The refresh of the UK Integrated Review makes clear the UK is reappraising its relationship with China. The latest iteration gives more emphasis to diplomacy, dialogue and engagement. There is a need to think through how the UK engages China on a range of ‘global challenges’. This blog explores the relationship the UK should be seeking with China on global health.
Polycrisis, global health, and the need for global solutions
We are living in an era of polycrisis with major implications for global health.
Weaknesses in any one country’s health system can enable the emergence of new infections, which can travel rapidly via today’s increasingly dense global transport and trade networks. Climate change, antimicrobial resistance (AMR), and microplastic pollution are global health threats with implications for all countries.
Conflict and political destabilization, the unsustainable debt facing some developing countries, commodity price spikes, and increased migration all have substantial health implications. And rapid advances in biotechnology, pharmaceuticals and digital health are being made in a number of countries, with global implications.
This period of polycrisis and rapid, complex change coincides with increased geopolitical tension and strained global governance. But there is a practical and moral imperative to find ways to advance cooperation on global health despite these headwinds.
Evolving thinking in China
China has a history of health cooperation, including sending medical teams abroad, building health facilities overseas, and training health workers. In the mid-2010s, there was exploration of a cross-government global health strategy, but that was largely overtaken by strategies linking BRI and health, and COVID vaccine diplomacy. Centres of expertise in global health are developing rapidly, increasing Chinese capacity to engage internationally.
Recent leadership speeches make clear a desire for China to play a greater role in global health governance and providing global public goods for health. Concepts such as building a ‘community of common health for mankind’ are innovations helping reframe China’s role in the global architecture. Academic discussion is starting to explore what this might mean in practice.
UK-China cooperation in global health
A decade ago, DFID initiated a programme with the Chinese Ministry of Health to support collaboration on global health issues of joint concern. It ran until 2018 and supported research, small-scale pilots in LMICs, and bilateral policy dialogue. At the same time, there were also research partnerships funded through the Prosperity Fund and topic-specific frameworks such as the Global AMR Innovation Fund. This has created a foundation for cooperation.
Where now?
The UK is a leader in aspects of global health, including strengthening health systems in LMICs, building capacity to respond to health emergencies, biomedical research, and developing vaccines and treatments. It also has an outsize footprint in areas of global health governance such as AMR and developing new antimicrobials. China, meanwhile, has immense scientific, technical and manufacturing resources, recent experience of tackling health issues relevant to developing countries, and a huge trade and investment footprint in many developing countries – but a nascent strategy towards global health.
There is now a need to clarify priorities for cooperation and practical ways to engage. Elsewhere, we highlight three ways to think about priorities: first, issues where China’s size and systemic importance make it essential to meaningful action; second, where China has the potential to help tackle challenges facing developing countries; and third, where it is a matter of the UK’s self-interest to engage.
We highlight key examples, but in-depth discussion of priorities is needed in the UK and in consultation with other developed and developing countries.
Tackling infectious diseases
COVID has highlighted the importance of global cooperation in tackling infectious diseases. An emergent threat anywhere can potentially affect the whole global community. China is now a major player in biotech and developing new products, and has strengthened its domestic surveillance systems. Priorities include:
- Measures to avoid ‘securitizing’ infectious disease threats, and agreements to ensure information is shared on new and emerging diseases, including antibiotic-resistant infections
- Collaboration on vaccines and therapeutics and agreements to implement effective stewardship of antimicrobial drugs
- Support for international collaboration in surveillance and response to outbreaks and for strengthening capacity in all regions to produce vaccines and essential therapeutics
Health systems strengthening
Another priority should be coordinating efforts to strengthen developing country health systems. China has a very recent history of developing its own health system and strengthening its public health programmes; it is now looking at where its technical expertise can be deployed globally. Priorities should include:
- Dialogue over how restructuring of developing country debt can be managed to preserve funding for essential health services. China is a major holder of developing country debt and has an interest in good outcomes in highly indebted countries.
- Dialogue over mechanisms to improve alignment of all partners’ health programmes with the health sector strategies of low-income countries in areas including construction of facilities, workforce training, developing digital health infrastructure, production and marketing of pharmaceuticals, and support for specific programmes, such as malaria. As China becomes more active in this area, there is a need for dialogue to ensure alignment, either on a case-by-case basis at country level, or through intervention to strengthen the role of WHO country offices to coordinate multiple partners’ support.
Biomedical R&D
Biomedicine is a strategic sector for both the UK and China. There are good reasons for cooperation in scientific research, drug development, and clinical trials. Research from Kings College has argued for strong scientific collaboration, backed by appropriate safeguards. While there will be competition for future markets, and there are signals that there are growing concerns about competition for technological leadership and about national security. Despite this, there is a need to identify areas of cooperation that contribute to global health, and to engage Chinese regulatory agencies on norms and standards.
Global health governance and standards
There is a need for engagement on reform of essential elements of global health governance.
- The most obvious example is WHO. Amid geopolitical competition, a strengthened WHO could help broker agreements on norms and standards and coordinate country-level activities. The Chinese government has stated its support for multilateral solutions to global health challenges, though developing concrete forms of cooperation will require engagement on both sides.
- China’s involvement is also essential in the governance of rapidly developing areas of biotech and digital health. This is a ‘rules of the road’ issue, where global consensus is needed to ensure that the benefits of scientific advances can be harnessed, while the (global) risks of unintended consequences or deliberate misuse are minimized.
Building a capacity for future engagement with China
As the UK clarifies its relationship with China, global challenges must be a key component. Identifying clear priorities will require informed debate in the UK, involving a range of stakeholders and taking the perspectives of LMICs into account.
Effective engagement will require effort, negotiation and diplomacy, supported by investment in UK capacities to cooperate on priority issues. That should include support for research to improve UK understanding of China, inform strategy, and reduce the likelihood of misunderstanding and miscalculation.
The IR refresh has made clear the importance of dialogue, diplomacy and engagement. It is now time to take that forward, focusing on important global challenges, including in global health.
