Tag Archive for: health

Taiwan, a leader in public health, should be in the WHO

Taiwan urges the World Health Organization and all relevant parties to recognise Taiwan’s considerable contributions to global health. We view health as a fundamental human right and universal value. Improved health results in greater well-being and has ramifications for the survival and development of individual countries and the world.

At the 77th World Health Assembly, held from 27 May until 1 June 2024, members adopted the WHO Fourteenth General Programme of Work for 2025 to 2028. Its objectives include improving health coverage and bolstering financial protections to ensure universal coverage. WHO has called on all countries to act on these issues.

Taiwan’s experience in making advances in public health should be shared through the WHO, from which it is excluded due to opposition from China.

Taiwan launched its national health insurance system in 1995. The system, which combined existing insurance schemes, now covers 99.9 percent of the population. It provides access to equitable and efficient healthcare and is an important pillar of social stability, health and safety. It has become a global benchmark for achieving universal health coverage. In annual health care indexes by Numbeo, a global database on cost of living, Taiwan has ranked first for the past seven years.

Taiwan’s national health insurance system operates on a pay-as-you-go, self-sustaining model, resistant to financial challenges such as aging populations and rising costs. The system has a sound, sustainable footing, built by reforming premium rates and adding funding sources, such as a tobacco surcharge.

To promote the health of our people, President Lai Ching-te described a vision of a healthy Taiwan in 2024. Remaining focused on people, families, and communities, we are expanding health promotion operations and preventive healthcare. Moreover, we are implementing a family physician plan, offering comprehensive care to patients with chronic diseases, and using telemedicine to improve accessibility in rural areas. By promoting integrated long-term care, palliative care, and aging in place, we ensure health equity—holistic, lifelong, and dignified care for all people.

In 2021, the WHO released the Global Strategy on Digital Health for 2020-2025. Under this plan, the global health body is seeking the development and adoption of person-centric digital health solutions to prevent, detect and respond to infectious diseases. It is also overseeing development of infrastructure and applications to use health data to promote health and well-being.

Taiwan exploits its prowess in information and communications technology to build effective health systems and services with a high return on investment. Taiwan’s health insurance system uses cloud storage, facilitating the efficient exchange of medical records. The adoption of internationally recognised data exchange guidelines, such as the Fast Healthcare Interoperability Resources standards, enhances international medical data sharing. Incorporation of artificial intelligence is advancing the development of smart healthcare, and virtual health insurance cards, and the My Health Bank app enable real-time management of health data.

In 2008, Taiwan introduced the Health Technology Assessment to facilitate evidence-based policymaking. In 2023, gene and cell therapies were covered for the first time, enhancing patient options and marking a new era for precision medicine. Taiwan also continues to leverage innovative technologies to improve the working environment for the medical workforce and to bolster the overall quality of medical service.

Despite facing political challenges, Taiwan has continuously participated in international health affairs and has been dedicated to supporting the global health system. Throughout the Covid-19 pandemic, Taiwan played a crucial role in sharing supplies, strategies and experiences, proving itself a reliable partner. Separately, Taiwan’s successful implementation of universal health coverage offers valuable lessons for countries worldwide. As we continue to share our experiences in universal coverage, financial management and digital health, we aim to help other nations achieve WHO’s goal of universal health coverage.

In this rapidly changing era, health challenges transcend borders and global cooperation is essential to addressing various health crises. However, Taiwan is prevented from participating in the WHO due to China’s continued distortion of United Nations General Assembly Resolution 2758 and World Health Assembly Resolution 25.1. Neither of these resolutions mentions Taiwan, nor does either declare Taiwan as part of China. They do not give China the right to represent Taiwan in WHO.

In light of this, and to uphold the core UN values of inclusiveness and universality, we urge the WHO and all relevant parties to recognise Taiwan’s considerable contributions to global health and the human right to health. The WHO must adopt a more open-minded approach and demonstrate flexibility, adhering to the principles of professionalism and inclusivity. Taiwan should be included, as a matter of pragmatism, in the World Health Assembly and all WHO meetings, activities and mechanisms, particularly those concerned with the WHO pandemic agreement. Taiwan earnestly hopes to work with the international community to create a future of borderless healthcare that realises the fundamental human right to health stipulated in the WHO Constitution, and the vision of leaving no one behind espoused in the UN Sustainable Development Goals.

To prepare for future threats, treat health security as national security

Health security is often seen as a peripheral security domain, and as a problem that is difficult to address. These perceptions weaken our capacity to respond to borderless threats.

With the wind back of Covid-19 pandemic policies, health security is no longer a national security focus. Governments have reprioritised, as there is much more to defend and deter.

However, public health is not the same as health security. For as long as conflict in the global north can reduce food security in the global south, health and human security should be considered part of the national security domain. But current departmental strategies lean into domain separation and perceived misalignment.

The National Preventive Health Strategy 2021-2030 is siloed and excludes Defence contributions to health security and pandemic control. Likewise, the 2016 Australian Defence White Paper made no reference to health security threats, despite the swine flu pandemic that preceded it. Pandemic preparedness is similarly absent from the 2024 National Defence Strategy.

Similar omissions are found abroad, with some exceptions.

Health and defence have been integrated into defence strategies in Canada (2024), Britain (2010 and 2023), the United States (2022) and New Zealand (2023). These documents have presented pandemic risks as tier-one priorities alongside military crises, some developing biodefence plans for transnational challenges. They identify pandemics and health security risks as causes of global standstill and recognise the pressure these risks place on critical investments, undermining the sustainability of defence forces and supply chains.

These issues remain relevant.

Nobody wants another pandemic. But to avoid health securitisation is to ignore the need for top-down collaboration, integration and whole-of-government approaches to tackling new and potential security threats, including borderless threats.

Gaps in Australia’s health security plans are an opportunity to widen the scope of our national security focus. Funding for the Department of Foreign Affairs and Trade’s Specialist Health Service advisory body ended in 2022, and support for the Australia’s National Action Plan for Health Security ended in 2023. Long-term planning investments seem better established in the regional focus.

The current Partnerships for a Healthy Region Initiative aims to deliver durable, flexible and adaptable outcomes through learning, communication, and coordination with strategic partners. Funding is scheduled to end in 2027.

Alternatively, the 2050 Strategy for the Blue Pacific Continent takes a sweeping view, emphasising that inclusive approaches are needed for future regional prosperity and resilience. The strategy addresses broad concepts, such as the urgent need to act on future pandemic control, the complexity of health challenges and the scope of traditional and non-traditional security issues. It offers a comprehensive, cross-domain and cross-department perspective.

Health security can part of the national security agenda, but new platforms for more modern considerations are needed to maintain its strategic relevance.

The phased establishment of the Australian Centre for Disease Control, with an agenda set to include the heightened surveillance of regional threats, is a promising step forward. The development of the first global Pandemic Accord is another notable opportunity for more strategic interpretations and developments in the post-pandemic environment.

Flexible and inclusive strategies can create more palatable and permanent connections between security domains. Australia must assess the gaps in its strategic preparedness. Otherwise, if disease variants, economic disruptions and systemic breakdowns converge again, global health security may become an impossible goal.

Policy integration may be the most relevant and sustainable approach to curbing an uncertain threat landscape. Australia should view health security as part of the national security domain, not peripheral to it, to better prepare for future threats.

Taiwan’s indispensability in preparing for pandemics

The three years of the Covid-19 pandemic resulted in a terrible loss of life and exacerbated health inequalities. The global economy slumped, and, worldwide, people’s lives were affected. This experience demonstrated that the present global health governance framework is not effective in responding to threats to global health. Although Covid-19 is no longer labelled a public health emergency of international concern (PHEIC), and trade and economic activity globally have returned to normal, the World Health Organisation (WHO) cautions against the threat of a ‘Disease X’ pandemic. Therefore, it is critical that countries across the globe unite to bolster health governance.

Taiwan’s participation in that effort should be regarded as indispensable.

The WHO and many countries began reviewing response strategies during the Covid-19 pandemic. Weaknesses in the International Health Regulations (2005) concerned with managing the crisis were revealed. As a result, changes are afoot. Proposed revisions include enhanced surveillance, reporting and information sharing, improved response readiness, and revised criteria for declaring PHEICs. At the same time, there is vigorous debate about a new pandemic agreement, which aims to craft a robust global pandemic governance framework grounded in accountability, transparency and equity. The agreement may be approved at the 77th World Health Assembly.

As Taiwan is not a WHO member state, we cannot directly influence revisions to the International Health Regulations or the drafting of the pandemic agreement. Nevertheless, we remain greatly concerned about the content of and developments regarding those central documents. We are eager to contribute our insights into pandemic management and learn from international best practices. Taiwan was the nation that initially identified the epidemic risk and promptly executed adaptive measures. Taiwan also proactively shared vital information with global partners and garnered public trust through a commitment to openness. This was crucial in effectively implementing pandemic policies. To address future pandemics, we will strive to refine approaches to obtaining vaccines, managing medical resources, utilising technology, safeguarding human rights and addressing misinformation.

We strongly endorse the passage and implementation of amendments to the International Health Regulations and the pandemic agreement. We call on the WHO to include Taiwan as a signatory to those documents. That would enable us to collaborate on monitoring new virus strains, reporting and exchanging pathogen diagnosis data, and sharing novel vaccine and antiviral research or clinical trial results. It would further collective global action against future pandemics and would greatly assist more resilient anti-pandemic efforts by the international community.

We urge the WHO to support Taiwan’s inclusion in overseeing global health. Taiwan remains committed to participating based on the principles of professionalism, pragmatism and making contributions. Taiwan seeks to cooperate with the WHO to remedy geographical gaps in global health security and to construct a comprehensive global health framework.

The WHO Council on the Economics of Health for All has found that at least 140 countries recognise health as a fundamental human right in their constitutions. Despite that, many nations have not passed and implemented laws to ensure that their citizens have access to healthcare services. Taiwan has worked hard to reach universal health coverage and has consistently improved the quality of health care over the past few decades, in line with WHO recommendations. We have effectively integrated and allocated social welfare resources to enhance primary and oral health care for all, implement mental health programs, and strengthen the social safety net. We have put in place an agile and resilient healthcare system able to combat both communicable and noncommunicable diseases. We are improving health for all individuals over the course of their entire lives. Moreover, Taiwan is working to share its experience and expertise in achieving universal health coverage to help the international community realise health for all.

The theme for World Health Day 2024 is ‘My health, my right’. This is a way to advocate for every individual, everywhere, to have access to high-quality health services, education and information, as well as to enjoy safe drinking water, clean air, good nutrition, good-quality housing, decent working and environmental conditions, and freedom from discrimination.

Through a public–private partnership, Taiwan has been contributing to global efforts to realise the right to health in collaboration with partner countries and international organisations. We have improved medical care in small South Pacific island nations; enhanced nutrition for women and children affected by an earthquake in Haiti; provided psychological support to Ukrainian refugee women, children and aid workers in Romania; bolstered climate-change adaptability in the Caribbean; and improved access to water, sanitation and hygiene at healthcare facilities in Kenya. Furthermore, Taiwan has provided humanitarian assistance through post-disaster recovery and reconstruction efforts that have helped people get through disasters in the Philippines, Japan, Hawaii, Turkey and Indonesia.

Taiwan believes that health is a human right. Yet the rights of Taiwan’s 23 million people are disregarded by the WHO for political reasons. Taiwan remains a steadfast partner in defending the right to health of all people everywhere. We urge the WHO and all relevant parties to recognise Taiwan’s considerable contributions to global public health and the human right to health. It is imperative that the WHO adopts a more open-minded approach and demonstrates flexibility, adhering to the principles of professionalism and inclusivity. Taiwan should be included, as a matter of pragmatism, in the World Health Assembly and all WHO meetings, activities and mechanisms, particularly those concerned with the WHO pandemic agreement. This would better empower Taiwan to collaborate with global partners to uphold the fundamental human right to health stipulated in the WHO Constitution and the vision of leaving no one behind espoused in the United Nations Sustainable Development Goals.

Healthcare preparedness for terror and disaster

 It’s now commonplace for terrorists to use industrially available chemical explosives like ammonium nitrate or everyday technology like mobile phones to detonate improvised explosive devices. In a recent op-ed in The Australian with my colleague Jacinta Carroll, I looked at the ‘Improvised Explosive Device Guidelines For Places Of Mass Gathering’ guidelines issued last month by the Australia–New Zealand Counter-Terrorism Committee. The document rightly notes that:

‘Terrorist or insurgent attacks using explosives occur regularly around the world. Terrorists favour explosives because of their proven ability to inflict mass casualties, cause fear and disruption in the community and attract media interest. Explosives are also generally within the financial and technical capabilities of terrorists and IEDs can be assembled with relative ease and used remotely’.

The guidelines provide general guidance to those operating places of mass gathering—such as shopping centres, sporting arenas, theatres and railway stations—in terms of emergency service requirements and security principles. The document provides useful guidance on detecting suspicious activity.

One of the weaknesses of the guidelines, however, is its treatment of healthcare issues. There’s no mention of post-blast planning and response, including the fact that the site of such an attack would be a crime scene, especially if injuries have occurred. In a post-blast incident there’d also be implications for immediate first aid and rescue before emergency medical services arrive.

The guidelines refer to ‘injuries’ and ‘people hurt’ but not that we’re likely to see multiple fatalities and a correspondingly larger number of casualties in a terrorist bombing in one of our major cities. There’s no discussion in the document of longer-term health issues: not all casualties will be immediately apparent and there’ll be a need to record those who felt the blast effects for medical observation and monitoring.

There’s no discussion either of on the scene triage or on how venue mangers might work with emergency medical services to transfer the injured to definitive care.

It’s not at all clear if a workable plan for that situation in Australia has been tested for large numbers of seriously injured. And as I’ve pointed out before (PDF), we lack available air assets and retrieval teams across Australia that would be able to provide support and respond to mass casualty events. The recent Defence White paper does, however, note that the ADF will acquire enhanced aero-medical evacuation capabilities (Para 4.94).

France’s health response after the recent Paris bombings was very good: many of the lesser injured patients went to more peripheral hospitals and only the more seriously injured ones went to the major disaster hospitals.

The fact is that we don’t devote enough attention to the healthcare preparedness aspects of terrorism—the medical issues related to terror attacks can be understood collectively as ‘terror medicine’—or to mass casualties as result of a catastrophic natural disaster.

The Director-General of Emergency Management Australia, Mark Crosweller, recently noted at the launch of ASPI’s Risk & Resilience program that when it comes to natural disasters we don’t do enough to prep for the ‘Big One’. EMA’s leader pointed out that catastrophic events are complex and intense and we need to close the gap of surprise and be able to ‘imagine and act when the time comes’.

Mark also pointed out that we don’t:

‘spend enough time looking at the potentiality of consequence. I think we look very much at before an event and try to risk manage and try to bring the risk down, but we don’t look enough at what the manifest consequence may well look like and turn our minds to how we are going to manage that when it happens.’

Mark’s comments are highly relevant in the context of healthcare preparedness for both man-made and natural disasters.

He’s absolutely right that we need to change our approach to residual risk by understanding that rarity doesn’t diminish consequence. There’s very little ‘no-notice’ training going on in Australian hospitals to prepare for mass casualties.

Several years ago, the Australasian Trauma Society and others—most notably Dr John Graham, the former chairman of the medical staff council at Sydney Hospital—argued that that the Commonwealth government should fund, with the states, a single ‘disaster prepared’ hospital in each state to prepare for mass casualties. That didn’t occur.

There’s been no real action to address the findings several years ago of a major study in the Medical Journal of Australia of the surge capacity for people in emergencies in Australasian hospitals. It predicted that all hospitals in Australasia would be quickly overwhelmed in that 60–80% of seriously injured patients wouldn’t have immediate access to operating theatres, and that there would be similar lack of access to ICU beds for critically injured and to x-Ray facilities for less critically injured patients. There’s been no similar survey to refute these findings.

As a first step to get more focus on this issue, it’d be useful for those responsible for counter-terrorism and catastrophic disaster planning to engage those in our health system who understand what’s required to manage a mass casualty event. A nation-wide desktop audit of what physical facilities are available would also be a good start: we’d then be able to assess what actual preparedness is possible. It wouldn’t be that hard.

But it would require some goodwill and cooperation between the Department of Defence and the health departments of the Commonwealth and State governments.