hen they heard about patients falling sick with a mysterious pneumonia in the Chinese city of Wuhan on Dec. 31, Taiwan’s health officials fired off an email to the World Health Organization asking for more information.
This four-sentence inquiry has since become fodder for the political brawl between China and the U.S. and threatens to bruise the reputation of the U.N.’s health agency as it leads the fight against an unprecedented global pandemic.
Taiwanese and U.S. officials have seized on the email to argue the WHO ignored an early warning that the coronavirus could likely be transmitted between people. In the weeks following the Dec. 31 note, the WHO echoed Chinese officials that there was “no clear evidence of human-to-human transmission”— even as cases began cropping up that raised suspicion of contagion.
In an interview with TIME, Dr. Lo Yi-chun, the deputy director-general of Taiwan’s Centers for Disease Control (CDC), says the WHO should have acted on Taiwan’s query by conducting its own investigation. Instead, he says the WHO “provided a false sense of security to the world.”
The WHO has defended its handling of the outbreak and says it relies on member countries like China to accurately report their findings. It also notes that Taiwan’s email did not explicitly mention human-to-human transmission, and that the self-governing island was not the first nor the only one to contact the organization about the disease.
Yet the scrutiny has intensified. President Donald Trump — facing criticism over his own government’s response — has cited Taiwan’s email as evidence of the WHO allegedly helping China coverup the severity of the outbreak, and suspended U.S. contributions to the health agency in April. Both Beijing and the WHO deny any concealment.
On Tuesday, Trump threatened to make the funding freeze permanent in a letter sent to the WHO leader as nations gathered virtually for the WHO’s annual decision-making meeting. Referencing “repeated missteps” in the WHO’s steering of the pandemic response — including choosing “not to share” Taiwan’s communication — Trump said he could no longer commit American taxpayers’ dollars to the agency unless it undertakes “major substantive improvements in the next 30 days.”
With Taiwan in the spotlight, TIME spoke with health officials, politicians and analysts to unpack what the island of 23 million knew in the critical early days of the pandemic when it initiated a quick response that helped it keep its infection rate among the lowest in the world.
The email
At 6:30 a.m. on Dec. 31, Dr. Lo at Taiwan’s CDC woke to an alert on his phone.
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His colleagues in the media monitoring unit had detected social media posts about a pneumonia of unknown cause in Wuhan. The original posts in China were quickly removed, but screenshots had been reposted on PTT, a popular online forum in Taiwan. Some commenters feared a resurgence of the Severe Acute Respiratory Syndrome (SARS), which had killed 774 people in 2002 and 2003, mostly in Asia.
Lo, an infectious disease expert, looked at the images of laboratory reports and doctors’ messages and suspected something else, something new. “But whether the source was reliable or … indicated the correct pathogen [couldn’t] be proved just from reading that,” he says. So he instructed his colleague to get in touch with counterparts in Beijing and the WHO through the International Health Regulations mechanism, a WHO framework of exchange between countries, to ask for more information.
Around 1:30 p.m. that afternoon, the Wuhan Municipal Health Commission announced 27 cases of pneumonia related to a seafood market. It said their investigations found “no clear human-to-human transmission.” It would be another three weeks before a top Chinese government-appointed expert would confirm on state TV that the disease could spread between people, followed two days later by a WHO statement that said data “suggests that human-to-human transmission is taking place in Wuhan.”
But Taiwan didn’t wait to step up precautions. On Dec. 31, the island began instituting health screenings for all flights arriving from Wuhan. “We were not able to get satisfactory answers either from the WHO or from the Chinese CDC, and we got nervous and we started doing our preparation,” Foreign Minister Joseph Wu tells TIME.
A matter of interpretation
It took time, but that email Lo instructed his colleagues to send to the WHO eventually kicked up a geopolitical storm. In March, Taiwan’s Vice President Chen Chien-jen, an epidemiologist-turned-politician, told the Financial Times the WHO had failed to relay the island’s early warning that the disease could be transmitted between people. The U.S. State Department took up the claim and said by not passing this vital information on to member states the WHO “chose politics over public health.”
Why did the W.H.O. Ignore an email from Taiwanese health officials in late December alerting them to the possibility that CoronaVirus could be transmitted between humans? Why did the W.H.O. make several claims about the CoronaVirus that ere either inaccurate or misleading....
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Taiwan doesn’t have a seat at the WHO due to objections from Beijing, which claims sovereignty over the island. This exclusion, Taiwan says, is dangerous for public health. The WHO, which is governed by its member states and so does not have authority over membership, says it has been sharing information related to the pandemic with Taiwan. Meanwhile, the Trump Administration has homed in on the status of its ally as it attacks the relationship between the WHO and China.
With the row escalating, and after WHO chief Tedros Adhanom Ghebreyesus accused Taiwan of backing a racist campaign against him, the island’s CDC publicly released its Dec. 31 email.
Written in English, the text mentions reports of “at least seven atypical pneumonia cases” and notes that patients were being “isolated for treatment.” Taiwan’s foreign ministry tells TIME in an emailed statement that this precaution was the smoking gun, “strongly suggesting that there was a possibility of human-to-human transmission,” since it would not have been necessary if the disease was not infectious. Public health officials could have discerned from this wording an implied warning about contagion, according to statements from Taiwan’s foreign ministry and CDC.
Health experts contacted by TIME were divided, with some noting that “atypical pneumonia is assumed to be communicable,” while others say isolating patients with a potentially novel pathogen is a sensible precaution.
A man holds a Taiwan flag as passengers disembark from the Diamond Princess cruise ship due to fears of COVID-19 in Yokohama, Japan on Feb. 21, 2020.
Philip Fong—AFP/Getty Images
For its part, the WHO denies ignoring a warning from Taiwan. Spokesperson Tarik Jasarevic says the WHO received Taiwan’s email only after Wuhan’s announcement about the outbreak. The inquiry, he adds, made no mention of human-to-human transmission, but was nevertheless forwarded to experts collating information on the outbreak.
