Mapping China’s Health Silk Road

On March 16, while Italy was in the throes of its coronavirus outbreak, Chinese President Xi Jinping held a phone conversation with Italian Prime Minister Giuseppe Conte. In addition to promising the delivery of medical teams and much-needed supplies, Xi raised the notion of working with Italy to build a “Health Silk Road” (健康丝绸之路). Since then, China has doubled down on its efforts to recast itself as a responsible global health leader, launching a widespread public diplomacy campaign and sending medical aid worldwide. But it has also continued to use the “Health Silk Road” moniker, suggesting that it may take on new importance. The Health Silk Road, a rhetorical extension of China’s Belt and Road Initiative (BRI), is not an entirely novel concept, but it has been unearthed in ways that may be advantageous to China in this moment of crisis.

It is no secret that China is making a push for global health leadership during the coronavirus pandemic. The Chinese government is providing medical aid and consultation on a bilateral basis, often delivered directly by local Chinese embassies such as those in Malaysia, the Philippines, and Greece. In other cases medical supplies have been provided by companies engaging in BRI projects abroad, such as Huawei or China Communications Construction Company. The Jack Ma and Alibaba Foundations have delivered relief packages to dozens of countries ranging from Uganda and Ukraine to the United States. China has also lent economic support to some afflicted countries, including a $500 million dollar concessionary loan to Sri Lanka. Moreover, China has played a coordinating role in multilateral forums to champion China’s international response to COVID-19. Xi Jinping gave a speech at a virtual meeting of G20 leaders, and Chinese representatives have engaged with ASEAN, the Shanghai Cooperation Organization, the European “17+1” mechanism, and the African Union touting Chinese leadership. These activities mirror broader Chinese Communist Party (CCP) crisis narratives: Xi Jinping has praised China as an exemplar in medical sciences and highlighted the need to promote a “community of common destiny for mankind”—the conceptual shorthand for China’s long-term strategic vision—in order to strengthen international epidemic prevention efforts. A People’s Daily column under the highly authoritative pen name Ren Zhongping also invoked the “community of common destiny” in the COVID-19 context, describing China’s international cooperation efforts as demonstrative of its benevolent behavior.

Alongside these efforts, China’s leadership has resurrected a lesser-known moniker in the “Health Silk Road.” Xi’s phone call with Conte was the first high-level reference to the term in the midst of the COVID-19 pandemic, which appears to be a rhetorical extension of the BRI into the global health sector (much like China’s Digital Silk Road in the technology sector). The Health Silk Road term was repeated by other officials and media outlets in the following days: a Ministry of Foreign Affairs spokesperson, for instance, called “on the international community … to build a Health Silk Road” in an effort to “strengthen global public health governance.” Like the BRI itself, the Health Silk Road is not a well-defined term, and it is not clear which of China’s activities fall under the banner. According to state media, the Health Silk Road includes mutual medical aid between China and Italy to “battle the COVID-19 pneumonia together”, as well as any activity that might support China’s vision of “a new approach for perfecting global public health governance.” This could certainly be expanded to include China’s activities with other countries.

Although it has been resurrected for the coronavirus crisis, the Health Silk Road is hardly a new concept. Xi first used the term during a visit to Geneva in January 2017, where he signed a memorandum of understanding with the World Health Organization (WHO) committing to the construction of a “Health Silk Road” that would aim to improve public health in countries along China’s Belt and Road. In August 2017, the Chinese government hosted a seminar in Beijing titled the “Belt and Road Forum on Health Cooperation: Toward a Health Silk Road,” where WHO Director General Dr. Tedros Adhanom Ghebreyesus praised Xi’s “visionary” proposal for utilizing the Belt and Road network to strengthen cooperation in the health sector. Tedros ended his speech by endorsing China’s recommendation that “the health leaders of 60 countries gathered here, and public health partners, build a healthy Silk Road, together.”

The CCP may be dusting off the Health Silk Road concept to take advantage of this moment of global upheaval. First and foremost, the Health Silk Road narrative serves a domestic role in legitimizing the rule of the CCP. Beijing’s highly conspicuous displays of aid to other countries signal to the Chinese people that the state is responding to the pandemic in a responsible way. Health Silk Road activities might also serve to mitigate concern within China as the place of origin of the novel coronavirus, using redemptive displays of aid and support to compensate for harm done.

Second, the Health Silk Road presents a framework through which Beijing may choose to revamp BRI, which it will likely do out of necessity due to COVID-induced shocks to the Chinese and BRI host economies. As China halted international travel, quarantined cities, and imposed lockdowns across the country in response to the epidemic, it compromised the labor and supply lines that BRI projects rely on. As China restarts its economy, which was already slowing, it may not be able to commit the same level resources to new BRI projects, which receive massive government subsidies. Moreover, BRI participant countries will soon be facing economic crises of their own, and more BRI projects will be expected to stall as many less-developed countries are economically ravaged by the crisis, rendering them unable to service their debts. BRI remains enshrined in the CCP constitution and continues to be a signature foreign policy of Xi Jinping—yet it is so vaguely defined that Xi can renovate it opportunistically. The Health Silk Road may be a convenient new banner for a signature foreign policy that China will simply not abandon even under significant strain.

The Health Silk Road could also be an opportunity to rebrand pre-existing aspects of BRI as more germane to the COVID-19 crisis. One could envision certain elements of the Health Silk Road being linked up to China’s Digital Silk Road, for example. If Beijing seeks to keep some high-profile aspects of BRI up and running, the Digital Silk Road’s relatively low price tag will make it a more attractive option compared to other more capital intensive traditional infrastructure options. The Health Silk Road could be merged with the Digital Silk Road for the sake of health monitoring. Digital tools to monitor contact tracing and quarantine enforcement have been deployed around the world to combat COVID-19, from Singapore and South Korea to Israel and India. China, for its part, has required some citizens to download an app that shares health, location, and travel data with local authorities. Healthcare codes are accessed through Alipay and WeChat, and Ant Financial and Tencent have partnered with and provided support to local governments to roll out the systems across the country. Beijing looks likely to rely on the Alipay standard as it rolls out a national model. With a long track record of Chinese companies sending digital surveillance technologies to BRI countries, it would not be surprising to see Beijing export its digital tools to other countries that seek to monitor quarantines and sort populations in an effort to safely restart local economies.

Lastly, the Health Silk Road might allow China to redeem its national reputation on the international stage, in particular by contrasting it with the maladroit responses of the United States and other European nations. Given China’s global aspirations, efforts to present itself as a global health leader should come as no surprise. It is still too early to tell the extent to which China’s global health sprint will transform its international profile—and there is reason to be skeptical that it will be revolutionary. But the United States has not done itself any favors with its own pandemic response, and its relative absence from early global health leadership has left China plenty of room to maneuver. The world’s road to pandemic recovery will be long and winding, but if China has its way it will run through Beijing.