Gender and Development

One Belt, One Road, One Health

China’s One Belt One Road Initiative has been gaining a lot of traction, not only through its promises of infrastructure and financial aid, but also because of its pledges in the realm of healthcare. Ana Zhelyazkova evaluates the state of China’s healthcare and its undertakings in the international arena.


In 2013, the Chinese government launched an initiative with the ambitious goal to transpose the Silk Road Economic Belt and the Maritime Silk Road into the economic and development future of the world – the Belt and Road Initiative (BRI). Although it specialized in infrastructure projects along the Silk road, Chinese investments have been expanding above and beyond the diplomatic, financial, coordination and facility resources needed for the completion of BRI. Among the list of Chinese investment interests, health represents a particularly large focus area.

The establishment of the Health Silk Road marked the first memorandum of understanding between the Chinese government and an United Nations organization – the World Health Organization (WHO). Even though the agreement is mainly designed to strengthen China’s diplomatic relationship with the United Nations, it serves a crucial role in recognizing the government’s efforts to promote and advance global health – a mission crowned by the first humanitarian Chinese response to a public health emergency during the 2014/15 Ebola outbreak.  In the following months, China capitalized on the WHO acknowledgment by unveiling the new International Development Cooperation Agency (IDCA) for foreign aid coordination and by succeeding to organize all countries involved in BRI to approve a communique aiming to “synergize efforts in medical emergency response and epidemic prevention”.

Why is health so vital to the BRI and China?

As the country adopts its relatively new upper-middle-income status, Chinese initiatives aim to establish a position of providing aid after decades of receiving it. Considering the rapid population growth and economic development of China in the past couple of years, investing in health within and beyond the country’s borders is a self-evident next step to pursue. Still, the 2003 outbreak of Severe Acute Respiratory Syndrome (SARS) sharply highlighted the need to prioritize health as a crucial part of any current and upcoming projects of the Chinese government. With Hong Kong (SAR) and mainland China being most affected by the SARS epidemic and suffering the largest impact of temporary economic shock of, respectively, 2.63% and 1.05% of GDP, advancing collaborative risk prevention and emergency response have been put under the spotlight. Additionally, estimates show that if SARS were a recurring epidemic, the immediate costs for the global economy would jump up by over 70% compared to the case where the 2003 outbreak was the only major SARS epidemic.

Solving the domestic problems first

Adopting a deductive approach and starting with the challenges within the country, China now has a 95% population coverage of basic health insurance and has achieved a 40-fold increase of its total health expenditure (5.6%) over the past two decades. However, looking forward, a particularly relevant aspect to be considered are the societal and cultural dynamics among the Chinese population. Despite the implementation of three five-year action plans for HIV/AIDS prevention and control, the virus and the circumstances around acquiring an HIV infection remain a significant public health problem. Furthermore, as the mindset regarding premarital sexual intercourse is evolving among the younger generation, HIV incidence especially in the population group aged 15-24 years increases. HIV diagnoses in this age cohort have doubled between 2008 and 2015 and the upsurge can be partially ascribed to the lack of sexual health education. Even with HIV testing being made more accessible, the risks of the increasing number of young people getting infected exceed the potential economic losses due to employment inactivity and health care costs. Stigmatization and institutionalized discrimination remain at the heart of problem in preventing and controlling HIV spread. 

Chinese (sub)standardization

Despite the moderate progress made in preventing and controlling AIDS, HIV is not the only communicable threat to China and Chinese global health diplomacy. Chinese efforts to rebrand the country’s public and global health reputation suffered a series of hits in July 2018. After the European Medicines Agency confirmed that valsartan-containing drugs by Zhejiang Huahai Pharmaceuticals were tainted with impurity, it triggered a series of international recalls. An investigation into Changchun Changsheng Life Sciences Limited found evidence that the company had illegally produced rabies vaccines for human use. Furthermore, reports revealed that the diphtheria-tetanus-pertussis vaccine produced by Changchun Changsheng and subsidized by the government had been of substandard quality. Beyond pharmaceutical companies’ fraudulent actions, the public sector also proved to be lacking in regulatory implementation after a UPI report revealed that Chinese disease control centers had begun using syringes filled with water instead of vaccines to meet the public vaccination needs.

With vaccine and drug products usually undergoing the toughest standards, tests and regulations, the events of the past few weeks demonstrate China’s inability to provide not only health care quality but basic do-no-harm guarantee.  Chinese authorities’ failure on public health level puts a question mark behind Xi Jinping’s pledges of action in the context of BRI and poses a challenge for the WHO and the international community in finding an approach to effectively utilize all provided resources while assuring the quality of the provided aid.

Ana Zhelyazkova is a student in the Master of Public Health program of Ludwig-Maximilians University. She also serves as Public Information Officer for the Association for UN Interns, New York, student employee at the Max Planck Institute for Social Law and Social Policy and volunteer for the German branch of Médecins du Monde.

Please note that opinions expressed in this article are solely those of our contributors, not of Political Insights, which takes no institutional positions.

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