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Commentary: What's behind China's controversial Health Silk Road efforts

The idea of a Health Silk Road predates the coronavirus outbreak and is a part of a growing Chinese brand of medical diplomacy, says Ngeow Chow Bing.

China medical
Chinese medics posing for a group photo after landing on a China Eastern flight at Rome's Fiumicino international airport from Shanghai, bringing medical aid to help fight the new coronavirus in Italy. (Photo: STRINGER/ANSA/AFP)

But the concept can be traced back to a document prepared by China’s health authorities in 2015.

The document laid out a three-year proposal to promote the Belt and Road Initiative (BRI) through cooperation in the healthcare sector.

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At the first BRI Forum in 2017, a Beijing Communique of the Belt and Road Health Cooperation and Health Silk Road was signed by China, the World Health Organization (WHO), UNAIDS and 30 countries.

A closer look at the Communique suggests that it shared many similarities with the 2015 document.

According to these documents, the main activities under the HSR include: Organising high-level regional forums for health officials, establishing a Belt and Road Public Health Network for coordinated reactions to public health emergencies, and capacity building and professional training.

The documents also emphasise cooperation — for example in monitoring, control and prevention of infectious diseases — between medical science professions in research and development and in the use of traditional medicine.

Chinese foreign minister Wang Yi has said Beijing is open to international cooperation to identify
Chinese foreign minister Wang Yi has said Beijing is open to international cooperation to identify the source of the novel coronavirus. (Photo: AFP/NICOLAS ASFOURI)

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Other initiatives include medical aid and donations, exchanges between different national healthcare systems, maternal and child health projects, trade and investment in the healthcare industry, and the standardisation of health and drug access.


Before the outbreak of COVID-19, the HSR was quietly progressing in some of these areas of cooperation, albeit unevenly.

Regional forums have taken place in the form of the China–ASEAN Health Cooperation Forum, the China–Central and Eastern European Countries Health Ministers Forum and the China–Arab Health Cooperation Forum.

China also established several regional health cooperation projects with its Central Asian and Greater Mekong Subregion neighbours. Networks such as the Association of Sino-Russian Medical Universities and the China–ASEAN Forum on Hospital Management Cooperation were formed.

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A China–ASEAN Human Resources Training Programme of Health Silk Road aims to train more than 1,000 ASEAN healthcare professionals by 2022.

As is the case with many projects in the BRI, some of these projects predated the conception of the HSR but were all eventually absorbed into it.


The COVID-19 pandemic makes the HSR more relevant. China is facing intense international scrutiny for its initial inadequate handling of COVID-19.

But after mostly containing the spread of the coronavirus in early March 2020, China is now actively exercising medical diplomacy.

China implemented a unique system of “a province for a country”, in which a province is responsible for providing both material medical assistance (masks and protective gears) and health experts to a paired country.

China's Foreign Minister Wang Yi is welcome by Laos President Bounnhang Vorachith before the A
China's Foreign Minister Wang Yi (R) is welcome by Laos President Bounnhang Vorachith before the ASEAN and China emergency meeting on the coronavirus in Vientiane, Laos February 20, 2020. (Photo: REUTERS/Phoonsab Thevongsa)

Since March, China has shipped out billions of masks and millions of pieces of protective gear, though the rushed production resulted in some sub-standard products that Western media were quick to highlight.

In a somewhat low-profile manner, Chinese officials and media have slowly raised the idea of the HSR amid the ongoing outbreak.

President Xi spoke of the concept with Italian Prime Minister Giuseppe Conte in March. The HSR was elevated as a new platform for BRI cooperation and in contributing to global health governance in a People’s Daily commentary that same month.

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The Beijing-based Belt and Road Think Tank Alliance organised the first online forum on the HSR in April, where more than 30 scholars and retired foreign statesmen participated. Song Tao, the head of the International Department of the Chinese Communist Party, gave the opening speech to the forum.

Some Chinese commentators are already packaging China’s medical diplomacy activities during the pandemic under the rubric of the HSR.


These are signs that Beijing will slowly and carefully redirect the HSR as a mainstay of the BRI after the COVID-19 outbreak.

Just like the BRI, a highly adaptive venture without a detailed blueprint, the HSR will be strong on rhetoric, the substance of which will be based on the concrete implementation of projects.

Chinese aid is unloaded from a plane in Haiti, one of many shipments of medical supplies by Beijing
Chinese aid is unloaded from a plane in Haiti, one of many shipments of medical supplies by Beijing to combat the coronavirus AFP/Pierre Michel Jean

With this overarching concept, China is repositioning itself as a responsible leader in global health governance and aims to repair its national reputation.

Yet China is also aware this is not the right time to push the concept aggressively, especially in the developed world, when the pandemic is accelerating the deterioration of its relationships with most Western countries.

In contrast, the target audience of the HSR is more likely to be the developing world, where there is generally less ideological scrutiny of how the Chinese government performed during the early stages of the outbreak.

Regardless of the misgivings, China is well positioned to offer substantive assistance. Many developed countries are suffering from the pandemic, due in no small part to the poor performance of their own governments.

The pandemic is also exposing the weaknesses of healthcare infrastructure in many developing countries and the HSR has the potential to help address some of these weaknesses.

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But the HSR is not immune to geopolitical competition. The US State Department just launched the US–ASEAN Health Futures initiative.

Southeast Asian (and developing countries in general) do not want to sign up for one initiative to the exclusion of another. Both initiatives should and can be equally welcomed on their own merit.

Both the United States and China have their own respective strengths to offer to the developing world. The major powers must resist treating international healthcare cooperation as a zero-sum game, as they often do in other spheres of rivalry.

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Dr Ngeow Chow Bing is Director of the Institute of China Studies at The University of Malaya. This commentary first appeared on East Asia Forum.


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