China's Health Diplomacy during Covid-19 - Stiftung ...
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
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 com-
Road, which summarises the fundamental panies, and raw material companies. The
elements of China’s BRI health policy. telecoms company Huawei preferentially
gave support to countries in which it was
pursuing strategic interests in the 5G ex-
Activating the BRI Networks as pansion: in Europe these included the
Part of “Mask Diplomacy” Czech Republic, Ireland, Italy, Lithuania,
the Netherlands, Poland, Romania, Serbia,
Once the coronavirus outbreak in Wuhan and Spain. Business foundations (especially
became known, China initially appealed to the Jack Ma Foundation and the Alibaba
the international community and received Foundation) delivered masks, respirators,
material and financial aid from more than and testing apparatus to over 150 countries.
58 countries (including Australia, Belarus, Trade associations, overseas Chinese, and
Djibouti, Germany, Pakistan, Bahrain, the NGOs were also involved. As part of “mask
USA and Surinam). Even smaller contribu- diplomacy”, many recipient countries saw
tions (for instance a €100 donation from the involvement of locally resident Chinese
SWP Comment 9
January 2021
3actors, who normally tend to live apart China’s mask diplomacy has been criti-
in parallel societies. These forms of help cised, particularly in Europe; the necessary
for the local population correspond to the logistics, activation of Chinese actors, and
objective formulated in many BRI docu- uniform external communications are never-
ments of generating broad support for theless remarkable achievements. For many
China’s Silk Road policy. countries China was a reliable partner, espe-
China even offered aid supplies to states cially since traditional aid donors (above
that do not (yet) have diplomatic relations all the USA) were absent. For the first time,
with Beijing, especially in Latin America. Beijing has given its global BRI rhetoric
In Paraguay the parliamentary opposition some substance.
demanded that relations with Taiwan be
broken off so as to receive aid from Beijing.
Belize received donations of auxiliary ma- Next Act: Vaccination Diplomacy
terials from Chinese organisations that were
supposedly NGOs. A remarkable PR coup Phase III trials are currently running in
for Beijing were the photos of Belize City 18 countries, especially in Latin America,
councillors posing in front of Chinese flags. Southeast Asia, and the Arab world, for the
China’s propaganda machine has been vaccines produced by five Chinese compa-
running at full speed for months. The con- nies (Sinopharm, CanSinoBIO, Sinovac and
tent for this streamlined Covid-19 narrative Anhui Zhifei Longcom Bio, IMBCAMS). China
comes from the white book Fighting Covid- has already concluded contracts for vaccine
19: China in Action. Chinese diplomats deliveries with 26 countries; 10 (see Map 2,
have been publishing articles in local daily p. 8) have approved Chinese vaccines (as
newspapers in which they describe China’s of 18 January 2021). Many other countries
relations with the country to which they would like to use a Chinese vaccine or are
have been posted according to this narra- currently negotiating contracts.
tive. These articles present China as a On this issue, too, the Chinese leadership
rescuer that is the equal of the aid recipient wants to be perceived as a “responsible great
countries, and as a responsible internation- power”. Once again it is acting bi- and
al great power. China’s help, the narrative multilaterally. On 18 May 2020 Xi Jinping
claims using a key BRI expression, is sym- announced in a speech to the WHO in
bolic of the “global community of common Geneva that China would be providing the
destiny” to which it aspires. The articles are world with an inexpensive vaccine as a
reminiscent of China’s propaganda strategy “global public good”. This is typical BRI
in the early days of the BRI: similarly, back rhetoric. The Initiative has been promoted
then sizeable newspaper adverts were used using the same vocabulary for years. Presi-
(though primarily by members of the leader- dent Xi also promised the WHO US$2 bil-
ship, not diplomats) to promote the BRI. lion for the fight against corona. In October
A new development is China’s presence Beijing joined the vaccine platform COVAX,
on “Western” social media such as Twitter an initiative by the United Nations, Euro-
or Facebook, which are not available in pean Union and France, which aims to en-
China. Almost every day, China’s diplomatic sure a fair distribution of vaccines.
missions disseminate updates on social net- While the first months of the pandemic
works about China’s local contributions to were marked by bilateral aid supplies, Bei-
combating Covid-19. Xi Jinping’s wife, the jing has been increasingly using China+x
singer and WHO special envoy Peng Liyuan, formats for its vaccine diplomacy. These
also has a role in China’s health diplomacy, formats link vaccine promises with the
for instance by leading online ceremonies prospect of economic support and long-
to mark Chinese assistance. Peng has also term cooperation projects. The starting-
personally donated protective masks to point was the Extraordinary China-Africa
many African countries. Summit on Solidarity against Covid-19
SWP Comment 9
January 2021
4(June 2020). The Chinese leadership prom- jing has increasingly been linking its con-
ised preferential vaccine deliveries, “debt tribution to combating the pandemic with
cancellation”, and reinforced economic the BRI narrative (e.g. the advantages of
relations after the pandemic (such as help global connectivity; the construction of
with investments in the digital economy, a “global community of common destiny”).
boosting renewable energies, and expand- With its high degree of flexibility, strong
ing the 5-G network). One month later, political will, and logistically advantageous
Beijing organised a health summit with the starting position, the BRI has so far been
Arab League states. Here too China held out able to weather the test of this crisis.
the prospect of vaccination cooperation as Beijing’s health diplomacy has revealed
well as strengthened bilateral economic the way the initiative functions, and espe-
relations (under the BRI framework). Also cially its adaptability. Virtually overnight,
in July, Beijing promised Latin American health was promoted from a marginal to
and Caribbean countries US$1 billion for a key subject of the BRI. In the briefest of
purchasing vaccines. On 24 August Prime times, China activated BRI networks around
Minister Li Keqiang explained that the Lan- the world. The necessary infrastructure
cang-Mekong countries would be prioritised was already available from other BRI com-
for vaccine deliveries and that funding ponents. BRI rail links and the so-called Air
could come from a Public Health Fund. In Silk Road (with hubs in Luxembourg and
turn Foreign Minister Wang Yi identified Liège) were repurposed as supply lines for
the ASEAN as a priority region for vaccines. aid goods. Now the interlinking of the Digi-
Similar promises (vaccine priority and ex- tal Silk Road with the health BRI is also on
pansion of economic relations) were made the agenda (for instance to facilitate con-
at the China-Pacific Island Forum. In Novem- tact tracing). Institutionally China can here
ber high-ranking officials from China and draw on numerous China+x mechanisms
South Asian countries (Bangladesh, Nepal, to drive the BRI forward.
Pakistan, Sri Lanka) held talks about vac- While, in the early days of the pandemic,
cinations. the USA mostly did not participate in inter-
What is remarkable is that the most national aid measures, China filled this gap
advanced format institutionally, the 17+1, and is now advancing further into the tra-
has played a subordinate role in China’s ditional backyards of the USA’s spheres
vaccine diplomacy. In 2020 only two of influence (Latin America and the Arab
webinars were held at vice-ministerial level. world).
China’s vaccine diplomacy in Europe, on The widespread view in Germany and
the other hand, has been designed bilater- Europe that China’s mask diplomacy has
ally and is aimed primarily at Hungary and been unsuccessful, fails to recognise that
Serbia. China has been targeting success in coun-
China’s commitment to Latin America tries outside of Europe, where it is increas-
and the Arab world is particularly promi- ingly viewed as a responsible great power.
nent. These regions have recently also Beijing has been helping third states effec-
gained importance for the BRI. The new tively and extensively.
China-Pacific Islands health cooperation After the pandemic, China might well be
forum in turn emphasises China’s strategic able to further expand its influence in key
orientation towards the southern Pacific. BRI regions: it has been acting strategically
and far-sightedly in its (health) initiative. Its
health diplomacy links measures to combat
Assessment the pandemic with BRI promises (prosperity
through connectedness with China). To
The BRI has not floundered on Covid-19, as counteract further growth of China’s influ-
some observers had predicted in the early ence on strategic regions, Europe should
days of the pandemic. On the contrary, Bei- make proposals to third countries for the
SWP Comment 9
January 2021
5post-pandemic period (political cooperation
and economic support). Europe has a lot of
catching-up to do in this respect. Its under-
standing of the geopolitical implications of
Covid-19 is insufficient.
Chinese competitors have so far not
emerged as forerunners in the vaccine race.
Yet there are promising Chinese vaccines.
Despite growing doubts over their efficacy,
Beijing will profit from national production
© Stiftung Wissenschaft capacities in the coming months and be in
und Politik, 2021 a position to provide the Global South with
All rights reserved vaccines. Beijing plans to vaccinate 50 mil-
lion of its own citizens against the corona-
This Comment reflects
virus by early February. It would not be
the author’s views.
surprising therefore if Chinese vaccination
The online version of teams were deployed in developing nations
this publication contains in the coming months under the BRI
functioning links to other banner.
SWP texts and other relevant
Political decision-makers in Germany and
sources.
Europe need to realise and react to the fact
SWP Comments are subject that China’s health diplomacy, just like the
to internal peer review, fact- entire BRI, operates on several levels simul-
checking and copy-editing. taneously: bi- and multilateral, regional,
For further information on and global. Multilateral commitments (e.g.
our quality control pro-
within the WHO) should be strengthened;
cedures, please visit the SWP
website: https://www.swp- where appropriate, China should be co-
berlin.org/en/about-swp/ operated with (for instance under COVAX).
quality-management-for- However, this alone is insufficient. Over
swp-publications/ the past few years, Beijing has massively
expanded China’s influence at the multi-
SWP
Stiftung Wissenschaft und
lateral level (especially within the WHO).
Politik To oppose this expansion in third countries,
German Institute for Germany and Europe would do well to
International and strengthen their own bilateral commit-
Security Affairs ments as well. Regional EU+x formats with
countries in strategically relevant regions
Ludwigkirchplatz 3–4
10719 Berlin (e.g. Indo-Pacific or Africa), or appropriate
Telephone +49 30 880 07-0 measures coordinated with the new Biden
Fax +49 30 880 07-100 administration in the USA, would be poten-
www.swp-berlin.org tial courses of action.
swp@swp-berlin.org
ISSN 1861-1761
doi: 10.18449/2021C09
Translation by Tom Genrich
(Updated English version of
SWP-Aktuell 5/2021)
Moritz Rudolf is an Associate in the Asia Research Division at SWP.
SWP Comment 9
January 2021
6Map 1
SWP Comment 9
January 2021
7Map 2 SWP Comment 9 January 2021 8
You can also read
