Breaking State-Centric Shackles in the WHO: Taiwan as a Catalyst for a New Global Health Order

Abstract

After World War II, states recognizing that “the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being” and “the health of all peoples is fundamental to the attainment of peace and security”, decided to establish the World Health Organization (WHO), with the aim of promoting and protecting health for all. Mindful of the fact that disease neither recognizes nor respects borders, the revised International Health Regulations (IHR) in 2005 reiterates the goal of the universal application “for the protection of all people of the world from the international spread of disease.” The WHO Framework Convention on Tobacco Control (FCTC), similarly, stands as an “evidence-based treaty that reaffirms the right of all people to the highest standard of health.” Such statements indicate an aspiration that the WHO’s normative work not just be about “a collection of nation states”, given the inherently global nature of public health affairs.

Such aspiration embedded in global health governance introduces a paradox vis-à-vis the WHO’s state-centric institutional design, as evidenced and amplified by the COVID-19 crisis. The exclusion of Taiwan—which alerted the WHO of potential human-to-human transmission at the early stage and successfully guarded its people against the pandemic—is heatedly debated. Taiwan’s WHO participation presents a sharp contrast between its goal of health for all peoples, on one hand, and its outdated state-centric design and power politics, on the other. While scholars proposed the concept of “global health law” to reflect the erosion of sovereignty and encroachment of state powers due to globalization, the WHO continues to rest its institutional design on the assumption of states being the dominant actors of international (health) law, envisaging international health governance rather than global health governance. This state-centric view inevitably goes hand in hand with power struggles that undermine global health.

Against this background, this paper aims to demonstrate how and why state-centric international health governance neither delivers its goal to “promote and protect the health of all peoples” nor accommodates the complexity of international politics, and to explore new venues allowing a pluralist membership structure that better serves the WHO’s promise. We proceed as follows. Part II analyzes challenges and constraints facing Taiwan’s participation in the WHO as a full member and as an observer under the existing institutional framework. Part III proposes an amendment to the WHO Constitution and maps a new contour of global health governance through the lens of the trans-governmental network. Part IV concludes.

Keywords: WHO, COVID-19, Sovereignty, global health governance, trans-governmental network, global heath order, Westphalia