As many Western nations rethink their pandemic policies to live with COVID, China is the last “zero-COVID policy” holdout. GJIA sat down with Dr. Yanzhong Huang, Senior Fellow at the Council on Foreign Relations to discuss China’s role in global health governance and the challenges an East-West split would have on future global health cooperation.
GJIA: How did you become interested in issues on global health governance?
YH: I was trained as a China specialist. When I was working on my dissertation, I chose the topic of health politics in post-Mao China, which is where I found my interest in studying health issues from a governance perspective. I received my Ph.D. degree in 2000, when health issues began to be reframed as a foreign policy and national security concern. I happened to join a project sponsored by a think tank that examined security aspects of health issues, which nurtured my interest in global health governance. Now I have this bifurcated interest: China and global health governance, but the two topics are overlapping given the central role China has played in the dynamics of health, security, and development.
Have you seen a lot of popularity since COVID and did you expect to be so sought after?
I got that feeling of becoming the media’s darling during the 2003 during the SARS epidemic. People suddenly realized that health issues are not just a “low politics” issue but one that has significant political, economic, and security implications. Certainly the COVID pandemic highlighted the non-health impacts of disease outbreaks. I have been approached by numerous media interviews and have also received invitations for speaking engagements since the beginning of the outbreak. Most times it is just difficult to say no, and I have to spend a lot of time with journalists, but I found it overall an intellectually rewarding experience.
COVID has upended almost every aspect of our lives. You encapsulate that well in your Washington Post piece from February 3, 2022, on the Chinese Winter Olympics that just concluded. You mention this showing of Chinese confidence through the Olympic games that demonstrates its rise against the West’s fall, especially in regard to COVID. Does this imply Chinese ambition to assume global leadership in global health governance?
If you had asked me that question twenty years ago, or even ten years ago, I would probably have given a negative answer. At that time, there was evidence that China was reluctant to shoulder more international responsibilities. Around 2016 and 2017, they became more confident in pursuing its global ambitions, emboldened by the Trump administration’s abdication of global leadership. So basically China said, “If you’re not interested in being a global leader, then we don’t mind filling the void.” But what’s interesting, as I mentioned in the Council on Foreign Relations Special Report, is that before the COVID pandemic, even though China had become more proactive in participating in global health governance, it was not considered a global health leader. But the pandemic has clearly provided China a perfect opportunity to pursue the status as a leader in providing global public goods, even though most of the masks and vaccines they provided were up for sale, and, strictly speaking, should not be considered “global public goods.”
Secondly, they clearly want to present an alternative model of global health governance. Look at the “zero-COVID” strategy. It is very different from the United States’ approach, and even from other countries such as Australia or Singapore that pursued a similar approach. China has arguably become the last zero-Covid holdout. While other countries are moving away from this approach, China stands firm, insisting that the Chinese model remains the best. They certainly have a strong case to make in terms of the number of infections [and] lives they have saved compared to countries like the United States. It gave them more confidence to showcase the superiority of the Chinese model. Also, if you look at China’s engagement with international organizations, such as the World Health Organization (WHO), they were also relatively successful in shaping the WHO’s agenda, so much so that the Trump administration considered the WHO “China-centric”. But compared to the United States, China is a very small contributor to its operating budget. In 2020, before the pandemic, China made up 1.5 percent of the WHO’s budget, whereas the United States made up 16 percent.
You also mention in your Washington Post article that China believes that it no longer needs the West’s help in public health projects, and you cite Xi Jinping as a support of that notion. Does this undermine the legitimacy and effectiveness of global health governance structures?
Global health challenges are challenges that every country is facing. In order to effectively combat a common challenge, you are supposed to have better coordination and cooperation among all the stakeholders. But if you have different sets of norms, rules, and institutions that happen to be irreconcilable with other ones, then you have a problem. That is especially so in the current pandemic, which is heavily politicized. Global pandemic response has also become intertwined with competition for ideological superiority. That makes it very difficult for the United States and China, two countries that supposedly have special responsibilities in combating global health challenges, to work with each other. Even today, there has not been a serious official discussion between the United States and China on how to work effectively with each other to improve global health security.
Is China’s capitalization on the West’s retreat from global leadership due to Xi Jinping’s vision for China?
I don’t know if this is part of his vision but it is certainly consistent with his pursuit for the China dream or China’s rejuvenation. He wants China to be respected, to be a leader, and in his words to guide global efforts to reform global governance. The pandemic provides China with a great opportunity to reassert that leadership, not just in public health but in other areas as well. The United States perceives China’s global ambitions as a threat to the liberal rules-based international order. This fear might explain why the Biden administration held this global democracy summit, which excludes China.
It is not an intentional retreat of Western leadership in global health. It is more caused by poor management of the COVID crisis, efficiency problems with multilateralism, and vaccine nationalism. These developments really undermined the West’s leadership in global health.
This transcript has been lightly edited for clarity and length.
Interview conducted by Jesse Lin
Yanzhong Huang is a senior fellow for global health at the Council on Foreign Relations. He is also a professor and director of global health studies at Seton Hall University’s School of Diplomacy and International Relations, where he developed the first academic concentration among U.S. professional international affairs schools that explicitly addresses the security and foreign policy aspects of health issues. He is the founding editor of Global Health Governance: The Scholarly Journal for the New Health Security Paradigm. Dr. Huang is the author of Governing Health in Contemporary China (2013) and Toxic Politics: China’s Environmental Health Crisis and Its Challenge to the Chinese State (2020). He has also published numerous reports, journal articles, and book chapters, including articles in Survival, Foreign Affairs, Public Health, Bioterrorism and Biosecurity, and the China Leadership Monitor, as well as opinion pieces in the New York Times, the Washington Post, Foreign Policy, and the South China Morning Post, among others. The Council on Foreign Relations recently published his special report: The COVID-19 Pandemic and China’s Global Health Leadership. He previously was a research associate at the National Asia Research Program, a public intellectuals fellow at the National Committee on U.S.-China Relations, an associate fellow at the Asia Society, a visiting senior research fellow at the National University of Singapore, and a visiting fellow at the Center for Strategic and International Studies. He has taught at Barnard College and Columbia University. He obtained his BA and MA from Fudan University and his PhD from the University of Chicago.
In recent years, economic relations between the United States and China have become increasingly strained due to a range of issues, including concerns over human rights violations and political tensions.