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China's Health Diplomacy During Covid‑19. the Belt and Road Initiative

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China's Health Diplomacy During Covid‑19. the Belt and Road Initiative NO. 9 JANUARY 2021 Introduction China’s Health Diplomacy during Covid-19 The Belt and Road Initiative (BRI) in Action Moritz Rudolf International cooperation in the health sector has been a firm component of China’s Belt and Road Initiative (BRI) for over five years. Since the outbreak of the Covid-19 pandemic, the Chinese leadership has been promoting this aspect of the initiative (“health silk road”) as essential to building a “global community of common destiny”. The pandemic has revealed the strengths of the BRI and the way it functions. China’s health diplomacy is farsighted and strategic. Beijing has been linking measures to combat the Covid-19 pandemic in aid recipient countries with the prospect of post- pandemic cooperation within the BRI framework. Above all, Beijing wants to be per- ceived internationally as a “responsible great power”. The West’s often narrow focus on the qualitative defects of Chinese aid fails to recognise that, in the absence of traditional aid donors, Beijing has supported many third countries effectively and extensively. To counter China’s increasing influence in regions that are strategically important for Germany and Europe, greater sensitivity is needed to the geopolitical implications of the pandemic, as well as specific Euro- pean proposals for third countries for the post-pandemic period. In parallel with more commitment at the multilateral level (for instance within the World Health Organisa- tion, WHO), other options include strengthening bilateral initiatives (e.g. via regional EU+x formats) and coordination with the new US government under Joe Biden. On 9 and 12 December 2020 the United Chinese leadership: China is a responsible Arab Emirates (UAE) and Bahrain were the great power. Since the outbreak of the pan- first countries to approve a Chinese corona- demic, China has linked its contribution virus vaccine. Other countries, especially in combating the virus to President Xi Jin- in the Global South, have announced that ping’s foreign-policy prestige project, the they intend to do likewise soon (by 18 Janu- Belt and Road Initiative (BRI). ary 2021, Egypt, Indonesia, Turkey and Brazil, among others, had approved Chinese vaccines). It is realistic to assume that China Health as Part of the BRI will play an important role in vaccinating the world’s population. This would be con- Health has been on the BRI agenda for over sistent with the narrative promoted by the five years. In March 2015 the framework document Vision and Actions on Jointly grammes for exchange and cooperation (for Building Silk Road Economic Belt And 21st- hospitals, the health industry, and univer- Century Maritime Silk Road already listed sities), access to markets (for example for cooperation to prevent and contain epi- medicines), and cooperation in combating demics among its objectives. According to infectious diseases like MERS and SARS (see official BRI documents, health cooperation the Suzhou Declaration of 20 June 2016). also includes: New structures have been created for this training programmes for medical staff; format, including the 17+1 Hospital Alliance, capacity-building for public health crises; the 17+1 Cooperation Network for Public ∎ emergency medical relief for crises; Health, the 17+1 Cooperation Network for ∎ promoting Traditional Chinese Medicine Health Workers, the 17+1 Research Net- ∎ (TCM); work for Health Policy, and the 17+1 Co- ∎ free treatment abroad by Chinese operation Forum for Approval of Medicines. doctors. Health was already a prominent part of ∎ The BRI framework document The Belt China’s relationship with the ASEAN coun- and Road Initiative – Progress, Contribu- tries before the BRI was announced. In 2012 tions, and Perspectives (April 2019) refers to the parties concluded a Memorandum of 56 bilateral health agreements that China Understanding on health cooperation. On has concluded, inter alia with the WHO and 26 October 2016, the participants in the first the Bill & Melinda Gates Foundation. The China-ASEAN Health Cooperation Forum BRI Standardisation Action Plans of 2015– adopted the Nanning Declaration. It focuses 2017 and 2018–2020 also mention Chinese on exchanging information, jointly prevent- efforts to set uniform standards for TCM ing and controlling infectious diseases, train- and the definition of medical terms. The ing health sector professional, promoting BRI Development Plan for Promoting TCM TCM, and deploying Chinese doctors. For (2016–2020) makes it clear that Beijing the “Lancang-Mekong” countries (Cambodia, plans to promote traditional Chinese medi- Laos, Myanmar, Thailand, and Vietnam), cine internationally. one focus of China’s BRI health diplomacy In realising the Health Silk Road, as in is on free eye operations. all other areas of the BRI, Beijing acts strategi- In September 2015 the China-Arab States cally, flexibly and at several levels simulta- Health Cooperation Forum was held as part neously (bi- and multilateral, regional, and of a dialogue forum that China has estab- global). The so-called China+x mechanisms lished with Arab League countries. Accord- are essential here. These are formats for ing to the Yinchuan Declaration that it Chinese cooperation, for instance with coun- adopted, this cooperation includes techno- tries from the Association of Southeast logical collaboration, promoting TCM, pre- Asian Nations (ASEAN) countries, Africa venting and controlling infectious diseases, (FOCAC), Central and Eastern Europe (17+1), medical training programmes, coordinating or the Arab League. Health cooperation public health system reforms, exchanges within these mechanisms does present between medical establishments and staff, differences from region to region, but it and coordinating on global health issues. reflects large swathes of the content (at Health cooperation is most significant in times verbatim) of the Chinese BRI docu- China-Africa relations, where it dates back ments. to long before the BRI was announced (for Since 2015 there has been a regular example, the deployment of medical per- forum of the Chinese health minister with sonnel, a decades-old practice). Since 2015 17 (until 2019: 16) Central and East Euro- it has been absorbed into the BRI as part of pean colleagues (2015 in Prague; 2016 in the Forum on China–Africa Cooperation Suzhou; 2017 in Budapest; 2019 in Sofia). (FOCAC). It consists, inter alia, of providing The declared objectives of the format are medical supplies, training programmes, the promotion of TCM in Europe, pro- building hospitals, and support for com- SWP Comment 9 January 2021 2 bating infectious diseases such as malaria Comoros) were used for propaganda by Bei- and Ebola (see e.g. the FOCAC Johannesburg jing as a sign of solidarity and evidence of Action Plan [2016–2018] and the FOCAC the Health Silk Road mentality. Beijing Action Plan [2019–2021]). In late February, when the Chinese Health was also important within the leadership had gradually regained control BRI on a bilateral level before the Covid of the outbreak in the country, Beijing pandemic. China has been sending medical quickly took on the role of relief supplier. personnel to offer free treatment in regions Since a majority of the world’s mask fac- where China+x formats are less widespread. tories are in China and many industrialised Here China’s commitment in South Asia nations had delivered relief aid to Wuhan, and Oceania must be emphasised (Beijing the Chinese leadership was in an almost has sent teams of doctors to Nepal, Micro- monopolistic position to provide the world nesia, Vanuatu, Tonga and Fiji, for exam- with masks and medical kits. In particular, ple). China is also active in Central Asia. Its countries that had inadequate medical most important pilot project is the Medical equipment very quickly received donations Services Centre of the BRI Core Region Xin- of much-needed aid supplies (masks, test jiang. This hospital cooperation platform kits, and respirators). Beijing also sent teams provides medical help for patients from of doctors to 43 countries. Nearly all the neighbouring countries (such as free heart world’s countries have received support operations for Afghan children). It also aims from China (see Map 1, p. 7). to network Central Asian hospitals with Aid supplies came from a variety of Xinjiang (for example for medical tourism). actors, not only from China’s central gov- Most important at the global level is the ernment and the Communist Party, and Memorandum of Understanding on Health often took into account China’s strategic Sector Cooperation under the Belt and Road interests in the recipient nation. Provinces Initiative signed by China and the WHO and cities supplied their partner municipal- on 18 January 2017. It uses the term Health ities and regions. Majority Muslim countries Silk Road for the first time. The WHO’s ex- (such as Afghanistan, Egypt, Iran, Iraq, plicit support for the BRI reflects the grow- Lebanon and Jordan) received masks from ing influence of the People’s Republic with- Xinjiang Autonomous Region. In Southeast in the WHO, which has been noticeable for Asia (e.g. Laos, Cambodia, Myanmar), sol- years. In August 2017 officials from many diers from the People’s Liberation Army countries, international organisations and delivered medical aid supplies. In countries non-governmental organisations (NGOs) where Chinese state-owned companies run signed the Beijing Communiqué on BRI BRI projects (for instance in Africa), donors Health Cooperation and the Health Silk included relevant banks, construction
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