Health Silk Road — How China plans to make BRI essential in Covid-hit South Asia

China’s foreign minister Wang Yi finally admitted late last month that the Covid-19 pandemic has severely slowed down Beijing’s flagship foreign policy project, the Belt and Road Initiative. He, however, asserted that the impact was temporary, and the BRI will be back, stronger than ever.

Yi’s comment follows some creative policymaking from China as the pandemic spread across the world. This involved dusting off and relaunching the Health Silk Road (HSR), a little-remembered component of the BRI. Beijing has wanted to shape public health governance since 2015, and the HSR allowed it an opportunity to launch the initiative globally. This helps China keep the BRI relevant, as well as gain control of a global narrative that has so far blamed them for obfuscation and misinformation.

This is not to suggest that healthcare will become the sole focus of the BRI. However, given that BRI partners are already asking for debt relief, it is unlikely that they will be keen to borrow heavily for mega infrastructure projects anytime soon. Shrinking capital will require Beijing to trim BRI projects, and healthcare investment may be more cost-effective in reaching partner countries.

What’s in it for China? 

As China ramps up the Health Silk Road to do more, at a time of changing geopolitical and geoeconomic realities, a commentary in the People’s Daily offers insights into three major objectives driving Beijing.

China’s immediate and global objective is to control the narrative about its role in the coronavirus pandemic and portray itself as a global health leader. What began as “mask diplomacy”, with China rushing medical supplies to countries all over the world, has evolved into “wolf warrior diplomacy” – the use of social media and communication channels to vehemently defend Beijing and the Xi Jinping government’s image. This has involved the consistent repetition of the official line that China was “transparent, open, and comprehensive” in dealing with the pandemic from the outset.

The focus on health allows China an opportunity to reorganise global public health mechanisms in a way that fits Beijing’s worldview. The World Health Organization (WHO) enthusiastically endorsed the HSR as early as 2017. But the current pandemic has allowed China the first opportunity to work directly with countries handling a medical emergency at a global scale and demonstrate that it can carry the burden by itself. In essence, this takes China closer to offering an alternative to the WHO, tied to the Health Silk Road — one that swaps the WHO’s multilateral model with one that operates on a hub-and-spoke model and has China at the centre.

China hopes that HSR will allow it to find newer markets. BRI partner countries will be the new incubators for China’s healthcare systems and technology. The country’s National Health Commission has had an exhaustive plan on the HSR ready since 2017. This includes offers of infrastructure development, capacity building, and identification, prevention, and control of diseases. Chinese contact-tracing apps bundled with e-medicine apps, tools for quarantine, and statistics for authorities could become ubiquitous in BRI member states.

Beijing can also share advances in gene-based research in biomedical technology or synthetic biology and collaborate on telemedicine. These will need real-time communication, which opens opportunities for Chinese companies offering 5G services.

The Way ahead for South Asia

The coronavirus pandemic has already taken a huge toll on South Asia, pushing it towards its worst economic performance in 40 years. This would mean that while countries in the region may still want to undertake new infrastructure projects, their appetite for taking on fresh loans to finance them will be far lower. In fact, China is already facing requests for debt relief. In South Asia, the Maldives and Pakistan have sought to restructure their debt to China while Bangladesh has requested China to consider deferring payments.

The current crisis has also exposed shortcomings in South Asia’s public healthcare capacities. According to the World Development Indicators, South Asian countries perform poorly in most essential healthcare parameters. Pakistan only has 0.1 health workers, 0.6 nurses, and 1 physician per 1,000 citizens, while Bangladesh spends a scant 2.3 per cent of its GDP on healthcare.

These startling deficiencies suggest that when these countries talk about infrastructure next, they will mean hospitals and laboratories along with ports and highways. As they seek to fill crucial gaps in their struggling healthcare systems, the Health Silk Road will become an integral component of the BRI in South Asia, at least in the immediate aftermath of the pandemic.

South Asian countries will also need to get used to China’s new “wolf-warrior” diplomacy, which comes in the form of inflexible political and economic strings attached to aid. In Africa, for instance, medical assistance has been conditional on preferential market access and positions on issues such as Taiwan that Beijing finds favourable. In the subcontinent, Nepal, most recently, had a taste of this, when a newspaper was censured for questioning China’s track record in dealing with Covid-19. As these countries are further drawn into China’s orbit through the HSR, such instances bordering on impingement on a state’s internal affairs will, no doubt, rise.


China’s strategic competitors, including India, are trying to contest its public health outreach. However, as of now, countries in South Asia do not have an alternative to China when it comes to building their healthcare sector. In essence, the success of China’s Health Silk Road will depend on how quickly it can roll it out in the subcontinent and how countries in South Asia deal with China’s increasing assertiveness.

The article was co-authored with Rahul Bhatia  and Suchet Vir Singh for The Print, on June 11, 2020.

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