China’s Engagement in Global Health Governance: Institutional Path and Future Choices —Using the Prevention and Control of the Cross-border Transmission of Infectious Diseases as a Case Study
—USING THE PREVENTION AND CONTROL OF THE CROSS-BORDER TRANSMISSION OF INFECTIOUS DISEASES AS A CASE STUDY
International institutions are core elements in global health governance. With large numbers of actors and complicated interest orientations in global health governance, it is of great practical significance to standardize behaviors and promote international cooperation through the establishment of effective international institutions. A manifestation of China’s progress in engaging in global health governance is its more active participation in multilateral international institutions and its efforts to build such institutions.
China’s Engagement in Global Health Governance Through Multilateral Institutions
Prompted by the severe acute respiratory syndrome (SARS) outbreak in 2003, China has attached increasing importance to the role of multilateral institutions as platforms to carry out cooperation with other countries in the sector of public health. To be specific, China has taken the following paths.
The first is to strengthen cooperation with the World Health Organization (WHO). The years after 2003 have witnessed closer cooperation between China and the WHO. By throwing its support behind the revision of the International Health Regulations (IHR), China has contributed to building a new system of rules for international cooperation against epidemics. In 2004, China’s Ministry of Health (now the National Health Commission) and the WHO signed an Memorandum of Understanding (MOU) on further strengthening cooperation and exchanges in the health sector. In the same year, Shanghai hosted the 55th session of the WHO Regional Committee for the Western Pacific.
In March 2011, China’s national regulatory system for vaccines passed the assessments by the WHO for the first time, indicating that Chinaproduced vaccines have gained the WHO prequalification. In October 2013, the Japanese encephalitis (JE) vaccine manufactured by Chengdu Institute of Biological Products Co., Ltd. passed the WHO prequalification and entered into the United Nation’s medicinal products procurement list. In addition, influenza vaccine, domestically-made bivalent OPV and hepatitis A vaccine produced by Hualan Biological Engineering Inc. have passed prequalification assessment and 22 domestically-made finished products have been listed as pre-qualified products. Such high quality and costeffective vaccines have substantially helped lower the prices of products of the same kind when they were brought to the global market.
China’s another contribution is its support for the WHO’s response to international public health emergencies. Since the Ebola outbreaks in West Africa in 2014, China has sent a total of 750 million RMB worth of assistance in four rounds to 13 African countries and sent around 600 medical personnel to epidemic areas to combat Ebola. China’s rapid action helped ease the pressure of insufficient international assistance in the early days and impressed the international community with its technical capabilities in vaccine research, development and transportation. After
the Ebola outbreak in the Democratic Republic of Congo, between August 2018 and February 2020, China provided the WHO with $4 million for epidemic response and sent testing, rescue and protection supplies to relevant countries through bilateral channels as well as dispatched public health experts to the region for epidemic prevention and control.
The second is to actively engage in building regional and cross-region multilateral cooperation mechanisms. The neighboring areas are the key venue for China to engage in regional health cooperation. “ASEAN Plus” represents the main institutional framework for health cooperation in East Asia. In 2003, leaders of China and ASEAN gathered for a special meeting on the prevention and control of SARS. With China’s efforts, the East Asia Summit in 2005 adopted the East Asia Summit Declaration on Avian Influenza Prevention, Control and Response, determining to strengthen communication at national and regional levels and jointly set up a network of stockpiles of antiviral drugs.
At the ministerial level, in addition to holding regular biennial meetings, East Asian countries also hold special meetings on such severe transnational infectious diseases as bird flu, H1N1 flu and Ebola. In 2008, “ASEAN Plus Three” launched an Internet-based infectious disease information center. In addition, China has launched a joint prevention and control project for cross-border transmission of infectious diseases with Cambodia, Laos, Myanmar, Vietnam and Thailand.
Africa is also a crucial partner for China in its efforts to engage in crossregional health governance. In recent years, in response to public health emergencies (such as yellow fever and Ebola) in Africa, China Center for Disease Prevention and Control has sent emergency teams to epidemic areas for prevention and control tasks. China also aided Africa to build the Africa Center for Disease Prevention and Control and helped Africa build a strong team of public health professionals through expert meetings and training courses.
The third is to step by step include health topics and health cooperation into important existing multilateral cooperation mechanisms. The Shanghai Cooperation Organization (SCO) is an example. The SCO, which originally aimed at pooling efforts to combat the “three evil forces” of terrorism, extremism and separatism, has explicitly called for enhancing health cooperation since 2004. Through the Joint Statement on Prevention and Treatment of Infectious Diseases in the SCO Region, the organization has also set up a mechanism to host regular meetings among leaders of epidemic prevention authorities. Tackling infectious diseases has also been identified as an important field of BRICS cooperation. BRICS countries have proposed to improve the capacity of disease treatment and the quality of medical services, incentivized the use of information and communication technologies (ICT), and set the goal of establishing a vaccine research and development center.
Global health issues have become an essential part of BRICS cooperation since 2011. On the issue of tackling
infectious diseases, BRICS countries propose to improve disease treatment capacity and medical services, as well as employ ICT to boost public health responses. For example, in response to the common threat posed by tuberculosis, BRICS countries have established a tuberculosis research network to advance the collective response through drug research and development. In 2018, BRICS countries proposed to establish a vaccine research and development center. In the meantime, as medicine and medical equipment sectors embrace growing trade and cooperation, they are now standing as a new highlight in the health cooperation among China, India and Russia.
The above-mentioned multilevel cooperation frameworks run simultaneously and are mutually propelling. The meetings of SCO health ministers and BRICS health ministers have iterated the importance of working with such international organizations as the WHO. The WHO has attended the China-Africa Forum on Health Cooperation and Development and China and Central and Eastern European Countries (CEEC) Health Ministers’ Meeting as an observer. China, whose multilateral health initiatives are highly consistent with the WHO’s vision and priorities, signed an MOU with the latter on the Belt and Road Health Cooperation Mechanism.
China’s Practice of Multilateral Cooperation in the Prevention and Control of COVID-19
In China’s history of engaging in the prevention and control of cross-border transmission of infectious diseases, it has consistently adopted a model with the WHO as basis and regional and cross-regional multilateral institutions as supplement. China adopts the same model when it carries out multilateral cooperation in response to the COVID-19 pandemic.
The first is to keep close cooperation with the WHO. On January 3rd, 2020, China informed the WHO on the situation of the epidemic, and later on January 12th, it shared the genome sequence of the virus, laying the foundation for the follow-up research. Domestically, China has adopted effective policies of prevention and control; globally, it has shown transparency and willingness to cooperate. Dr. Tedros Adhanom Ghebreyesus, Director General of the WHO, stated on various occasions that China’s measures “bought the world time to prepare and slowed down the spread of the virus to other parts of the world.” China also invited a team of WHO international experts to visit Beijing, Guangdong, Sichuan and Hubei, and issued the Report of WHO-China Joint Mission on COVID-19. As the virus spreads worldwide, the Chinese government has donated twice to the WHO, totaling $50 million.
Chinese enterprises also strengthen cooperation with the WHO. To address the lack of necessary protection for medical staff due to the collapse of the personal protective equipment market, a number of Chinese manufacturers agreed to supply such equipment to the WHO so as to improve the international allocation of supplies. Despite of enormous domestic demand, China has been open for the export of epidemic prevention supplies and provided and facilitated the procurement of such supplies by other countries.
The second is to engage in cooperation through regional multilateral mechanisms. On February 20th, the Special ASEAN-China Foreign Ministers’ Meeting on Coronavirus Disease was convened, calling for stronger cooperation in regional response. Within the framework of “ASEAN Plus Three”, the Special Video Conference of the Senior Officials Meeting on Health Development on 2019-nCoV, the Special Video Conference of Foreign Ministers and the Special Video Conference of Health Ministers were held, where officials maintained frequent coordination and exchange of information. On April 14th, leaders of ASEAN, China, Japan, and South Korea held the Special ASEAN Plus Three Summit on COVID-19 via video conference and issued a joint statement to put forward 18 concrete measures for cooperation. The mechanism for coordination among East Asian countries features a high degree of consensus, a wide range of sectors and workable cooperation initiatives. It thus stands as a shining example for other regional cooperation.
The third is to advocate international cooperation through the G20, the coordination mechanism among major powers. At the G20 Extraordinary Virtual Leaders’ Summit on COVID-19 on March 26th, 2020, Chinese President Xi Jinping proposed to convene the G20 Health Ministers’ Meeting and the High-level Meeting on Global Public Health and Security to improve information sharing, strengthen joint efforts against the epidemic and mutual assistance, and formulate an action plan to stabilize the world economy. The G20 leaders pledged to inject $5 trillion into the world economy, significantly boosting the confidence of the global market. On March 31st, working on the commitments at the G20 Extraordinary Leaders’ Summit, G20 finance ministers and central bank governors met virtually and reached consensus on supporting the world economy, safeguarding financial stability and diverting proper financial assistance to developing countries. On April 19th, the G20 Health Ministers’ Meeting was held in the form of a video conference. Ma Xiaowei, Minister in charge of China’s National Health Commission, called on all parties to continuously support the WHO’s leading role in coordinating international cooperation against the COVID-19. He also called for international cooperation in carrying out joint prevention and control and in helping countries with vulnerable health systems to better cope with the pandemic.
The fourth is to actively carry out bilateral and multilateral cooperation in medical technologies as well as share its experience with the rest of the world. In March 2020, Chinese medical experts held video conferences with their counterparts in Japan, South Korea, countries in Europe, Asia, Latin America and the Caribbean, West Asia and North Africa and international organizations. They elaborated on the development trend of
the pandemic and China’s experience and practices in epidemic prevention and control, clinical treatment and social management, and pledged to act on the vision of building a community with a shared future for humanity and provide assistance to the international community to the best of their ability.
In short, in the fight against the COVID-19 pandemic, China has called on countries to work together rather than work alone as the right response to global threat. In addition to engaging in such existing multilateral mechanisms as the WHO, the G20, and the ASEAN Plus Three, China has also flexibly carried out exchanges and cooperation with regions where developing countries prevail.
Future Options for China to Engage in Global Health Governance and Multilateral Health Cooperation
In view of the multilateral cooperation against the COVID-19 pandemic by far, the global health governance system and capacity is facing multiple challenges. First, developed countries underperform in complying with international rules and obligations of health governance. On February 5th, 2020, the WHO Director-General Tedros criticized some high-income countries for being well-behind in sharing complete information about cases and he “didn’t think it’s because they lack capacity”. Second, the international community lacks consensus on prevention and control policies. Although the WHO has repeatedly emphasized how important testing is to tracing the pandemic development and cutting off the transmission chain, some developed countries have one by one announced the suspension of testing for mildly ill patients with COVID-19, resulting in the missing of window of opportunity for prevention and control and the eventual development into a pandemic. Third, support for developing countries is so lackluster as to fail to meet their demands. The traditional pattern of channelling assistance from developed countries to developing ones is no longer sustainable. Moreover, the WHO is still lacking sufficient policy instruments to regulate some key issues, such as the pricing power of vaccines and their distribution.
Both the problems facing the global health governance system per se and the emerging challenges posed by the COVID-19 pandemic have raised higher requirements for China to engage in multilateral health diplomacy and cooperation. Engaging at multiple levels and as diverse actors is an effective path for China to play a leading role in global health governance and push forward the building of a global community of health for humanity.
Firstly, China should make consistent efforts to enhance coordination and mutual assistance with neighboring countries. China should, through the Sherpa mechanism, push forward the implementation of issues for cooperation identified in the joint statement by leaders of ASEAN member states, China, Japan and South Korea, formulate action plans for joint prevention and control, regularly assess the progress of cooperation, and share the experience of regional coordination with the international community. Looking ahead, China could consider further promoting the regularization and institutionalization of public health cooperation in East Asia and summarize the progress of cooperation by publishing annual reports. In addition, since South Asia is a densely populated region with relatively developed transportation yet lamentably inadequate health facilities, China should vigorously promote coordination and cooperation among countries in South Asia.
Secondly, China should take SouthSouth cooperation as basis and further explore a feasible cooperation model for developing countries to cope with the COVID-19 pandemic. Since developing countries suffer from relatively scarce medical resources and finite financial resources, containing the spread of virus in a feasible and especially economically-affordable way remains a top priority. China has extended assistance such as testing kits and medical protection materials to many developing countries and has established online “knowledge centers” for epidemic prevention and control and clinical diagnosis and treatment. The training of healthcare professionals could be identified as the area for China and other developing countries to enhance cooperation. The format of online training could be adopted to increase the efficiency of training.
Thirdly, China should actively participate in new multilateral organizations to shape a more equitable governance system. China’s health diplomacy mainly remains inter-governmental, but the country has also started exchanges and cooperation with non-governmental organizations and new public-private partnership organizations. Bill & Melinda Gates Foundation is a good example. Chinese President Xi Jinping spoke highly of the foundamental efforts and supported its cooperation with relevant Chinese institutions. China could enhance contacts with newlyestablished multilateral organizations such as the Global Alliance for Vaccines and Immunization and attempt to render health assistance to developing countries through such institutions. Moreover, Chinese enterprises and civil society have started to play a more vigorous role in addressing global health challenges.
Fourthly, China should link health cooperation with advancing the Belt and Road Initiative and usher in new areas of global health governance. The COVID-19 pandemic has exposed the acute shortage of public health infrastructure in many countries, especially in developing countries. Health-related infrastructure includes not only hospitals, but also ancillary power and clean water facilities. China could actively explore to work with such international institutions as the Multilateral Development Banks to set the format of public health infrastructure cooperation with other developing countries. Such a new format could serve as an effective means and a new source of growth of advancing the initiative of “Health Silk Road”.