Abstract
Over the past two decades, several factors have amplified the risk of emerging infectious diseases spreading beyond national and regional borders. Concerns have been raised over Southeast Asia’s environmental, social, and demographic specificities and its traditional aversion to accepting global and formal instruments of international governance. With its large size population and high economic growth, China will shape international health-security policy at the local, regional, and global levels.
This chapter explores China’s participation in that policymaking by considering its embeddedness in and compliance with the International Health Regulations and their custodian agency, the World Health Organization. The investigation is relevant for the broader international relations agenda, as a fundamental question of the last twenty years concerns the implications of the rise of China and whether the country is challenging the rules-based international order created after the Second World War.
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Notes
- 1.
For a COVID-19-related debate, see inter alia, https://www.washingtonpost.com/world/asia_pacific/chinese-officials-note-serious-problems-in-coronavirus- response-the-world-health-organization-keeps-praising-them/2020/02/08/b663dd7c-4834–11ea-91ab- ce439aa5c7c1_story.html.
- 2.
See also Huang’s later production mentioned below in the chapter and the Global Health Strategies Initiatives, 2012, ‘Shifting Paradigm: How the BRICS [Brazil, Russia, India, China, and South Africa] Are Reshaping Global Health and Development’ GHSi BRICS Report, March 27. New York: GHSi. www.ghsinitiatives.org/downloads/ghsi_brics_report.pdf. in Huang, 2015, 42; Huang, 2013; Sutter, 2020.
- 3.
- 4.
- 5.
See also “New Rules on International Public Health Security”, Bulletin of the World Health Organization 85 (6) (2007): 428–30 available at https://apps.who.int/iris/handle/10665/269957; and Fidler & Gostin, 2006.
- 6.
Author’s interview with former WHO officer of the WHO World Health Emergency Department. Recall that the United States also made relevant reservations to the treaty, regarding the need to preserve consistency with ‘its fundamental principles of federalism’ and to guarantee that the US armed forces operate effectively (IHR, 2005, 60–61), making the country’s overall position less consistent than it seems.
- 7.
This idea was validated during multiple conversations with former WHO technical officers working at WHO World Health Emergency Department, Country Preparedness & IHR.
- 8.
For an overview of the expanding role of nontraditional security in contemporary Chinese foreign and security policy, see Ghiselli (2018, pp. 614–14).
- 9.
For more on the WHO’s response to SARS, see inter alia Hanrieder Hanrieder & Kreuder-Sonnen, 2014.
- 10.
For a deeper investigation over the role of SARS in activating the latent norm conflict between rules relating to sovereignty and health security in China and within the WHO see Kreuder-Sonnen, 2019.
- 11.
For more on the significance of China–Taiwan discord in the World Health Organization see Tubilewicz, 2012.
- 12.
For a more detailed account about the implications of Chinese support for Chan’s campaign see Shen, 2008.
- 13.
- 14.
We could hardly interpret such a reaction as an existential challenge to the health-security policy in front of the European Union ‘border politics’ adopted in the early months of the COVID-19 crisis and the historical pervasive use of external border control (border orientation) in the face of actual or perceived health threats (Kenwick & Simmons, 2020).
- 15.
The only available measure of a country’s health-security profile is the Global Health Security Index, an academic tool which allows intercountry comparisons on pandemic preparedness (available at https://www.ghsindex.org , accessed 2022, 17 June). The GHSI, a project of the Nuclear Threat Initiative and the Johns Hopkins Center for Health Security developed jointly with The Economist Intelligence Unit, comprises 6 categories (prevention, detecting and reporting, rapid response, health system, compliance with international norms, and risk environment), 34 indicators, and 85 sub-indicators based on 140 questions. In 2019, China positioned itself at 51st place among 195 countries with scores in all but one category (norms) that are higher than average scores. The index also ranked China as the 12th most prepared country out of 56 upper-middle level income countries (Bell & Nuzzo, 2021: 100).
For a commentary, see https://chinapower.csis.org/china-health-security/.
Unfortunately, the utility of the index is limited in two ways. On the one side, data are not available for years before 2019 which makes time series analysis and longitudinal studies impossible. On the other side, recent studies have questioned the predictive value of the GHSI with regard to public health emergencies. As a matter of fact, the index has showed a poor correlation with countries’ COVID-19-related mortality outcomes or disease risk importation (Haider et al. 2020). Beyond suggesting the need for a reappraisal of the ranking system and methods used to obtain the index based on experience gained from this pandemic, those studies imply that at the time being a qualitative/comparative analysis, as the one performed in the chapter, it is still appropriate to appreciate the evolution of Chinese health provisions with regards to both diseases prevention/management and public health emergency response.
- 16.
- 17.
Author’s conversation with a former P5 officer, WHO World Health Emergencies, Country Preparedness & IHR, for a different opinion see also https://www.thinkchina.sg/china-cdc-head-hero-or-villain
- 18.
I confirmed this interpretation during interviews with former WHO staff, World Health Emergencies Department (WHO-WHE). To learn more about US–-China government-to-government health relationship and bilateral technical exchanges between the two countries in the aftermath of SARS, during the Obama’s and Trump’s years, see Seligsohn, 2021
- 19.
To fully assess WHO’s constraints and challenges in handling a global pandemic also acknowledge WHO WHA 73/10 2020 (WHO – IOAC, 2020).
- 20.
Under this perspective it is important to not overestimate China’s pre-Covid contribution to the WHO budget. Prior to 2020 (biennium 2018–2019), China contributed only 0.21% percent of the WHO budget compared to the US’s 14.67%, with only a slight increase in voluntary contributions with respect to the past. For more data on WHO budget and accountability online at http://open.who.int/2018-19/contributors/contributor. See also WHO, 2019 and Chorev, 2020.
- 21.
For an accurate analysis of Beijing’s interventionism and impact on the media international ecosystem, see Lim et al., 2021.
- 22.
For a comprehensive analysis of Chinese soft power projection, foreign propaganda, domestic externalities, international shortfalls, and the outcomes of those strategies, see Gill 2020.
- 23.
- 24.
For a commentary, see Hernández, 2020.
- 25.
Note that the Resolution WHA 73.1, requesting the WHO Director-General to identify the source of SARS- CoV-2 and the route of transmission to humans, does not mention China not even once (WHA 73.1 2021).
- 26.
For a comprehensive analysis, see ‘The deterioration of Australia–China relations’ 2020.
- 27.
See also Director-General's report to Member States at the 75th World Health Assembly 2022, 23 May, available at https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-address-at-the-75th-world-health-assembly. 23-may-2022.
- 28.
- 29.
Although according to the WHO’s director China’s first reaction to the proposal seemed optimistic only one year ago, Beijing would hardly accept ceding to WHO more power than has already been done. Along these lines, the American senate would hardly get to the two-thirds majority it needs to ratify, possibly for the reasons (https://www.telegraph.co.uk/news/2022/05/14/pandemic-pact-would-leave-world-chinas-mercy/).
Under this perspective it is useful to recall that the US position on outbreak’s investigations and inspections has not been always consistent as the country sank the verification protocol project within the BTWC in 2001 after having sponsored the initiative for years.
- 30.
The work of the group is published at the WHO’s ‘governance’ webpage available at https://apps.who.int/gb/wgpr/ accessed 2022, 17 June.
- 31.
- 32.
For a discussion over the perspective diffusion of illiberal pandemic response strategies, risks of democratic backsliding, and democratic erosion, see Greitens, 2020.
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Cerutti, F. (2023). Health Problems, World Institutions, and China’s Approach to Pandemic Outbreaks. In: Attinà, F., Feng, Y. (eds) China and World Politics in Transition. Global Power Shift. Springer, Cham. https://doi.org/10.1007/978-3-031-27358-2_7
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