Seeing China as a burden on world health rather than a contributor of solutions or dismissing the ‘Health Silk Road' as a geopolitical ploy are not helpful. It would be wiser for the US - and China - to view global health more as a public good and less as an extension of development aid.
Now that President Joe Biden has restored American membership in the World Health Organization, can the United States and China find renewed impetus for cooperation on global health? Certainly, Beijing and Washington should work together to improve their respective public health situations. Making it easier for institutions such as the WHO to address the world's health challenges is another worthy goal. The state of US-China relations, however, may make such goals too lofty if some underlying policy conditions are not addressed conscientiously. Former president Donald Trump's confrontational approach - including in public health - towards China is viewed as a positive achievement by many in the West. The Biden administration will have to answer the question of what has changed before it can alter course in dealing with China. Meanwhile, China may find itself on the receiving end of initiatives from the US. But Covid-19's continuing ravages present both the US and China with an opportunity not to be wasted. One way to translate rationale into action is to begin by examining the very notion of global health. The term “global health” started to gain currency in the 1970s, as an extension of concern about global population problems. For decades, global health was part of the West's broader development aid strategy, to improve health in nations needing economic development.
Since the 1970s, China has been a main beneficiary of international health and economic development agencies, and of the governments of developed economies. This, coupled with China's poverty elimination drive, helped quickly improve the health of the population. Chinese life expectancy at birth increased from nearly 60 in 1970 to 77 in 2018. The severe acute respiratory syndrome (Sars) outbreak in 2002-2003 in China caught many Western nations off guard as, by then, they had thought themselves free of epidemics. Some scholars of international public health thus called Sars a post-Westphalian pathogen: conventional reliance on and emphasis of the sovereign state as the primary actor is no longer adequate. Implied in such framing is that China, in spite of the help received, has failed to buffer the West against the migration of deadly viruses. Similar sentiments are not difficult to fathom in commentaries about the Covid-19 pandemic. China is thus defined as a burden on global health.
Yet throughout modern history, China has contributed to global health solutions. Identification of the Yersinia pestis bacteria from treatment of the 1894 plague in Hong Kong was a major success in Western medical science. China's organization of an international conference in 1911, in the wake of the northern Manchurian plague, helped to spread medical knowledge, including affirming the utility of face masks. Between 1850 and 1950, China played a role in the emerging global biomedicines industry, amid its incessant wars, revolutions and famine. The conventional question of whether medical ideas and institutions created in the West were successfully transferred to China is inadequate. International exchange and cooperation are crucial in achieving breakthroughs in epidemic control and the treatment of non-communicable diseases.
Typically, Chinese studying medical sciences went to universities in the West. Western physicians and medical researchers came to China in search of effective treatments. Even when China was under an economic blockade in the wake of the Korean war, doctors from abroad came to China in search of treatments, such as for schistosomiasis, described by Mao Zedong as “the god of plague”. A more contemporary example of China's contribution is the internationalisation of an inexpensive live attenuated vaccine against a strain of encephalitis, common in Asian children. Developed and approved for use in China in the 1980s, it attracted interest from the US.
After 15 years of collaboration between American and Chinese vaccine developers, the product passed the WHO's prequalification in 2013, and became available for adoption outside China. Three more Chinese vaccines have acquired the WHO's prequalification status, with more in the pipeline. The 2015 Nobel Prize in Physiology or Medicine was divided, with one half awarded to Chinese scientists led by TU Youyou,who found a way to extract artemisinin, used to treat malaria, from a traditional Chinese medicine.
In one sense, China's public health achievements affirm the value in seeing global health as part of Western development aid. In another sense, China's help, especially to the Global South, should be viewed as enlarging the pie of health provision. To promote US-China cooperation, it would be useful to end the politicisation of the WHO. The organisation, like so many other specialised UN agencies, relies on funding from member states, with the US by far its largest contributor, given that fees are assessed on per capita income. Voluntary contributions from multinational pharmaceutical corporations enlarge the WHO's operating budget. Beijing and the country's health business corporations can and should make a larger monetary contribution to the WHO. Just as importantly, China should work with the WHO and help more countries reap the same public health benefits that it has.
Likewise, the Chinese vision of a “Health Silk Road” should not be dismissed as a geopolitical ploy. No one can predict from where the next deadly pathogen may emerge. Disease prevention is as crucial as treatment. Indeed, it would be wise for both the US and China to view global health less as an extension of development aid, and more as a public good. The assurance of health as a public good requires proportional contributions by all. Such rethinking ought to lead to renewed impetus for global health cooperation between the two, and led by both.
Edited by Olivia LOU
