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Taiwan’s Health Diplomacy Didn’t Start With the COVID-19 Crisis

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Taiwan’s Health Diplomacy Didn’t Start With the COVID-19 Crisis

Despite diplomatic exclusion, Taiwan has worked to provide wide-scale humanitarian assistance during the COVID-19 pandemic — and beyond.

Taiwan’s Health Diplomacy Didn’t Start With the COVID-19 Crisis
Credit: Office of the President, ROC (Taiwan)

An unexpected consequence of the ongoing COVID-19 outbreak has been the recent shift in rhetoric on Taiwan among several high-ranking global political figures. Take Ursula von der Leyen, president of the European Commission, as an example. Although the EU has previously remained assertive in its adherence to the Beijing formulation of a “One China policy,” Taiwan’s generous donation of much sought-after medical supplies to several member states prompted the top EU official to directly address Taiwan in a message of thanks.

Even though Taiwan’s generous assistance to Western countries stricken by the pandemic, as well as its effective containment of the virus domestically, finally provided media attention to the island, not all responses have been positive. World Health Organization (WHO) Director General Dr. Tedros Adhanom Ghebreyesus recently accused the Taiwanese Foreign Ministry of instigating the threats and racist abuse he has received in recent months. “This attack came from Taiwan,” said Tedros, the WHO’s first African leader. Importantly, the allegations emerged after a number of politicians from around the globe spoke up in favor of Taiwan’s participation in the work of the WHO, and as many voiced their criticism of the WHO’s questionable handling of the pandemic. It is noteworthy that Tedros consistently defended China’s response to the coronavirus outbreak while continuously ignoring warnings and best practices shared by Taiwan.

The Taiwan Ministry of Foreign Affairs as well as President Tsai Ing-wen promptly dismissed the allegations as “baseless,” and emphasized that there was no evidence of Taiwan’s encouragement or participation in racist attacks against Tedros. It would be futile to argue that Taiwan is entirely free from the ills of racism. Instead, it is important to consider how it continues to support its overseas partners in their quest to strengthen their healthcare systems, while being systematically discriminated against by the international community. The recent donation of crucial medical supplies to Western countries is, of course, a much-needed response to the global health crisis without precedent in living memory. Nevertheless, we argue that it ought to be understood in the context of Taiwan’s long-standing commitment to acting as a responsible stakeholder within the global public health regime.

A former aid beneficiary, Taiwan’s policy of “pragmatic diplomacy” introduced at the end of the 1980s brought about a dramatic increase in Taiwan’s provision of foreign aid. This included flagship projects in the field of medical assistance. As a response to its diplomatic isolation, which began with the handover of the UN seat to Beijing in 1971, Taiwan sought to employ its economic might to regain its footing in the international community. While the primary objective of expanding humanitarian relief and developmental aid efforts was to gain diplomatic support, this exercise in soft power proved to be successful, as Taiwanese expertise in international cooperation continues to be highly sought after despite the country’s diplomatic situation.

One of the most prominent success stories of Taiwan’s medical diplomacy is its cooperation with São Tomé and Princípe. An island nation located off the Western coast of Africa, São Tomé had struggled to control the spread of infectious diseases. Malaria had been a particularly pressing problem. A team of Taiwanese epidemiologists, led by eminent Lien Jih-ching, also known as Dr. Mosquito, helped reduce the incidence of malaria in the country from 50 percent in 2003 to 1.01 percent in 2015. Despite this fruitful cooperation, São Tomé decided to break diplomatic ties with Taiwan in 2016 and “recognize the PRC, accepting Beijing as the only legitimate Chinese government.”

Taiwan also proved to be keen on sharing its technological expertise to support the healthcare systems of its allies. In Paraguay, Taiwan’s International Cooperation and Development Fund (the primary institution dedicated to development assistance) supported the strengthening of the e-health system and provided training in hospital management. Taiwan’s healthcare providers enjoy a very high rate of e-healthcare maturity. As a matter of fact, computerization of medical records is considered to be one of the central pillars of the successful implementation of the widely-praised National Health Insurance system. Taiwan’s cooperation with Paraguay also exemplifies its commitment to the holistic approach to development assistance, which features strong capacity-building and institution-strengthening pillars.

Finally, it is also noteworthy that Taiwan remains actively engaged in healthcare-related development projects in countries with which it has no formal diplomatic ties. For instance, a two-year project coordinated by the Ministry of Foreign Affairs allowed Taiwan to tackle the issue of high rates of HIV, tuberculosis, and hypertension among cross-border patients in South Africa and Malawi. Although successful, the program did not bring about a noticeable change in diplomatic relations between Taiwan and its two African partners. Additionally, given the sheer size of their economies, it can hardly be classified as checkbook diplomacy. As such, this cooperation demonstrates that Taiwan transitioned its aid regime from state- to society-centered. Rather than merely pursue intergovernmental transactions, Taiwan sought to manifest its commitment to the values of human health and people-to-people exchanges. Essentially an exercise in soft power projection, this collaborative project effectively exemplified Taiwan’s society-oriented approach to developmental assistance.

The society-centered nature of Taiwan’s aid is further illustrated by the fact that the country’s civil society organizations also successfully operate their own aid initiatives. The Buddhist Compassion Relief Tzu Chi Foundation (慈濟基金會) is a good case in point. The Foundation collaborated with the U.S. State Department and the UN Refugee Agency to provide healthcare services for the ever-increasing refugee population in Bangkok. This coordinated effort provides critical medical attention to several hundred refugees per month, even offering translation services in nine languages.

A closer look at the history of Taiwan’s and China’s engagement with the Global South exposes distinct models of development cooperation. As China continues to develop economically, it began to seek new markets to satisfy its voracious hunger for raw commodities. Consequently, Beijing became a forerunner of South-South cooperation, embarking on a pivot to areas where Taiwan’s diplomatic presence has been most significant – Latin America and Africa. And while China itself has promoted its narrative of “win-win cooperation” and “South-South solidarity,” the ghost of colonialism continues to hang over China’s relations with the Global South, leading many to interpret Beijing’s interests as “neocolonial.” While Taiwan’s developmental aid agenda is focused primarily on strengthening its soft power, Chinese assistance can instead be understood as a tool of positive economic statecraft, or a means to Beijing’s materialist ends.

While Chinese financing is alluring to many developing countries as it allows them to construct essential infrastructure – including in healthcare – the balance of loans is often deemed unsustainable. This has led China to take control of borrowers’ natural resources as a collateral – in Ecuador, where the debt to China amounts to 38.7 percent of the nation’s GDP, up to 90 percent of crude oil exports are now committed to Beijing. Consequently, the normative underpinnings of China’s global economic ambitions remain troubling, as they appear to perpetuate the unequal core-periphery dynamic in the international system. Instead of solidarity, we see evidence of exploitation.

In particular, China’s growing presence in Dr. Tedros’ native Ethiopia merits further consideration. As China began to expand its economic presence in Ethiopia, Beijing allowed positive innovations to the financing mode, as loans for infrastructural projects were backed with sesame seed exports, rather than more traditional raw commodities such as oil. This signaled China’s understanding of and respect for the local economic context. Nevertheless, as the debts of the East African country continue to mount and the sustainability of China-backed projects proved to be weak, Beijing began to take interest in Ethiopia’s untapped mineral and natural gas resources. While Addis Ababa clearly benefited from Chinese financing to develop its critical infrastructure – including for expansion of the Tirunesh Beijing Hospital, a flagship institution – it is important to remain vigilant about any potential negative externalities resulting from these precarious investments. Chinese commodity-backed loans continue to attract critical questions from experts due to their questionable sustainability.

The contrast between Taiwan’s and China’s modi operandi in development and humanitarian cooperation continues to be noticeable also in the time of the COVID-19 pandemic. We believe that Taiwan’s decision to donate masks to not only its diplomatic allies, but also influential nations in Europe and the Americas is a continuation of the society-centered soft power offensive that has shaped the nation’s framework for development cooperation for over three decades. Despite ascending to the position of world’s second-largest producer of face masks, Taiwan refrained from seeking explicit economic advantage resulting from this status. Masks were only exported as donations through official government channels; even individuals can only ship a limited number of masks via mail to their relatives overseas if they obtain an export license. This allows Taipei to effectively manage two pressing challenges: the domestic supply of personal protection equipment (PPE) as well as the timely exercise in international reputation building.

China has also embarked on a scheme to support its partners – an effort the Beijing authorities have named the largest since 1949. The country provided states around the world with PPE, thermometers, and ventilators. Yet, the response to these donations has been largely lukewarm, as experts warn of possible geopolitical strings attached to those deals. According to Marcin Przychodniak, an analyst at the Polish Institute of International Affairs, “There are possibly strings attached such as underlining the Chinese narrative of ‘wise leader and successful political system’ which helped to overcome the virus in China, by European partners.” It is also important to highlight that many of the donations from China were neither initiated nor financed by the government, but rather by big corporations such as Alibaba or civil society groups. Moreover, commercial exports of medical and protective equipment from China have remained controversial, as the list of foreign complaints about faulty medical gear and testing kits continues to expand. Notably, Chinese authorities sought to distance themselves from the grievances of foreign consumers. Chinese Ministry of Foreign Affairs spokeswoman Hua Chunying even implored buyers to “avoid making mistakes in a rush” and alleged that due diligence is the responsibility of the consumer, rather than the government. 

Chinese authorities subsequently decided to implement more meticulous customs checks for exports of medical supplies – presumably due to fears over damage to its international reputation. Nevertheless, the Chinese approach to exports of medical supplies to date has been distinct from that adopted in Taiwan. Specifically, it resembles state-centered approach to developmental assistance, rather than the society-centered perspective preferred across the strait. The state-centered perspective focuses on political ramifications of politically motivated transactions. By adopting a people-centered approach, Taiwan has thus effectively filled in the niche largely ignored by China.

Developmental cooperation and humanitarian aid are not manifestations of political altruism. These are highly politicized activities that yield political benefits for the donor countries, irrespective of which approach to developmental cooperation one considers. What remains remarkable, however, is Taiwan’s resilience in expanding its highly successful strategies for emergency response and humanitarian aid even as its diplomatic recognition continues to shrink. With only 15 diplomatic allies around the world, Taiwan actively demonstrates its commitment to the core value of human development, and in turn, human health. Nevertheless, the country still remains largely isolated by the international community.

The point here is not to determine the normative superiority of either approach to humanitarian assistance. It would be alarming, however, if Taiwan’s wide-scale efforts continue to go unrecognized. The recent change in rhetoric on Taiwan has the potential to serve as more than insular instances of politeness. World leaders, who have now experienced first-hand that Taiwan can indeed help, have an unequalled opportunity to elevate the status of this small but mighty nation.

Marcin Jerzewski (葉皓勤) is a Taiwan Scholar of the R.O.C. Ministry of Education and a graduate student in the College of International Affairs at National Chengchi University. He currently serves as a Research Intern with Taipei City Government. 

Kuan-Ting Chen (陳冠廷) is the Chief Research Officer at Taipei City Government. He obtained his B.A. in Political Science at the University of Wisconsin-Madison, and M.P.P. from the University of Tokyo.