China’s Health Silk Road: A way forward for global health equity in a post-pandemic world

The cross-border transmission of COVID-19 pandemic highlighted major challenges of mounting an efficient global response to disease threats, from sustained economic investment, strong political will, to resilient national and global health systems. Pioneering bilateral or multilateral health development initiatives with concerted efforts can become an effective weapon in reshaping and transforming the capacity in regional and national health settings. In this sense, China’s Health Silk Road, a crucial part of the Belt and Road Initiative (BRI), provides a unique opportunity to address some fissures exposed by the COVID-19 pandemic, and to make further, fundamental steps towards global health equity.

On July 1^st, 2021, a white paper released by the Information Office of China’s State Council confirmed that developing Health Silk Road will be China’s key priority under its 14^th 5-year plan for national economic and social development.¹ On November 19, 2021, President Xi further emphasized on the third BRI Symposium that China would continue to provide foreign assistance in the fight against COVID-19.² Already investing financial means, the BRI would be guided by universal principles of good governance and rule of law, including transparency, equity, fairness, shared responsibility, and accountability. This way, the Health Silk Road can (1) assist other developing countries in realizing their right to health through the participation and creation of an international initiative and (2) help its participating countries—and the entire international community—cope more successfully with the next inevitable emerging infection by providing international development assistance for assistance based on universal values.

A Practice Paradigm for Achieving Health Equity

Until March 2022, 146 countries have joined the BRI by signing a Memorandum of Understanding (MoU) with China.³ Among them, 43 countries are in Sub-Saharan Africa; 34 countries are in Europe and Central Asia; 25 countries are in East Asia and Pacific; 20 countries are in Latin America and Caribbean; 18 countries are in Middle East and North Africa; 6 are in southeast Asia. Some countries have BRI membership that overlaps with existing regional organizations such as Asia Pacific Economic Cooperation (APEC),⁴ the Group of 20 (G20),⁵ and the Shanghai Cooperation Organization (SCO).⁶ Member countries can be roughly divided into two groups based on the extent of participation. The first group includes countries that China directly involves in its plan by including them on the Belt and Road Portal or engaging their citizens or registered companies directly in BRI projects. The second group includes countries that have indicated their interests and involvement in the BRI by pledging their support during the BRI Forum or on other occasions.

The BRI participants exhibit a large gap between the rich and poor, with uneven distribution of health resources, and different capacities to address public health crisis. But no matter what kinds of the ranking health problems are in each setting along the Health Silk Road, achieving health equity is always the most compelling strategy to tackle whatever challenges come along. In terms of complicated public health situations, the counties along the route can be divided into the following three groups. The first group is the developed European economic circle, which enjoys a high level of healthcare and advanced medical technologies. This group is most interested in exerting its influence as a cadre of European countries, but also understands the economic benefits of BRI participation. The second group is the populous East and Southeast Asian economic circle. This region has both economically rich and poor states, but they all share one common risk—that an infectious disease breaks out in this region, it can rapidly spread, becoming a global epidemic. The third group is the surrounding areas with less developed economies that lead to material poverty and an inability to independently respond to epidemics. This third group includes many countries in West Asia and North Africa. Therefore, external health assistance is often a life-saving measure. Overall, when formulating BRI health diplomacy, a unified, one-size-fits-all health cooperation plan may be not feasible. China should comprehensively analyze the characteristics of each local health system and its pattern of disease advancement, so it can develop different cooperation modes with different countries for a fair and reasonable redistribution of health resources.

China is very likely to build out regional vaccine hubs and retrofit vaccine infrastructure (cold storage, supply chains, and data systems) along the Health Silk Road.⁷ Such regional hubs can facilitate information sharing and coordinate activities whenever a pathogen is circulating along the Silk Road. The regional hubs, if work well, can not only reduce the risk of a sudden lack of raw materials and be prepared for an unexpected manufacturing disruption, but also provided a feasible solution to reduce lower-income countries’ reliance on charity for future health crises. Establishing closed supply chains under the regional vaccine hubs can also bring benefits for higher-income countries participating in the BRI, since the hubs can prevent vaccine loss in consideration of the wide-spread vaccine hesitancy.

A Shared Human Destiny

The WHO declared 2019-nCoV a Public Health Emergency of International Concern under the International Health Regulation (hereinafter IHR) on January 30, 2020.⁸ Since then, SARS-Cov-2 Coronavirus has threatened the economic and social development of every country in the six continents. More than 6 million deaths due to COVID-19 have been reported globally due to shortages of testing kits, PPE, diagnostics, ventilators, therapeutics, vaccines, and other essential lifesaving supplies.⁹

Yet, out of COVID-19 crisis comes new opportunities to build a safer, healthier, and more just world that reflects our shared human destiny. The shared goal of public health security, rather than fostering competition, mutually benefits participating countries: one country’s prosperity does not take away from the prosperity of other countries. Any health issues that a single person is burdened with become a common burden of all humankind without any exception. Accordingly, as the world second-largest economy, China would shoulder the greater part of the global burden to save lives and propel economic recovery in the current pandemic world.

Above all, China should continue its support for an IP waiver at the WTO. This can give governments the option to allow local manufacturers to produce SARS-CoV-2 vaccines themselves. Most importantly, TRIPS-plus provisions (such as patent term extensions, and restrictions on compulsory licensing or parallel imports) should not be used in any free-trade agreements (FTAs) under the BRI. Second, the value of a shared human destiny should ultimately be reflected by the validity and stability of global health law. The Independent Panel for Pandemic Preparedness and Response (IPPPR) condemned the WHO’s existing pandemic alert system not fit for purpose and called for a new global framework to support prevention and protection from pandemics.¹⁰ Hence, when the pandemic recedes, WHO member states, including China, ought to mobilize the WHO to reform international legal authorities, to clarify state obligations and facilitate legal accountability. Fundamental revisions to the International Health Regulations (IHR) framework or the development of an international treaty on pandemic prevention and preparedness are the two promising ways for a more prepared future of global health security. Third, fundings are critical to smooth systemic economic disruption during the COVID-19 pandemic. The BRI should work closely with multilateral financial institutions to commit pandemic relief spending by canceling many of the poorest countries’ debts. Most importantly, already turning on the finance spigot, China could make more donations to COVAX. As a pooled procurement mechanism, if is well-funded, COVAX could be lifesaving not just during this pandemic, but also the next one.¹¹

Conclusion

During COVID-19 pandemic where health products are becoming increasingly important while also being severely limited, China can be more proactive in providing public goods to the world via Health Silk Road. Guided by the value of a shared human destiny, the Health Silk Road can pave the way for more people to enjoy the right to health in a post-pandemic world through international development assistance for health.

Funding

None.

Conflict of Interest

The authors declare no conflicts of interest.