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A New First Author? China’s Science and Health Diplomacy

Since the Cold War, global health and science has been dominated by the United States. In 2017, it spent $10.4 billion on global health, including $113.5 million in assessed contributions and $324 million in voluntary contributions to the World Health Organization, making up roughly a quarter of WHO’s $2.2 billion budget for the year. In biomedical research, the United States likewise boasts funding and publication output numbers that dwarf those of other countries. As the world’s largest economy, the US should be expected to be a major contributor to biomedicine, but its complete dominance also reflects its larger foreign policy goals. American foreign policy’s emphasis on security has led to global health and biomedical research initiatives that tend towards epidemic management and biodefense research.

Global health and science have political practicality outside of security as well in the form of increasing soft power in other nations. The current trends in typology and amount of US global health and science, however, suggest the US is neglecting to utilize its health and science superiority to expand influence. By contrast, China has made increasingly rapid gains in health and science within the last fifteen years, also enacting policies that augment the power projection abilities of health and science.

China’s Belt and Road Initiative (BRI), introduced in 2013, has defined China’s overall development and investment strategy and heralded increasing Chinese involvement internationally in a bid to increase soft power. South-South partnerships, a central part of the BRI, in part look to provide China with improved access to emerging markets and grow Chinese influence long-term. China’s aid programs reflect this trend, with nearly half of Chinese aid going towards Africa and another third towards Asia.

Infrastructure projects have typified Chinese investments, including much of its health aid to developing nations. Infrastructure projects address a critical shortcoming in healthcare of developing nations, but China has also begun to diversify its global health aid. China recently pledged $60 billion towards projects in Africa that improve healthcare equality and capacity through monitoring and evaluation programs and improved access to medicines and equipment. Additionally, China has undertaken efforts to train and educate healthcare workers in Africa. Part of its Ebola response included training for 13,000 health care workers, and recent initiatives include plans to instruct 30,000 additional health care workers throughout Africa. China has slowly increased its voluntary contributions to the World Health Organization as well, but favors bilateral or multilateral projects of its own design that place China at the center of the relationship. This direct approach facilitates more efficient cultivation of diplomatic ties in select strategically important nations.

Whereas the United States focuses on specific diseases and outbreaks with its health aid, China directs its aid to more general health projects within countries. This reflects the United States’ focus on its own health security, in sharp contrast to China’s economic and political goals. Developing countries appear to favor aid that can produce sustainable and comprehensive health services, rather than assistance towards sporadic pandemics or only particular endemic diseases. The most recent World Health Organization Director-General, selected in a general election for the first time, campaigned on implementing these larger changes in an effort to progress towards universal health coverage globally. His election served as a referendum on the policy priorities of all member-states rather than just the elite few, with the results demonstrating favoritism towards general health projects rather than epidemic response. China’s policies, then, more effectively fulfill the desires of developing nations than those championed by the United States; continued increase in the magnitude of Chinese health aid means it will outcompete the US in cultivating goodwill and influence in strategically-important developing nations.

After the SARS epidemic in 2003, China quickly learned the importance of multilateral global health, a key component of projecting legitimacy and authority. China’s failure to cooperate allowed the disease to spread both within China and internationally. As a result, travel warnings were placed on the country, a significant economic burden, while China’s image also suffered globally. In response, China reformed its approach to global health, with far more active participation in global health consortiums. Recent engagement in multilateralism has narrowed the gap between China and the US in global health influence.

With more explicit impacts on development, global health aid typically overshadows scientific research as a policy tool. But international collaborative research projects can still effectively improve a nation’s image and forge a closer bond between states. Similar to China’s global health image problems as a result of the 2003 SARS outbreak, academia in China similarly suffers from skepticism abroad. Corruption and fraud are systemic issues within Chinese research compared to other high research-output countries. As a result, researchers from other nations typically look at Chinese research less favorably. Degradation of China’s research image impacts its overall appearance as a state, characterizing it as corrupt or ineffective.

Collaborative research projects with other nations can repair such issues in image, creating a direct link between researchers in different nations and in turn facilitating a better understanding and appreciation for each other’s findings. Strengthening research bonds and feelings of goodwill advances a nation’s overall stature through soft power. China seems to have recognized this advantage: the Health Silk Road Communique, signed by 20 to 30 BRI countries in 2017, explicitly calls for an increase in international research efforts between China and Health Silk Road countries. While China has recently increased overall collaborative publications as a percentage of total publications at a rate roughly equal to most other nations, it has also seen more accelerated increases with particular regions. Africa, the Middle East, and Latin America have seen the most rapid growth within the last decade; coincidentally, China has invested most heavily in these regions. Collaboration with BRI countries also saw a significantly higher surge compared to non-BRI nations. Foreign policy interests, then, appear to be central to China’s collaboration efforts. This heightened collaboration was also shown to have elevated China into a more prominent position within a more interlinked research network between countries, indicating that China has considerably bolstered its research clout within geopolitically-significant circles.

While the US is currently the leading academic force, the Trump administration is looking to decrease funding for both global health and international collaborative research. The administration proposed unprecedented $2.2 billion cuts in global health spending in its 2018 and 2019 proposals, with some of the largest cuts to HIV/AIDS, malaria, and global health security. Despite these cuts to infectious disease prevention programs, the White House’s new National Security Strategy identifies biological weapons and pandemics as a defense priority. The document advocates only for strengthening US emergency responses to epidemics and improving US biodefense through intellectual property laws. Regarding more comprehensive global health initiatives to improve health security, the administration only plans to “encourage other countries to invest in basic health care systems.” Health security implications aside, US leadership demonstrates a disregard towards the global health programs that would expand soft power most at a time when China increasingly orients its health policies towards influence expansion. The proposals also call for a reduction in US funding for the UN, which would include the World Health Organization. While China effectively developed its image through multilateralism, the United States may choose to reduce its involvement in international health organization; should it do so, its global legitimacy will suffer.

Similar trends extend into international research collaborations, an area where the United States has already been lagging behind other high research-output nations. While the percentage of these collaborations has still been increasing, this might not continue. Proposals by the current administration to eliminate or reduce funding to the Fogarty International Center (responsible for finding international research), among other budget cuts, as well as immigration restrictions that impede the United States’ ability to attract foreign scientists, degrade America’s image as a research powerhouse. Even if Congress votes against such policies, international perception of the United States will still shift and reduce the effectiveness of American science diplomacy.

Even if the US can or will not compete with China in economic and infrastructure development to expand influence, health and science are areas in which it can outdo this particular rival. The US is trending towards neglect of a powerful foreign policy tool while China rapidly increases its use. While the US will still provide a higher volume of global health aid and conduct more international research collaborations for some time, China is quickly gaining ground. The overall effectiveness of Chinese policies in expanding soft power means China may obtain better results from its science and health diplomacy than the United States. If the United States has any intention of maintaining its global influence, it could learn from China’s policies.

Photo: “US, China and China CDC (CCDC) flags Blue-jing”

About the Author

Sean Joyce '19 is the Section Manager for the World Section of the Brown Political Review. Sean can be reached at