Sunday, June 29, 2008

Who needs the WHO?

TAIPEI, Taiwan--The country is in the midst of an outbreak of enterovirus 71 that is affecting young children. There is no need for a scientific definition of an outbreak. It is simply an increase in the number of cases compared to what is normally observed. In 2006 and 2007, enterovirus cases did not spike past 5 in any month for the entire year. For 2008, figures have already shot past 30 for the summer months. In the previous 2 years, no cases were reported until May, whereas cases started showing up this January. There have been 260 cases so far, and the death toll now stands at 9. The latest victim was a 4-month-old girl from Yunlin County, who died in just 5 days.

Ten years ago, there was widespread panic when many children started to develop skin rashes, with some of them dying quickly. It turned out to be the first outbreak of enterovirus 71, and the lag in knowing the causative agent was detrimental. Weeks went by before the US CDC arrived in Taiwan to help with prevention efforts and put pressure on the WHO to get involved. The 1998 outbreak resulted in 78 deaths, almost all of them under the age of 5. Among the survivors, there were 405 cases of serious complications involving neurological damage. Given that smaller outbreaks had occurred nearby in Singapore and Malaysia, being part of the larger public health community may have lessened the damage.

Unfortunately, Taiwan has had to rely on informal contacts with the WHO and US CDC since China took its UN seat in 1972. Efforts to become an official member of the WHO or even just an observer in the World Health Assembly (the decision-making body) have been blocked. Furthermore, the MOU signed in 2005 between the WHO and China limits the amount of contact Taiwan has with the organization. China filters all the information that is trickled down to us. Taiwanese citizens are restricted from joining expert panels. The Chinese decide which Taiwanese members are invited to meetings, and both sides must be present at all times. Essentially, the WHO has hired China as our booking agent.

Despite all this, Taiwan has chosen to be a responsible member of the global community by voluntarily complying with the WHO’s International Health Regulations (IHR) that went into effect last year. The IHR puts obligations on countries to reduce the threats of infectious diseases by participating in a worldwide system to disseminate information on outbreaks. In addition, Taiwan has been involved with medical humanitarian efforts to its allies in Africa and provided aid to Indonesia after the tsunami in 2004 and to Burma after the recent cyclone. In response to the Szechuan earthquake, Taiwan sent in a rescue team on its own. After the 9-21 earthquake that killed more than 2,000 people in central Taiwan, emergency rescue efforts were delayed because teams could not pass through Chinese airspace.

Aside from engaging in petty political maneuvers, the Chinese government has proven that it has a hard time caring for the health of its own citizens. The SARS pandemic 5 years ago was the direct result of a delay in Beijing's disclosures about the disease. Among its rural areas, unsafe practices of organ selling and blood selling are rampant. The number of AIDS cases is grossly underestimated, in part due to the detainment of many AIDS activists.

The current Director-General of the WHO is Dr. Margaret Chan, who hails from China and has served as head of Hong Kong’s Department of Health. Earlier this year for fear of a flu outbreak, Hong Kong closed its schools for 2 whole weeks. An infectious disease attack on the children in her home country would have been embarrassing. Likewise, Taiwan is unlikely to make any progress on its entry into the WHO before Chan’s term ends in 2012.

As the highest international health authority, the WHO’s role is based largely on controlling outbreaks. With the ease of global travel, everyone needs to be part of the public health system. This becomes an even bigger issue now that Chinese tourists are expected to come to Taiwan in large numbers. However, while outbreaks are sporadic and part of nature’s ebb and flow, the WHO has other responsibilities to negotiate prices for drugs and vaccines, commission research on the latest technologies and make health-related recommendations and policies. Unfortunately, all too often Taiwan’s status has become a political question, not a legal or even professional one.

In response to the recent outbreak of enterovirus, the new Minister of Health Lin Fang-yu (林芳郁) was heavily criticized and eventually apologized for saying that all we could do was pray. In its reasoning for rejecting Taiwan’s application yet again, the WHA cited that China was responsible for the health of the 23 million Taiwanese citizens. Now, THAT should give us religion.

Wednesday, June 4, 2008

Ma and Tsai, let the games begin! (Part II)

TAIPEI, Taiwan--As expected, there was great anticipation over President Ma Ying-jeou’s (馬英九) inauguration speech, and I believe that it showed off his true colors. He spent the first part criticizing President Chen Shui-bian’s (陳水扁) performance during the past 8 years. That wasn’t all. Before making his speech at the Taipei Arena, he went to the Presidential Office for the transfer of power ceremony. Afterwards, staff members stood in line to shake hands with the outgoing Chen and Vice President Annette Lu (呂秀蓮). Before they could finish and had a chance to get out the door, Ma and incoming Vice President Vincent Siew (蕭萬長) followed right behind them. So you had one pair saying goodbye and another pair saying hello all at the same time. You shouldn’t rain on anyone’s (farewell) parade. What’s with all this talk about Ma being a gentleman?

As I saw images of the Presidential Office on TV, a certain memory came up. Every New Year’s Day, there is a flag-raising ceremony in front of the Office. I went to one during Chen’s first term and had a good view near the front of the crowd. I remember hearing noises (more like shrills), and upon looking over I saw Ma walking along and shaking hands with some of his fans. He was wearing a jogging shirt (the sleeveless kind) and shorts (the really short kind). This was just after the sun had come up, and even in Taiwan there was a chill in the air. He doesn’t live anywhere close to the Office, so this was not his regular jogging path. Needless to say, his showiness has always bothered me.

On the other hand, his wife Chow Mei-ching (周美青) is the complete opposite and makes having to watch the couple somewhat tolerable and even interesting. I respect that she worked 3 jobs to put her husband through Harvard Law School and that she has always taken the bus to get to work. I admire her cool demeanor and no non-sense style. In that way, she reminds me a bit of Tsai Ing-wen (蔡英文).

However, every time I see her on the news as the paparazzi (aka Taiwanese media) shows her going to work, she is always dressed in jeans and some plain-looking shirt. She holds a managerial position in the legal department of a major bank. Her outfits during the inauguration ceremonies prove that she is not incapable of dressing up. I could be wrong, but I just cannot imagine that this is the dress code at any financial institution in Taiwan or that she would put up with the hassle of changing at the office. Why is this working woman dressed in the same attire as when she goes to walk her dog? How is this not special treatment?

Going back to Ma’s inauguration speech, my ears must have perked up every time he said Republic of China. I had thought that he rarely used the term Taiwan, but I was wrong. The paparazzi did an actual count, and the ratio was 50:9 in favor of Taiwan. Still, I’m a person who prefers quality over quantity, and I was rather appalled that he also played on the importance of the ROC, which represents a hegemonic monster to many Taiwanese people.

He said that the ROC would celebrate its 100th anniversary during his term, having been established in China for 38 years before coming over to Taiwan. While he and the other “post-war immigrants” can make October 10, 2011, a really big deal, the majority of Taiwan will probably just sleep in on the day off.

He also mentioned the so-called “1992 Consensus”, which doesn’t even fit the definition of consensus when China’s stance is “one China” period, while the KMT prefers “one China, different interpretations”. The DPP and a few others, such as former President Lee Teng-hui (李登輝), think of the entire 1992 Consensus notion as an urban legend.

To end his speech, Ma chanted “Long live Taiwan’s democracy!” followed by “Long live the Republic of China!” He really should have ended it after the first phrase, but can you blame him for not trying hard to please everyone?

However, it’s no secret that this is a man who once opposed the direct election of the presidency. In a not-so-recent interview, he had said that electing members of the National Assembly (who eventually vote for a President) was the same as having citizens vote directly, just that the result doesn’t come in for weeks or months.