The Belt and Road Initiative and disease control amid the COVID-19 pandemic

Abstract

Climate change, human activities and globalization have exposed human beings to increasing threats from emerging infectious diseases and new pathogens.1,2 Some pathogens may cause uncontrollable epidemics and result in devastating calamity, as shown by the ongoing coronavirus disease 2019 (COVID-19) pandemic. How can we be better prepared for epidemics of infectious diseases? As the global health communities have been battling against COVID-19 for more than a year, there emerge at least three important lessons from the health system’s perspective. First, a more concerted global collaboration is urgently needed. Second, it is essential to establish and maintain a stable and uninterrupted supply chain and to build digital infrastructure, ensuring that medical supplies reach places in need and digital technology is applied to enhance disease control. Third, sufficient financing for health should be prioritized to strengthen public health infrastructure and increase countries’ capacity to detect, manage and monitor the disease of interest. China launched a massive global infrastructure plan—Belt and Road Initiative (BRI) in 2013—aiming to build a new platform for international cooperation and development with strong emphases on policy, infrastructure, trade, financial and people-to-people connectivity. More than 160 countries and organizations have joined the initiative. The BRI provides development finance and implements projects to build networks of connectivity through railways, highways, bridges, airports and ports to boost global, regional and domestic economic development. BRI consists of six economic corridors including the New Eurasian Land Bridge, the China–Central Asia–West Asia Corridor, the China–Pakistan Corridor, the Bangladesh–China–Myanmar Corridor, the China–Mongolia–Russia Corridor and the China–Indochina Peninsula Corridor. So far, most investments have been concentrated in about 60 countries along the historical Land Silk Road through Central Asia to Europe and Maritime Silk Road through Southeast Asia to South Asia, Middle East and Africa. Despite the BRI’s focus on economic development and infrastructure investment, its impact on global health is looming.3 With the three lessons mentioned above, we examined the BRI from the lens of health systems for disease control. China’s spending on Digital Silk Road projects by country. Source: Bloomberg Businessweek, 2019. Note: It includes projects completed or initiated from 2012 to 2019. The dollar amount does not reflect the country’s totals as it is unavailable for some projects. Since its start, the BRI has placed a particular emphasis on fostering global collaboration. To enhance the global health collaboration, the Chinese government proposed the ‘Health Silk Road’ (HSR) initiative in 2017. A series of regional and inter-regional programmes have been launched under HSR, such as training health professionals, establishing disease research and control centres, and forging research and knowledge sharing networks.4 Amid the COVID-19 pandemic, many BRI partner countries have used HSR to periodically share information and exchange experiences on the COVID-19 control through virtual conferences, webinars and meetings. This helped partner countries to develop their pandemic control strategies and measures by building upon China’s lessons as the first country to cope with COVID-19. For example, from February to October 2020, eight virtual meetings had been organized among clinical and public health experts from China and Egypt to exchange ideas and information on the COVID-19 control and discuss COVID-19 clinical treatment guidelines and disease control strategies.5 In addition, medical teams from China were deployed to provide in-person technical support to implement COVID-19 control measures in the early stage of the pandemic. As of 31 May 2020, China had sent 29 medical expert teams to 27 countries to assist the control of COVID-19 from both clinical and public health perspectives,6 and had provided medical assistance to >150 countries and 10 international organizations in 2020. The assistance ranged from material support such as donation of personal protection equipment (PPE), medical team support, to knowledge exchange and training, and constituted the most intensive and largest-scale emergency humanitarian assistance mission in Chinese history since 1949.7 In addition, China has partnered with at least 16 countries (e.g. Brazil, Indonesia, Turkey, Egypt and Jordan) to test the efficacy of COVID-19 vaccines produced by China and started distributing vaccines in some low- and middle-income countries. Most of such medical diplomacy activities have been packaged under the umbrella of the HSR during the pandemic. Building a network of connectivity (e.g. roads and railways) in partner countries is one of the major investments of the BRI. In the past years, the investment in roads and railways has significantly reshaped and strengthened the inter-regional, regional and domestic supply chain in some countries.8 One of the most important railway networks is the Sino-Europe Railway Network that connects dozens of cities in China to those in Europe across 19 countries in Central Asia and Europe (e.g. Kazakhstan, Uzbekistan, Turkmenistan, Russian, Poland, Germany, The Netherland, Italy, France, etc.). It was reported that Sino-Europe Railway freight trains had completed >10 000 trips from January to October 2020 and exceeded the trips run in 2019 and shipped >7.51 million items of medical supplies including PPE, with a total of 620 thousand tons to countries in need (e.g. Serbia, Poland, Italy, France and Germany).9 Globally, China had shipped >70.6 billion masks, 340 million protective suits, 115 million pairs of safety glasses, 96.7 thousand ventilators and 225 million test kits as of 31 June 2020,6 contributing to the global endeavour to combat COVID-19. Another important investment of BRI has been to enhance partner countries’ digital infrastructure. It is evident that the COVID-19 pandemic has boosted the application of digital health for tracing contacts, raising community awareness, risk communication and providing telemedicine services. However, without stable and wide-range covered network connectivity, the application of digital health would have not been possible. China launched the Digital Silk Road (DSR) Initiative under BRI to work with participating countries to enhance their digital connectivity in 2015. Since then at least 16 countries have signed the Memorandum of Understanding with China to collaborate on DSR projects.10,Figure 1 shows China’s spending on DSR projects in selected countries. In Nigeria, China has been working on expanding and upgrading internet networks in the country and made impressive progress to strengthen its digital infrastructure, together with international development partners such as the World Bank. Mobile cellular subscriptions had increased from 74.1 in 2013 to 88.2 per 100 people in 2019, and the number of secure internet servers increased from 2.2 to 74.8 per 1 million people in the same period.11 The widely available mobile networks have facilitated the contact tracing and information sharing on COVID-19 in the country12 and improved the efficiency of the disease control. Perhaps, the most direct impact of the BRI on the health system is its potential to increase financing for health in partner countries. First, the BRI provides a platform to directly finance COVID-19 responses. The influx of COVID-19 patients into health facilities requires countries to mobilize substantial financial resources to implement disease control activities, such as procuring drugs, laboratory test kits and equipment. To support COVID-19 responses, the Asia Infrastructure Investment Bank created the Crisis Recovery Facility and pledged $13 billion to be used for tackling COVID-19 in 2020–21. A total of $1.5 billion was approved and disbursed for eight countries, including Bangladesh, Turkey, Uzbekistan, Maldives, Indonesia, Georgia, India and China, to strengthen their health systems for emergency responses to the COVID-19 pandemic in 2020.13 Second, the BRI’s focus on stimulating economic recovery and growth would ultimately help lift the resilience of the budget for health in partner countries. Despite the gloomy world economy in 2020 due to the pandemic, China’s investment in and trade with BRI partner countries have increased substantially. The statistics from the Ministry of Commerce of China shows that China’s direct investment in 58 countries along the Land Silk Road and Maritime Silk Road amounted to $17.79 billion in 2020, with an increase of 18.3%, in comparison with that in 2019. The main investment went to Singapore, Indonesia, Vietnam, Laos, Malaysia, Cambodia, Thailand and Kazakhstan.14 It is anticipated that the vibrant economic exchange would contribute to the resilience of the economy and thus the budget for health in the involved countries to absorb health and economic shocks resulting from the pandemic. Although it is still too early to thoroughly assess the BRI’s impact on global health, the BRI offers a platform to cope with disease epidemics through the strengthened collaboration, improved supply chain, elevated digital infrastructure and more sustainable financing. The pandemic has also highlighted that economic development and population health complement each other. Economic development is unattainable without healthy populations and vice versa. Programmes, such as the BRI, that integrate health with economic development may offer a new paradigm for building a strong and resilient health system to address disease epidemics and health. None declared. G.L. was supported by the Key Research Project in Philosophy and Social Science of the Ministry of Education of the People’s Republic of China (18JZD044). The funder had no role in designing and conceptualizing the study. W.Z. conceptualized the manuscript; W.Z. wrote the first draft; J.B., R.D., H.W. and G.L. critically reviewed the manuscript; all authors contributed to the revision and finalization of the manuscript. Not applicable.

Topics & Concepts