China's global health diplomacy

Dr Moritz Rudolf

In its pursuit to reform the international order, Beijing views third (developing) states as its main allies and health diplomacy as an essential tool to build international coalitions.

The People’s Republic of China (PRC) has abandoned its traditional foreign policy restraint and is playing an active role in shaping the global order of the 21st century. Our most recent analysis shines a spotlight on these changes, concentrating explicitly on China's global health diplomacy. The main focus of the analysis is to provide a comprehensive overview of Beijing’s health cooperation efforts, illustrating how the Chinese leadership has utilized health diplomacy to generate soft power. Beijing’s stated goals are addressed as well as the country’s strategic interests in engaging in health cooperation. In particular, this analysis places China’s recent international COVID-19 relief assistance in the broader context of the Belt and Road Initiative (BRI) and the Health Silk Road (HSR). This analysis closes with a series of proposals for how Europe can better counter China in the field of global health policy. These recommendations address setting priorities vis-a-vis third countries so as to be perceived a reliable partner on health issues.

China’s health diplomacy programme did not develop overnight

The PRC’s health diplomacy programme did not develop overnight.Beijing has been sending medical teams abroadfor decades, while Chinese provinces have been cultivatingclose relationships with individual countries. For instance, HenanProvince has sustained its relationships with Zambia, Ethiopia, and Eritrea, while Yunnan has maintained close tieswith Uganda. Moreover, the PRC has utilized health diplomacy to achieve political goals on the multilateral level for many years, an example of which can be seen in how it generated support among former European colonies in Africa and Asia for its admission to the UN in 1971.

In order to facilitate a better understanding of China's global health diplomacy, the Asia-Pacific Department of the Friedrich-Ebert Stiftung (FES) recently published a new analysis entitled China's global health diplomacy. The report, written by Dr Moritz Rudolf, shows how Beijing stepped up its international health cooperation efforts after the 2002 SARS-CoV-1 outbreak, which challenged China’s economic and political stability. Moreover, he goes on to demonstrate how the 2015 launch of the HSR marked the beginning of a strategic, centralized, and streamlined health diplomacy campaign.

The declared goal of the HSR is to generate “soft power and influence in the field of regional and global health governance,” and to increase China’s “status as a major country”. It includes the following areas: (1) Expanding health cooperation mechanisms, (2) prevention and control of infectious diseases, (3) capacity building and talent training programmes, (4) emergency medical assistance, (5) Traditional Chinese Medicine (TCM), (6) health system reform and health policy coordination, (7) health development assistance (e.g., free surgeries), (8) health industry development.

COVID served as a catalyst and accelerator for Beijing’s regional outreach efforts

The COVID-19 pandemic served as a catalyst and accelerator for Beijing’s efforts to extend regional health cooperation. A majority of third states welcomed China’s health cooperation and, in many cases, endorsed key policy positions of China in regional and multilateral settings (e.g., regarding Xinjiang and Hong Kong). Not only for this reason, and despite Beijing’s quixotic Zero-COVID-19 policy, Dr Rudolf concludes that decision-makers in Europe should be aware of the long-term effects of Chinese aid to developing countries and to see health cooperation through a more strategic and geopolitical lens as well. While Beijing has been pushing the narrative of Western decline, European decision-makers should promote the narrative of the West’s ability to vaccinate themselves back to normality, extending an open invitation to third countries.

For example, it is important to broaden the view and draw analogies. The PRC's health diplomacy illustrates the functionality of the BRI and the PRC's approach to foreign policy. The BRI is here to stay as a comprehensive vision to establish China-centred networks across a multitude of policy areas, including health. Moreover, European decision-makers should be aware of the extent of China's ambitions to win over third countries. It would be wrong to underestimate the People's Republic's ability to learn from its mistakes and improve its health diplomacy. Beijing is aware that the support of third countries is crucial for the maintenance and reform of the international order. For this reason, China is targeting third countries and offering itself as a natural partner to developing countries.

This report is part of a FES publication series, which examines Beijing’s strategy in a range of different global policy fields. The overarching theme of the series is the future of multilateralism in light of China’s rise to world power and the growing competition over the establishment of values and norms. It seeks to address questions such as: How can we go about initiating a constructive process of political negotiation between Europe and China on the regulatory framework for global governance? In which areas is there potential for more coordination and cooperation with China? And, in contrast, where should Europe be taking countermeasures and conducting its own groundwork, for example to ensure that newly industrialized and developing countries see it as a reliable partner?

Rudolf, Moritz