Tag Archive for: health

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.