Focus Asia Perspective & Analysis September 2021 China’s Health Diplomacy: Taking Forward the Health Silk Road in Southeast Asia Geopolitical competition over Covid-19 vaccines is at its peak. In the absence of a fair and equitable mechanism to coordinate vaccine access, procurement seems to be based either on nationalistic goals or on geopolitical favors. While the extent to which major powers like the US and China are using vaccine diplomacy to create long-term dependencies is yet to be seen, signs of it are already noticeable, for example, in Southeast Asia. China’s health diplomacy there is not new but has always been a major part of their strategic relationship and China’s Health Silk Road. Increasing spotlight on it has, however, invited an increased sense of fervor among the Western countries to also court the region. Engagements are already in full swing, and the ASEAN countries are adopting multilateralism to navigate these complex dynamics. So, this paper first seeks to trace the trajectory of China’s health diplomacy in Southeast Asia. Secondly, we shall see how the Chinese health silk road is opening doors to strategic vaccine diplomacy for China. Introduction are now planning to re-imagine the economy and accelerate growth, distinct diplomatic trends can be Covid-19 has overhauled the global public health seen in the way countries are conducting business order. It has revealed not only the inefficiencies with one other. in the health infrastructure but also the caveats existing in government functioning with regards to Governments are now practicing strategic vaccine formulating an effective response to a pandemic. diplomacy to secure sufficient vaccines for their While the degree of disruption varies, Covid-19 has population. For the vaccine supplying countries, invalidated the notion that the First World is always this has led to a surge in vaccine production and best equipped in times of crisis. Despite having the prejudiced distribution. Covid-19 vaccines are being infrastructure, weathering a pandemic requires a systematically and implicitly instrumentalized for high level of preparation and a robust foundation for political gains and this has huge implications for recovery that cannot be built overnight. As countries the developing world.1 China too is carving a space 1 Focus Asia Perspective & Analysis China’s Health Diplomacy September 2021 for its own global health agenda through its aid and vaccination program. It has made its domestic vaccines “a public good” and distributed them far The Institute for Security and Development Policy is an and wide. independent, non-partisan research and policy organization based in Stockholm dedicated to expanding understanding What helped China increase its distribution of of international affairs. vaccines to the developing world can be traced For enquiries, please contact: [email protected] back to the stance the western countries had taken No parts of this paper may be reproduced without ISDP’s to bolster their vaccination rates. While the latter permission. had overwhelmingly focused on vaccinating their Disclaimer: The opinions expressed in this paper are those of residents first, China positioned itself as a champion the author only and do not necessarily reflect those of ISDP of vaccine distribution, signifying its adherence to or its sponsors. making vaccines a global public good. It also helps their cause that their vaccines—Sinovac, Sinopharm and CanSino Biologics—are more portable, feasible in terms of storage and cheaper than the others. and, more importantly, in regional and global health Having exported on a massive scale, their vaccine governance.4 Covid-19, in this way, has accelerated outreach has been dubbed as vaccine diplomacy, existing geopolitical trends of China’s ascendance aimed primarily to gain influence and favor. The towards attaining leadership in the region. outreach has been in terms of both commercial transactions and donations and more in implicit The Sino-US trade war already has deep economic ways than explicit quid pro quo ways that might ramifications on global supply chains, which undermine China’s soft power.2 are crucial for the region’s interconnected trade- dependent markets. Anticipating a more China- centric world order, commentators debate on how Covid-19 vaccines are the Chinese vaccines could have strings attached being systematically and to them, the South China Sea being the perfect example. So, how will SEA now shape its foreign implicitly instrumentalized policy approach towards China and other major for political gains and this powers like the US? has huge implications for This paper takes a renewed look at the emerging geopolitical realities in the region, a reminder of the the developing world.” non-alignment movement in the past where nations did not engage in isolation but chose not to formally Beijing is also pushing forward its Health Silk Road align with any power bloc. The ASEAN could be (HSR), which, just like the Belt and Road Initiative said to be a forerunner in Asia in this regard— (BRI), leaves room for interpretation but mostly keeping their geopolitical outlook focused on involves cooperating bilaterally and multilaterally in solving transnational issues through consultations, the healthcare sector.3 Such health projects already dialogues, and consensus while maintaining strict exist in the multilateral (ASEAN) and sub-regional non-interference. This, however, does not imply (Mekong region) arrangement, making Southeast major power influence can be obliviated. The paper Asia (SEA) an obvious beneficiary of the HSR will, thus, first trace the trajectory of China’s health due to its proximity to China and their strategic diplomacy from the early years to contemporary partnerships. The HSR adds to China’s already times. In the second part of the paper, we shall see existing health diplomacy by providing a framework how Chinese vaccine diplomacy is rapidly evolving for strengthening its role in medical supply chains now and how other major powers are responding to 2 Focus Asia Perspective & Analysis China’s Health Diplomacy September 2021 it while strengthening their own diplomacy. where cooperation was shaped more by diplomatic technicalities than mere humanitarian goals. Since China’s Early Health Diplomacy Days the end of the 1990s, the Chinese system of health and development has come to be known far and Health diplomacy was defined by Adams and wide. It has been actively pushing for comprehensive Novotny (2007) as the “tools of diplomats and health diplomacy, especially in four sectors—bilateral statecraft [that] can be employed for the dual purposes and multilateral health cooperation, investment in of improving health and relations among nations.”5 health technologies and capital, formal and informal Health-related issues, due to their transboundary health-related discussions, inflow and outflow of nature, are already considered a human security multifarious health assistance.11 Moreover, with challenge, thus requiring international cooperation. increased market-oriented reforms, healthcare has Unlike traditional security threats, which take on taken on a new lease with medical collaborations a zero-sum nature, health diplomacy can be more becoming a source of profit-making. China too is complementary in terms of establishing reciprocal diversifying its foreign aid towards concessional relations in foreign policy.6 medical loans, building medical infrastructure and attaining markets for its pharmaceutical companies In China’s case, health diplomacy has gone through and traditional medicine worldwide.12 several phases, mediated by varying geopolitical concerns. From being a benefiter of health supplies to the World Health Organization (WHO) to China still uses health actually being a consistent partner to African and Latin American countries, China’s history of and developmental health diplomacy touches upon various diplomatic diplomacy as a means to strategies, which has slowly but strategically helped to extend its footprint as a consistent net donor in build strategic, oftentimes global health and development.7 While its foreign what appears to be policy strategies have met several controversies, China still uses health and developmental diplomacy crooked, relationships” as a means to build strategic, oftentimes what appears to be crooked, relationships.8 Now, an important stakeholder in global health governance, China is a crucial source of development Very briefly, China’s initial phase of health diplomacy assistance for health (DAH) and overseas began right after its independence when it was development assistance (ODA), focusing on sharing “leaning towards one side” influenced by Soviet know-how and eradicating transnational infectious Union’s Communist ideology. It was a recipient disease threats.13 While most widely noticed is of the Soviet Union’s health aid and expertise.9 It China’s medical assistance to Africa through the did not take much time to transform from an aid setting up of medical and disease control institutions, recipient to an aid donor, and during the Cold China’s health diplomacy with SEA countries also War period, China organized many missions to goes far back. SEA countries have always been at the “intermediate zones” and dispatched medical the juncture of China’s strategic calculations and supplies to African, Asian, and Latin American economic statecraft. In such scenarios, tapping on countries. It was following the principle of “the poor non-traditional security