Not the ‘Direct Links’ You Would Think Of…

Promoting Health For All

Taiwan in the WHO: Promoting Health For All

Taiwan -AT LAST-

…may notify World Health Organization (WHO) directly: cutting out the middle-man (Beijing, China)!

The CDC received a letter from Bernard P. Kean (top aide to WHO Director-General Margaret Chan), from January 13, which the WHO have agreed in accepting Taiwan under the IHR.

Acting on the Executive Yuan’s instruction, Steve Kuo submitted the letter to the WHO Secretariat, expressing appreciation in their latest decision in admitting Taiwan into the IHR mechanism.  In the letter, Kuo continues, reiterating Taiwan’s desire to become a WHA observer.  “Our goal of having our delegates attend the annual WHA conference as observers remains unchanged,” Kuo said.

In his letter to the WHO Secretariat, Kuo mentioned, he also said that Taiwan is eager to send its first personnel to the WHO, headquarters in Geneva, in meeting to discuss technicalities to the recent participation in IHR operations.

This move has adhered the International Health Regulations (IHR) 2005, Article 3 states: “the implementation of these Regulations shall be with full respect for the dignity, human rights and fundamental freedoms of persons” and “the implementation of these Regulations shall be guided by the goal of their universal application for the protection of all people of the world from the international spread of disease.” 

This does not limit to the 23 million Taiwanese inhabitants, but includes the greater 400,000 residing foreign nationals.  It is like the National Health Plan (that we all so love and are grateful for), but extended.

Okay, so Taiwan is officially within “Article 3” of the WHO, what is “Article 2” and why aren’t we in it?

Article 2 of the IHR (2005) reads: “… the purpose and scope of these Regulations are to prevent, protect against, control and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic and trade.”  As a member of World Trade Organization (WTO) and as the 16th largest trading nation, Taiwan holds the significant responsibility (under IHR 2005) in ensuring sound public health practices without the interference in international trade and traffic to Taiwan.

Academia Sinica historian Yu Ying-shih receives the 2006 John W. Kluge Prize for the Study of Humanity at the United States Library of Congress. TECRO Representative David Tawei Lee and Mrs. Lee attended the award ceremony and congratulated Dr. Yu on his success. Representative Lee hailed Dr. Yu’s lifetime contributions to the fields of Chinese history and the humanities. (photo courtesy Amanda H. Chen of World Journal)

Academia Sinica historian Yu Ying-Shih receives the 2006 John W. Kluge Prize for the Study of Humanity at the United States Library of Congress. Taipei Economic and Cultural Representative Office (TECRO) Representative David Ta-Wei Lee and Mrs. Lee attended the award ceremony and congratulated Dr. Yu on his success. Representative Lee hailed Dr. Yu’s lifetime contributions to the fields of Chinese history and the humanities. (photo courtesy Amanda H. Chen of World Journal)

The Fight to Win:

David Ta-Wei Lee, representative of the Taipei Cultural and Economic Office, would know well of Taiwan’s years of rejected attempts in regaining membership.  Lee is as well recognized for the establishment of the Taipei Office 17 years ago. In his career as diplomat, Lee has represented Taiwan in Belgium, Luxembourg and the European Union.  His most recent posting was as representative in Washington, D.C. In addition, he has served in senior positions in the Taiwan foreign ministry.  As he settles in his new post (as representative), he says it is important for Canadians to re-evaluate and re-energize their relationship with Taiwan, which he says has made tremendous progress in the political arena.

It has been a tough 12-year struggle for Taiwan in the fight to gain membership as which CDC Director Steven Kuo (郭旭崧) calls a “major breakthrough.”

“… this is a positive move and we will keep in touch with the WHO to see [that this new development] gets implemented.

“But the IHR do not cover WHO activities in their entirety and cannot replace observer status at the World Health Assembly  [WHA],” he adds,  “… We will continue our efforts to become a WHA observer.”

Dr. Steve Kuo, Taiwan CDC, speaks in a press conference in Taipei. (photo, courtesy of mofa.gov.tw, dated to May 15, 2006)

Dr. Steve Kuo, Taiwan CDC, speaks in a press conference in Taipei. (photo, courtesy of mofa.gov.tw, dated to May 15, 2006)

The good news happened only recently, on January 13 of this year, when Bernard Kean, Executive Director of WHO’s Office of the Director-General, notified Taiwan, their official inclusion in the health framework.  According to Kuo, this action was based on Kean’s letter as response to two requests made in 2005 and 2006, in request to be included within the health framework.

If even in a matter of significance, Kean’s letter did not state “Taiwan, China” as suggested by the Beijing Capital (as in a letter dated, 2005); instead, the letter was addressed to “CDC Director in Taipei” while the content referred to the CDC as “contact point in Taipei.

We do not need a reminder of how our seat was taken in 1972 upon China’s entrance as member, no.  We all only hear far too much of that.  In schools, in news, in magazines, in reports and videos – so, I will skip all what we already know too well.

Now, as part of the IHR, Taiwan will be included in the Global Outbreak Aleart and Response Network (GOARN) and be in sync with the rest of the world on the latest updates on epidemics,” CDC Deputy-Director Chou Jih-Haw (周志浩) said.

“We are pleased with the news, but we will not stop our efforts to become an observer at the annual World Health Assembly,” Ministry spokesman Henry Chen (陳銘政) said.

Department of Health and the Ministry of Foreign Affairs (MOFA), together welcomed the gesture of increased warming Cross-Strait relations.  They believe through this improvement, will Taiwan hold a recognized membership in global organizations.

An Argentinian national holds an international certificate of vaccination booklet issued by Argentinas Health Ministry, and a hypodermic as he awaits to be immunized against yellow fever in Buenos Aires 16 January 2008 before traveling to Brazil. The World Health Organization advised travelers to forested areas in Brazil to get yellow fever vaccinations as the number of confirmed deaths from the disease in the country increased.  (Photo courtesy of daylife, dated to January, 2008)

An Argentinian national holds an international certificate of vaccination booklet issued by Argentina's Health Ministry, and a hypodermic as he awaits to be immunized against yellow fever in Buenos Aires 16 January 2008 before traveling to Brazil. The World Health Organization advised travelers to forested areas in Brazil to get yellow fever vaccinations as the number of confirmed deaths from the disease in the country increased. (Photo courtesy of daylife, dated to January, 2008)

The take on “yellow fever” in Taiwan, by WHO.

What Influenced the Revision?

June 15, 2007, after a decade in the making, the revised IHR (2005) replaced the previous IHR (1969) for all WHO member countries.  The extent of international travel in the modern world presents an extraordinary opportunity for international disease transmission. IHR (2005) are now better adapted to the increasing volume and speed of international traffic and trade than were their predecessors.  The revision has broadened the scope of notification of health events to WHO from three diseases (cholera, plague, and yellow fever), to “all events which may constitute public health emergencies of international concern.”

The extended spectrum of diseases and events under IHR (2005) that may cause a public health emergency of international concern necessitated a revision of the existing “International Certificate of Vaccination or Revaccination Against Yellow Fever” to the International Certificate of Vaccination or Prophylaxis” (ICVP).   The change in name, and a completely new format whereby the name of the vaccine or prophylaxis must be written out each time, enables the certificate to be used to document prevention and prophylaxis against international public health threats in addition to yellow fever, should they be mandated at any time by WHO.

However, at the present time, yellow fever remains the only disease for which proof of vaccination may be required of travelers as a condition of entry.   Vaccination against yellow fever has been required for several decades by many countries with receptive mosquito vectors to prevent the importation of this disease virus from a country that had ongoing transmission. Importation of the virus by an infected traveler could potentially lead to the establishment of infection in mosquitoes and primates, with a consequent risk of infection for the local population.

(Photo, courtesy of nppa.org, by Karen Kasmauski)  YELLOW FEVER.  An anxious Brazillian boy is inoculated against the yellow fever virus spread by mosquitoes.  Viruses cause many different diseases, ranging from the common cold to HIV-AIDS.
The yellow fever epidemic was not part of major press coverage.  There were no famines killing thousands, no ethnic cleansing, no drama big enough to capture international media attention.  Over several months, fifty people in a very remote part of Brazil died of yellow fever.  A few viruses like Ebola grab media attention when they appear because they act in spectacular ways.  But yellow fever victims fade quietly away as that boy almost did.

So far, what people know of this “yellow fever” is that it has happened, it has passed, it is contaminable, and it is deadly.  BUT what is it??

Despite the new, social term of yellow-fever being that of a Westerner satisfying one’s tempromental or visual craving for an Asian-ethnic person by means of conversation, friendship, relationship and at times, marraige.

No, this is not what has changed IHR forever.  This creature, that has existed over 30 million years, what happened??

Alias: yellow jack, black vomit, or American Plague.  It is an “acute viral disease” found in many African and South American countries, despite existence of an effective vaccine, however treatment only helps the symptoms and not the virus itself.  The yellow of the name, refers to the “jaundice symptoms” that affect some patients.

SEM of a mosquito, a blood-sucking insect that spreads yellow fever, dengue fever (refer to Chinese tourism in Taiwan health risks) and filiarisasis.  Only female A. aegypti mosquitoes carry the arbovirus which causes yellow fever in humans (only female mosquitoes bite anyway, as they need estrogen from blood to hatch their eggs).

SEM of a mosquito, a blood-sucking insect that spreads yellow fever, dengue fever (refer to Chinese tourism in Taiwan health risks) and filiarisasis. Only female A. aegypti mosquitoes carry the arbovirus which causes yellow fever in humans (only female mosquitoes bite anyway, as they need estrogen from blood to hatch their eggs).

According to the Centres for Disease Control and Prevention (CDC), it is a flavivvirus.  What?!!  Who is worldly enough to be able to pronounce that on their first try??  Well, this flavivirus is trasmitted to others through [infected] mosquitoes; it is an illness ranging in severity from a self-limited febrile illness to severe hepatitis and hemorrhagic fever.

What Lays Within IHR (2005):

Under IHR (2005), countries are obligated to establish a National IHR Focal Point, which should be a national center for urgent communications, according to regulations.  These include a decision-making instrument in leading National Focal Points through a series of 4 questions in coming to a conclusion in reporting events to WHO for international alert and response.  IHR (2005) cover events of international importance which may involve, but are not limited to: contaminated food and outbreaks of food-born diseases.  In 2004, WHO, in collaboration with the Food and Agriculture Organization (FAO) of the United Nations, launched the International Food Safety Authorities Network (INFOSAN) to further improve the exchange, awareness and cooperation of food safety information.

The following below, is a list of Articles of the IHR (2005), but not all.

Article 1.1, IHR 2005 makes surveillance central to guiding effective public health action against cross-border disease threats.  The regulations define surveillance as “the systematic ongoing collection, collation and analysis of data for public health purposes and the timely dissemination of public health information for assessment and public health response as necessary.”

Article 2, purpose and scope of the Regulations are to prevent, protect against, control and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoid necessary interference with interntional traffic and trade.

Artilce 3, princles:

1.  The implementation of these Regulations shall be with full respect for the dignity, human rights, and fundamental freedoms of persons.

2.  The implementation of these Regulations shall be guided by the Charter of the Untied Unions and the Constitution of the World Health Organization.

3.  The implementation of these Regulations shall be guided by the goal of their universal application for the protection of all people of the world from the international spread of disease.

4.  States have, in accordance with the Charter of the United Nations nd the principles of international law, the sovereign right to legislate and to implement legislation in pursuance of their health policies.  In doing so, they should uphold the purpouse of these Regulations

Articles 4.2 and 6, Officials at the national level must be able to report through the national IHR focal point to WHO when required under IHR 2005.

Article 4.2, Requiring that a national IHR focal point be established is another surveillance initiative in IHR 2005.  The focal point is designed to facilitate rapid sharing of surveillance information because it is responsible for communicating with the WHO IHR contact points and disseminating information within the state party.

Article 4.3, The regulations also mandate that WHO establish IHR contact points that are always accessible to state parties.

Article 4.4, By linking national IHR focal points through WHO, IHR 2005 establishes a global network that improves the real-time flow of surveillance information from the local to the global level and also between state parties.

Articles 5.1 and 5.2, annex 1, Building and maintaining the surveillance system envisioned in IHR 2005 will require substantial financial and technical resources.  State parties will be primarily responsible for providing resources needed to develop their core surveillance capacities.  Each state party has to assess its ability to meet the core surveillance requirements by June 2009. In addition, each state party has to develop and implement a plan for ensuring compliance with core surveillance obligations.

Article 5.1, Surveillance is central to IHR 2005’s public health objectives, which explains why IHR 2005 requires all state parties to develop, strengthen, and maintain core surveillance capacities.

Article 5.1, annex 1, IHR 2005 describes key aspects of the surveillance process from the local to the global level.  As part of IHR 2005’s core surveillance and response capacity requirements, each state party has to develop and maintain capabilities to detect, assess, and report disease events at the local, intermediate, and national levels.

Article 5.3, WHO is obliged to assist state parties in meeting their surveillance system obligations.

Article 6, in addition to events that may constitute a PHEIC, IHR 2005 also requires state parties to report the health measures (e.g., border screening, quarantine) that they implement in response to such events.

Article 7, if a State Party has evidence of an unexpected or unusual public health event within its territory, irrespective of origin or source, which may constitute a public health emergency of international concern, it shall provide to WHO all relevant public health information.  In such a case, the provisions of Article 6 shall appy in full.

Article 8, in the case of events occuring within its territory not requiring notification as provided in Article 6, in prticular those events for which there is insufficient information available to complete the decision instrument, a State Party may nevertheless keep WHO advised thereof through the National IHR Focal Point and consult with WHO on appropriate health measures.  Such communications shall be treated in accordance with paragraphs 2 to 4 of Article 11.  The State Party in whose territory the event has occurred may request WHO assistance to assess any epidemiological evidence obtained by that State Party.

Article 9, WHO may take into account reports from sources other than notifications or consultations and shall assess these reports accoring to extablished epidemiological principles and then communicate information on the event to the State Party in whose territory the event is allegedly occurring.  Before taking any action based on such reports, WHO shall consult with and attempt to obtain verification from the State Party in whose territory the event is allegedly occurring in accordance witht he procedure set forth in Article 10.  To this end, WHO shall make the information received available to the States Parties and only where it is duly justified may WHO maintain the confidentiality of the source.  The information will be used in accordance with the procedure set forth in Article 11.

Article 9.2, public health risks associated with importation of contaminated goods may be reported to WHO independent of the event’s meeting the Annex II criteria. This stipulation would allow reporting when available information is insufficient to make an adequate assessment under Annex II. We found WHO INFOSAN Emergency complementary to the management of IHR (2005).

Article 10, Verification:

1.  WHO shall request, in accordance with Article 9, verification from a State Party of reports from sources other than notifications or consultants of events which may constitute a public health emergency of international concern allegedly occurring in the State’s territory.  In such cases, WHO shall inform the State Party concerned regarding the reports it is seeking to verify.

2.  Pursuant to the foregoing paragraph and to Article 9, each State Party, when requested by WHO, shall verify and provide: (a.) within 24 hours, an initial reply to, or acknowledgement of, the request from WHO; (b.) within 24 hours, available public health information on the status of events referred to in WHO’s request; and (c.) information to WHO in the context of an assessment under Article 6, including relevant information as described in that Article.

3.  When WHO receives information of an event that may constitute a public health emergency of international concern, it shall offer to collaborate with the State Party concerned in assessing the potential for international disease spread, possible interference with international traffic and the adequacy of control measures.  Such activities may include collaboration with other standard-setting organizations nd the offer to mobilize international assistance in order to support the national authorities in conducting and coordinating on-site assessments.  When requested by the State Party, WHO shall provide information supporting such an offer.

4.  If the State Party does not accept the offer of collaboration, WHO may, when justified by the magnitude of the public health risk, share with other States Parties the information available to it, whilst encouraging the State Party to accept the offer of collaboration by WHO, taking into account the views of the State Party concerned.

Article 14, paragraph 1, the other competent intergovernmental organizations or international bodies with which WHO is expected to cooperate and coordinate its activities, as appropriate, include the following: United Nations, International Labour Organization, Food and Agriculture Organization, International Atomic Energy Agency, International Civil Aviation Organization, International Maritime Organization, International Committee of the Red Cross, International Federation of Red Cross and Red Cresent Societies, International Air Transport Association, International Shipping Federation, and Office International des Epizooties.

Article 21 (WHO Constitutional Basis for the IHR), the Health Assembly shall have the authority to adopt regulations concerning:

(a) sanitary and quarantine requirements and other procedures designed to prevent internationl spread of disease.

Article 22, (WHO Constitutional Basis for the IHR), regulations adpoted pursuant to Article 21 shall come into force for all Members after due notice has been given of their adoption of the Health Assembly except for such Members as may notify the Director-General of rejection or reservations within the period stated in the notice.

Article 44.1, State parties are required to collaborate with each other in providing technical cooperation and logistical support for surveillance capabilities and in mobilizing financial resources to facilitate implementation of IHR 2005.

Article 43, state parties are also specifically required to inform WHO within 48 hours of implementing additional health measures that interfere with international trade and travel, unless the WHO Director-General has recommended such measures.

Article 54, paragraph 1, State Parties and the Director-General shall submit their first report to Sixty-first World Health Assembly (WHA), and that the Health Assembly shall on that occassion consider the schedule for the submission of further such reports and the first review on the functioning of the Regulations pursuant to paragraph 2.

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~ by Lan on 2008 FriUTC2009-01-23T18:02:38+00:00. 15.

2 Responses to “Not the ‘Direct Links’ You Would Think Of…”

  1. Very good post—thanks for writing this.

  2. When I first read of WHA here a few days ago, I thought it was a typo, since I had never heard of it. Now, I know better.

    It’s good to see Taiwan receive some sort of recognition. I remember when Taiwan was ejected from the U.N. in favor of the mainland. Back then, as an outsider, I thought the answer was simple; Taiwan should join the U.N. as Taiwan – a separate, sovereign nation. Little did I know that there was an internal tug-of-war going on.

    Another observation is that as long as I’ve known about Taiwan, China has always seemed to be the big, threatening bully. The relationship reminds me of a village that lives at the base of an active volcano; you never know when it’s going to erupt.

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