Reviving China’s Health Silk Road Initiative? Battle of Narratives and Challenges for Transatlantic Leadership

Yixiang Xu

New Research Initiative Fellow

Yixiang Xu is the Fellow for the New Research Initiative at AICGS, working on the Institute’s China-Germany-U.S. triangular relationship initiative. He also researches international economic and trade issues. Previously, he worked at AICGS as a research assistant.

Mr. Xu received his MA in International Political Economy from The Josef Korbel School of International Studies at The University of Denver and his BA in Linguistics and Classics from The University of Pittsburgh.

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yxu@aicgs.org | 202-770-3262

Many European nations’ healthcare systems are pushed beyond their limits by the novel coronavirus pandemic. In the race to secure medical supplies, it’s every country for itself. China, which bore the first wave of the virus attack and saw infections subdued at home after aggressive lockdowns that brought its economy to a virtual standstill, is now broadcasting its support for European countries, sending testing kits, ventilators, masks, and teams of medics.

At a time when Europe and the U.S. are consumed by domestic battles against the pandemic, China’s recent PR offensive is working hard to recast the country as a resourceful and responsible leader in the global public health crusade. In a phone call with the Italian prime minister Giuseppe Conte, the Chinese president Xi Jinping revealed his intention for a Health Silk Road. The concept reminds many across the Atlantic of the similarly sounding Belt and Road Initiative (BRI) and hints at a new front of strategic competition with China.

Morphology of A Strategy

The idea to construct a Health Silk Road has been in the making for some time. As early as 2013, the year that China officially revealed the BRI, health was mentioned as an aspect of the grand Chinese strategy to link Asia, Europe, and Africa with infrastructure development and investments. Since 2015, the BRI strategy officially includes public health cooperation, which the Chinese government deemed to “provide a consistent mechanism for negotiation, adoption of collective action, and the monitoring of normative rules.” One year later, China hosted the WHO Global Health Promotion Conference in Shanghai to embellish its credentials for advancing the global health agenda.

The climax for the initiative arrived in 2017, when China and the WHO signed a Memorandum of Understanding (MoU) to jointly establish the “Health Silk Road.” While participating in the Belt and Road High Level Meeting for Health Cooperation in Beijing later that summer, the WHO director-general Tedros Adhanom Ghebreyesus lavished China with praises for its vision and leadership in global health, affirming the WHO’s support for a Health Silk Road. Delegates from participating countries, WHO, UNAIDS, the GAVI Alliance, and the Global Fund signed the Health Silk Road communiqué, which pledged to increase collaboration on research, health security, and education among BRI partner countries. Then, things went quiet.

BRI by Another Name

The lack of progress to develop the Health Silk Road concept into a fully-fledged, stand-alone strategy is due in large part to competing priorities of the BRI.  Xi’s vision for connecting much of the old world fundamentally rests on infrastructure construction of a vast network of railways, energy pipelines, highways, and ports as well as investments in foreign technologies, natural resources, and strategic assets. While regional health cooperation could provide genuine benefits to BRI participants, Beijing’s promise of economic development is the core attraction of the strategy.  Official documents and Chinese studies on the BRI’s public health proposals emphasize that economic and health issues are tightly intertwined. Thus, the Health Silk Road concept is rather an extension of the BRI and will likely be tailored to serve a complementary list of core state interests.

Mirroring China’s development assistance approach under the BRI, its international health aid programs are heavily bilateral and are often conditioned to generate strategic benefits for Beijing and commercial gains for Chinese companies.

Mirroring China’s development assistance approach under the BRI, its international health aid programs are heavily bilateral and are often conditioned to generate strategic benefits for Beijing and commercial gains for Chinese companies. In Africa, where China’s health engagements remain the strongest, Chinese funds finance hospitals built by Chinese construction firms; China’s drug donations and deployment of medical professionals facilitate Chinese pharmaceutical companies and equipment enterprises to make rapid inroads into the African market. Bilateral deals such as the Chinese telecommunication company ZTE’s contract for establishing the African Union’s (AU) Smart Monitoring Room in 2017, ostensibly to aid the digital transformation of Africa’s health delivery system, gave ZTE and other Chinese telecom companies like Huawei privileged access to construct Africa’s budding ICT infrastructure.

Battle of Narratives

Xi’s revival of the Health Silk Road came at a time when the Chinese government is waging a propaganda battle to deflect criticism over its initial suppression of information and slow response at the early stage of the virus outbreak in Wuhan. Beijing launched a two-pronged strategy to absolve China of its original sin in the pandemic and curtail anti-China sentiments abroad that is based on an intense publicity drive for its assistance offers, on the one hand, and a public spit fight with the U.S., on the other hand.

Chinese officials and state media levied accusations against the U.S. regarding the origin of the virus. The Trump administration responded with rhetorical escalation but struggled to attract international support for its narrative. For days, President Trump called COVID-19 “the Chinese virus” and a G7 meeting of foreign ministers ended without a group statement as U.S. Secretary of State Mike Pompeo insisted on identifying the virus as the “Wuhan virus.” Beijing is eager to highlight the lack of U.S. leadership, but the Trump administration’s fumble in diplomacy doesn’t proclaim a Chinese victory.

China’s battle of narratives doesn’t change the fact that the global pandemic is forcing governments to spend billions of dollars to fight a public health war and even more to rescue economies from a certain recession. Chinese assistance also isn’t free. A coronavirus-ravaged Spain will pay €432 million for Chinese face masks, testing kits, and ventilators, orders that will help China restart its manufacturing at home. European countries like Estonia and Lithuania that have recently locked horns with China were forced to turn to Beijing for medical supplies, but are unlikely to change their skepticism of expanding Chinese influence in Europe. Instead, Beijing’s bilateral approach to aid individual European nations provoked a backlash from EU officials concerned about division within the bloc. European struggles to procure medical supplies and maintain industrial production also put into sharp focus the risk of global supply chains’ heavy reliance on China.

Challenges for Transatlantic Leadership

For now, the resurgence of the Health Silk Road looks more like a Chinese tactic in the battle of narratives over the pandemic than a new front for strategic confrontation between China and the West. Nevertheless, it should trigger a sputnik moment in Europe and the U.S.

The current global health crisis lays bare the absence of the kind of strong, reliable global leadership the U.S. displayed to bring the 2014 Ebola outbreak under control. The Trump administration has embraced narrow nationalism and turned away from multilateral cooperation and global governance. Speaking to the UN General Assembly in 2018, President Trump declared, “We reject the ideology of globalism, and we embrace the doctrine of patriotism.” U.S. disengagement from international institutions opened the door for China to extend its influence and advance its narrative of China’s global leadership. China already leads four of the fifteen UN specialized agencies and uses its resources to set Beijing’s agenda for multilateral engagement, including the promotion of BRI projects.

U.S. disengagement from international institutions opened the door for China to extend its influence and advance its narrative of China’s global leadership.

Many proposals associated with the early Health Silk Road concept, such as standardizing monitoring systems, instituting regular data sharing agreements, and establishing regular programs to exchange best practices are genuinely good policy ideas and could boost the appeal of BRI projects. Criticism of Beijing’s opaque bilateral development deals, poor coordination with international organizations, or disregard for human rights and environmental concerns will fall on deaf ears if there’s no strong alternative to Beijing’s vision. It is a reminder that the EU and the U.S. must step up their game and work together to both offer alternative development resources and engage the international institutions they created to advance common transatlantic values in true transparency, accountability, and sustainability.

To that end, the EU and the U.S. must not allow discord in the current transatlantic relationship to distract from their shared strategic interests and values. The U.S. administration needs to rediscover the value of partnership and diplomacy while the EU’s search for more European autonomy should not lead to equal distance to the U.S. and China. There is strength in numbers and even more so in collective goodwill.  Nothing rebuts better the narrative that democracy is no longer relevant, or that the liberal world order is dead, than a transatlantic coalition that is willing and able to deliver global public goods. In their ongoing strategic competition with China, the transatlantic partners need to find solidarity in leadership.

The views expressed are those of the author(s) alone. They do not necessarily reflect the views of the American Institute for Contemporary German Studies.