Health partnerships: views from East and West

China-Europe health cooperation: opportunities and challenges

The COVID-19 global pandemic is not only a public health crisis; it has negatively impacted every aspect of society. The post-COVID-19 world will likely face a socio-economic crisis as well as a crisis of globalisation and economic transformation. In these unprecedented times, differences between China and Europe will emerge, but there is still plenty of room for further strengthening China and Europe’s cooperation in the health sector – a renewed partnership would benefit both. The two should therefore work to reinforce trust, inclusivity, transparency, and mutual understanding.

The key to overcoming differences is engaging in frank discussions or debates without any prejudice. Through honest exchanges and dialogue, mutual trust between China and Europe can be enhanced. This is crucial if the two are to overcome divergences and strengthen their partnership. However, building trust takes time, honesty, patience, and hard work. A single action or event can destroy trust, and it is hard to rebuild. It is only through trust that cooperation can be sustained, and mutually beneficial outcomes achieved.

In the field of health, it is in their shared interest to work together. In fact, cooperation is the only way for mankind to defeat COVID-19. China and Europe should join forces so as to better prepare for the outbreak of infectious diseases in the future. This pandemic has exposed the fragility of global health systems. If this has taught us anything, it’s that in order to cope with the next pandemic, we need to entirely rethink how to make health systems stronger and more resilient.

To strengthen these systems, China and Europe need to analyse and assess the existing shortcomings. This should include identifying potential obstacles to rapid crisis response and any potential gaps in surveillance data on COVID-19.

China should also enhance cooperation with Europe when it comes to health systems research, especially on the use of artificial intelligence and big data technology in surveillance and rapid response to emerging infectious diseases. Both parties should share knowledge regarding integration of public health systems, improving clinical support decision systems and telehealth, and medical informatics education training.

Establishing the mechanisms for sharing information and expertise is the cornerstone of successful cooperation. Such a cooperation model should be flexible to allow multi-level governance across China and Europe, as well as diverse value systems – resilient enough to introduce normative health measures. It should also be actionable, inclusive, transparent, accountable, and trustworthy. This should be underpinned by reinforced academic exchanges and collaboration between non-governmental organisations. Through this, China and Europe can solidify mutual trust.

Only when China and Europe trust each other can they rapidly and transparently share accurate data, information and expertise. Working together would help to provide real-time guidance to epidemiologists seeking to contain the outbreak, to clinicians managing patients, and to researchers who develop prognoses and evaluate the effectiveness of interventions. The real-time dissemination of accurate and comprehensive data, reliable information and expertise are needed most during this phase of the pandemic.

In terms of health cooperation, the new ‘Health Silk Road’ – which falls under the framework of the Belt and Road Initiative – provides a possible model. It calls for certain key measures, including enhancing consultation and exchange on health policies and regulations, establishing institutions, defining international health standards and norms, strengthening cooperation in disease prevention and control, and training and capacity-building.

After COVID-19, China-Europe health cooperation should be further deepened and improved on the basis of the new Health Silk Road. History shows that cooperation works better than conflict in overcoming human crises and challenges. Only through mutual respect, trust and friendly cooperation can we defeat the next pandemic.

EU-China cooperation on health: one ‘yes’ and one ‘no’

The European Union is convinced that, yes, only through the pooling of resources and transnational cooperation can the international community address the formidable challenge of the COVID-19 pandemic. This was amply demonstrated at the global pledging conference, which was convened by the EU on 4 May 2020 and helped raise €7.4 bn for vaccine development. It is most unfortunate that the US shied away from this significant event. And it is no less unfortunate that China’s participation in the conference was limited to a bland statement by Beijing’s envoy to the EU.

It goes without saying that for Europeans, the World Health Organization (WHO) is a key and indispensable stakeholder in this global effort. However, this does not mean that the EU approves of the organisation’s recent track record and practices. Some European governments are reportedly discussing a much-needed overhaul of the WHO, which indicates inter alia concerns about the international body being too close to China. Sadly, this suspicion is fully confirmed by the WHO Director-General who misses no opportunity to act as Beijing’s portavoce and urges “countries around the world to emulate the position taken by the Chinese government” – notably, the quote is from an official report of the China Global Television Network (CGTN). It is clear that China’s undisguised sway over the WHO has discredited, not enhanced, ‘the world’s doctor’.

For all that, the EU does not endorse the decision of the Trump administration to withdraw the US from the WHO – far from it. Unlike Washington, the EU continues to support the WHO, with a critically constructive stance. At the May 2020 World Health Assembly (WHA), which the US abandoned, the EU and Australia managed to craft a carefully worded proposal for an investigation into the pandemic, officially dubbed ‘evaluation’. They made sure that the WHA resolution, adopted by more than 130 nations, accommodated China’s sensitivities about the origins of the pathogen as well as Beijing’s missteps and lack of transparency at the initial stage of the outbreak. Europeans have demonstrated that they are strong believers in multilateralism and international cooperation with all partners, including China, even if this support is not unconditional.

The Health Silk Road (HSR) proposed by China is not an entirely novel concept. It first appeared in a speech given by Chinese President Xi Jinping in Uzbekistan in 2016. But the idea can be traced back to a document prepared by China’s health authorities a year earlier. The paper suggested that the HSR be promoted within the framework of China’s Belt and Road Initiative (BRI) through cooperation in the healthcare sector. Xi Jinping then used the term in January 2017 in Geneva, where he signed a memorandum of understanding with the WHO on the creation of a Health Silk Road that would aim to improve public health in countries along BRI routes. In August 2017, Beijing hosted an international seminar titled the ‘Belt and Road Forum on Health Cooperation: Toward a Health Silk Road’, where the newly-elected WHO Director-General Dr. Tedros Adhanom Ghebreyesus praised Xi’s ‘visionary’ proposal.

The HSR concept has been unearthed just as China has doubled down on its efforts to recast itself as a responsible global health leader. Beijing has organised a number of teleconferences to champion what it touts as China’s exemplary response to COVID-19 and international cooperation efforts in the area of public health. While the US is navel-gazing, Beijing is shrewdly stepping into the void left by Washington.

Yet, China’s aggressive response to the demand for transparency and accountability has undermined its efforts to burnish the country’s image. Beijing’s abrasive ‘wolf warrior diplomacy’, which has gained steam with the pandemic, is doing more harm than good. Shí Yīnhóng (时殷弘), professor of international relations at Renmin University in Beijing, has warned that efforts “to project the image of China as a world leader in combating a global health crisis (…) are being done too hastily, too soon and too loudly in tone, so there is a huge gap between what is intended and what is achieved.”

As a result of Beijing’s controversial ‘mask diplomacy’ drive in Europe, there is very little trust between China and the EU these days, and there’s no hiding it. The European Commission has come out with unambiguous messages about China’s efforts to spread disinformation related to the coronavirus outbreak in Europe.

Furthermore, EU Commission President Ursula von der Leyen has suggested that China may have been behind a spate of cyberattacks against hospitals and dedicated computing centres in Europe during the coronavirus outbreak. She has stressed in no unclear terms that such malicious activities, just as China’s disinformation campaign in Europe, “cannot be tolerated.”

It is in this toxic context that China is bringing back the HSR concept and there are reasons to believe that this should be viewed as yet another “battle of narratives”, to borrow Josep Borrell’s wording. The debate on the resumption of a China-led Health Silk Road has started on the wrong foot and for the wrong reasons, which is why the EU’s response can only be a firm ‘no’. Europeans are happy to work with everyone, including China, not under China.