 192 members states accepted a call by China to take no action on Taiwan's request to become an observer.

Beijing has treated Taiwan as a breakaway province of China since anti-communist forces in the Chinese civil war were defeated in 1949 and fled to the Taiwanese islands. China argues that only sovereign states can take part in the annual WHO Assembly, which is meeting until today.

Just 26 nations, including Nauru, recognise Taiwan. Most are small, impoverished countries in Latin America, Africa or the Pacific that seek to play Taiwan against China for financial and other aid.

Taiwan, now a self-governing democracy of 23 million people, first sought observer status at the WHO in 1997. Its Government refuses to accept Beijing's policy that Taiwan is an inseparable part of China. This prompted recent legislation in China reiterating that any declaration of independence would be countered by force.

China has blocked Taiwan's WHO application for years - even during the Severe Acute Respiratory Syndrome (Sars) crisis in 2003, which killed 800 people, mostly in Asia.

Taiwan claims that its exclusion from the WHO poses an international danger because the island has a significant role in preventing not just a resurgence of Sars but also the spread of avian or bird flu, which health experts worry could cause the next major influenza pandemic.

Taiwan's claim is exaggerated - China's Health Minister, Gao Qiang, assured the WHO last week that Beijing would allow it to send experts to investigate any disease outbreak on the island and that Taiwanese medical experts would be able to consult the WHO.

But the episode is symptomatic of a more serious problem - weak international co-operation in the face of growing threats to human health from infectious diseases such as bird flu and the Ebola and West Nile viruses, which can spread more rapidly than previous contagions because of the ease of modern travel.

The H5N1 bird flu virus has killed more than 50 people in Asia since 2003, mainly in Vietnam, Thailand and Cambodia. Two more cases were detected in Vietnam last week. Health experts fear the often-fatal virus might mutate into a form that can pass not just from poultry or other animals to humans, but from human to human.

This month, a senior official of the UN Food and Agriculture Organisation accused unnamed Asian nations of preventing proper bird flu monitoring by giving too few poultry-infected samples to FAO scientists to pass to the WHO. The latter reportedly told the journal Nature that it had obtained only six human samples of the virus and no infected poultry samples in the past eight months.

Joseph Domenech, head of the FAO's animal health service, said the countries were worried about losing control of the situation and of negative publicity that could undermine investor confidence, frighten tourists and damage their economies.

The WHO has been negotiating revisions to its international health regulations for two years to make them more effective against the spread of disease. On Monday it agreed guidelines for restricting trade with, or travel to or from, an area hit by a public health emergency. They also make it mandatory to report to WHO any outbreak of Sars, bird flu, smallpox and polio. But anything else of potential international public health concern should also be reported.

At the WHO meeting, US Secretary of Health and Human Services Mike Leavitt warned there was a grave and growing threat of bird flu becoming a global pandemic.

"I believe that the world is closer to a potential influenza pandemic now than at any time in decades," he said.

Problems in dealing with Sars in Asia two years ago, especially China's reluctance to allow access to international health officials, was the main spur to revising the regulations. They were drawn up 50 years ago and cover basically only cholera, plague and yellow fever.

The WHO is also seeking to strengthen a global alert and response network for infectious diseases. The network links 130 disease control centres and laboratories in dozens of nations. But the agency wants wider co-operation, especially in developing countries.

"The success of our global effort to maintain and increase security depends on reliable information that is available and clear to all who need it," said the WHO Director-General, Dr Lee Jong-wook.

"We have to be able to see with clarity and precision the health needs confronting us and the means at our disposal for meeting them."

* Michael Richardson, a former Asia editor of the International Herald Tribune, is a visiting senior research fellow at the Institute of Southeast Asian Studies in Singapore.