Maddalena Procopio

Yes, so far, though with limitations that suggest the road ahead is still bumpy and uncertain. China has a long history of health diplomacy, especially in the Global South, where it used this foreign policy tool widely to portray itself as a responsible power and attain geopolitical ambitions. The first Chinese medical teams, sent to Africa, date back to the 1960s, though it was the 2014 Ebola crisis in West Africa that made China an aspirant global health leader. If in 2014 China was still learning how to navigate a global health crisis, and the US promptly led the international response to Ebola, this time around China finds itself on a somewhat new global playing field. The US appeared unwilling and, more importantly, unable to lead a global action. European countries struggled first with Personal Protective Equipment (PPE) shortages in the first phase of the pandemic, and as of late with the deployment of vaccination plans, raising criticism over vaccine nationalism.

China instead has been acting in a tactical and far-sighted fashion, at home and abroad. After suffering from the reputational damage of being the origin of the Covid-19 outbreak, China moved rapidly to provide support worldwide through the distribution of PPE and other medical supplies, topped by the dispatch of medical teams and the online availability of infectious disease experts for practitioners worldwide. President Xi Jinping pledged to provide Chinese vaccines as a ‘public good’ through donations and affordable purchase agreements and joined the COVAX initiative to guarantee global access. In addition, China has been collaborating with countries in Africa and Latin America to boost logistics-chains and create local manufacturing and distribution hubs for the Chinese vaccine. This suggests that China has not merely promptly provided goods and acted as a global health aid provider but has set the pace for a crisis management approach that tackles health security while potentially promoting industrial development in developing countries. This modus operandi is part of a long-term strategy to raise China’s international profile and gain a more significant foothold in the global pharmaceutical market where China is still a relatively minor player. Should the approach gain ground, it would reduce healthcare-related inequalities in developing countries and contribute to economic development (and indirectly to the wider public good).

The situation is, however, fluid. So far, China’s financial commitments, vaccine deliveries and industrial support have been limited to a few countries, despite being ostensibly publicized. Technology and quality still need testing, determining China’s capabilities and reputation. Technologically, Chinese vaccines may be less resilient to virus variants than those from the US or UK, raising questions about their contribution to global health security. In terms of quality, given the lack of transparent trials, vaccines’ rollout will be the litmus test. China’s ambitions to be a global public goods leader will also, in due course, be measured against other contenders, such as the US the EU and India. Irrespective of what will be, China’s prompt response and its dual healthcare-industrial approach align with a global leader’s thinking – though the jury is still out as to whether implementation will keep it up.

Hannah Bretherton

Just one year ago, China was rapidly acquiring an unfortunate reputation as a global health pariah, squarely in the spotlight as the accused viral propagator of the calamitous COVID-19. Shift forward to March 2021 and China is leading a dogged campaign to fundamentally alter its legacy in the historic tale of this century’s great pandemic. Domestically, China has been one of the most successful nations to contain the virus, with a remarkably low number of cases given its 1.4 billion strong population.

Looking abroad, China has espoused the view that vaccines should be a public good. With a particularly strong focus on expanding access across the Global South, China has officially stated that it is donating vaccines to 69 developing countries. Independent tallies estimate that 45 countries should receive around half a billion of China’s home-grown COVID-19 vaccines, across Central and South East Asia, Africa, South America and Eastern Europe. China’s ‘vaccine diplomacy’ boldly aims to follow in the footsteps of its successful ‘mask diplomacy’; it managed to export 224 billion face masks between March and December last year.

While Chinese Foreign Minister Wang Yi has publicly denounced ‘vaccine nationalism’, critics have observed that many of China’s jab recipients are existing signatories to its politically and economically strategic Belt and Road Initiative (BRI). China’s mission to share public health technology and equipment across the globe pre-dates this latest coronavirus and crafting a ‘health silk road’ as part of its BRI activities is a goal that China has openly articulated.

It seems obvious that China would focus its effort on BRI countries with which it has existing trade and investment links. The trade routes carved out through the BRI have served as useful passageways for medical supplies over the past year, something that China has touted as indicative of the strength of the BRI as a global community of support during COVID-19.

As the political debate on health inequality between the world’s richest countries crescendos, China seems to be getting on with the job of supplying goods to strategic locations across the globe. It might seem convenient that COVID-19 has turned into an opportunity for China to expand its sphere of influence as a geopolitical player, however, the beneficiaries across Africa who have largely been forgotten by Western vaccine producers would have little cause to contest China’s pursuits. For China, rebranding itself as a global health leader is far more attractive than remaining sullied with the tag of ‘Covid Conjurer’, yet for the rest of the world, the success of this strategy remains yet to be seen.

Chris Alden

China’s ‘health diplomacy’ is one of the most enduring features of its global public outreach and is seen to be one of the best expressions of its commitment to act as a purveyor of global public goods.  What is particularly interesting about China’s role in global public health is that it is an approach that pre-dates the staggering economic rise of ‘Global China’ and the razzamatazz that accompanies that phenomenon.

Mao Zedong’s China started sending small teams of health officials out to parts of independent Africa as early as the mid 1960s as part of China’s preliminary technical assistance to developing countries. Drawn from provincial medical staff in rural areas at home, these so-called ‘barefoot doctors’ were trained to administer basic health care, prevention and treatment and brought these skills to target populations outside China. Indeed such was the influence of this concept that liberation movements and subsequently governments in power in areas as far afield as Ethiopia, Mozambique and Algeria imitated the focus on providing basic health training as part of its outreach to local communities.

By the mid-1980s, the folkloric quality of this initiative had been supplanted both at home in China and abroad with more specialised teams focusing on maternal and infants health, and were running clinics in rural villages, towns and cities. By the 1990s, these medical teams were complemented by infrastructure projects to build clinics and hospitals underwritten by the Chinese government and increasingly sophisticated blend of Western-style vaccine programmes and preventative care alongside the promotion of traditional Chinese medicine.

A transition point for China’s involvement in global public health was its response to the Ebola outbreak in West Africa in 2014.  Coming as it did in the aftermath of its poor response to the SARS pandemic in 2003, the effort to mobilise Chinese doctors, medical and financial resources, and – perhaps most importantly – to do so in coordination with other countries operating in the region was a critical sign of the changing approach to international public health. Though not without criticism, overall China’s efforts were commended by medical and public health officials in the region and abroad. Beijing’s prestige grew from this initiative and expectations were that it would build upon this to take up a leading role internationally.

It was against this background that China’s response to Covid-19 has been measured.  Initial failures to address the outbreak in Wuhan in late 2019, including poor communication with outside health agencies and apparent suppression of information by local officials, brought on a barrage of criticism and reputational loss for Beijing. In the fractious atmosphere that followed, the scope for international cooperation of the kind seen in the Ebola crisis proved to be politically impossible. With the situation stabilised in China by February 2020, and Western governments now reeling in the face of the virus, Beijing launched a high-profile international public health campaign aimed at distributing PPE abroad and, subsequently, the newly developed vaccine. Neglected regions like Africa, Latin America and parts of Asia particularly welcomed China’s ‘mask’ and ‘vaccine’ diplomacy as they struggled to stem the tide of disease in their countries.

Today Chinese pharmaceutical companies and Chinese manufactured medical equipment vie with competitors from around the world to market their products, while Chinese researchers develop vaccines and devise treatments for a range of diseases. Chinese traditional medicine, somewhat controversially, has been recognised by the World Health Organisation, while China’s Sinovac is being rolled out across the world as part of a global effort to combat the Covid-19 pandemic. In short, China is a hugely significant player. In all aspects of the global public health arena, despite setbacks experienced, it is one whose place is even more assured in shaping international response in this sector than it was only a few short years ago.

This article gives the views of the authors, and not the position of the China Foresight Forum, LSE IDEAS, nor The London School of Economics and Political Science.