Initiative for U.S.-China Dialogue on Global Issues

It was not until the 2014 Ebola outbreak that the world saw its two major leaders, China and the United States, stand and fight shoulder-to-shoulder. The two countries have made dramatic achievements respectively in strengthening their capacity in public health. Yet there is generally a lack of coordination and cooperation between them in addressing health incidents worldwide. Nonetheless, there are plenty of good reasons why both sides should work closely with each other in promoting global health. ​​

As many distinguished scholars have pointed out, the national borders today have become more porous than ever before. Anything can be moved from one place to another in a stupendously short period of time, thanks to internet connectivity, cross-border transportation, and international trade. But that comes with a cost. Threats from terrorists, cross-border crime, and infectious diseases start to sneak in. Without prompt information sharing around the globe or a well-coordinated and responsive public health network, no country is likely to single-handedly fend off the attacks. ​

That is why for global leaders like China and the United States, it is high time that they assumed leadership to bring benefits to the international community in global health. China itself used to be a recipient country, and it has grown over the years with the help of the other global health pioneers and their wisdom. China has been upgrading its Center for Disease Control and Prevention to emulate its American counterpart. The China Food and Drug Administration (CFDA), established in 2013, is modeled after the U.S. Food and Drug Administration (FDA) as well.

Based on the previous progresses and the initiatives of the new type of major-country partnership agreed upon by U.S. and Chinese leaders, four major areas can be identified for both sides to work on to advance global health.

● Capacity building featuring trilateral cooperation.  This should evolve to be a key Sino-U.S. focus. Many African countries lack essential public health infrastructure or well-implemented frameworks, the improvement of which requires substantial financial support and technical expertise. China and the United States can together engage the recipient country to form a trilateral partnership, with each side contributing its strength. A recent case of trilateral cooperation in Sierra Leone, marked with cooperation from both sides in carrying out training programs and field study, has proven its feasibility. In some cases, international organizations such as the World Health Organization (WHO) are engaged as well to provide expertise and leadership. Combining the benefits of North-South dialogue and South-South cooperation, more partnerships of this kind should be developed.

● Monitoring platforms with big data technologies. With the rapid development of information technologies, big data is seen to have an increasingly important role in supporting public health. Companies boasting big data technologies can help governments establish or improve their public health monitoring systems, as is in the case of partnership between China’s Tencent and the Guizhou Provincial Government. Compared with governmental partnerships, this emerging public-private partnership  model is more flexible and responsive because of its unparalleled capacity in data collection and processing.

● Business partnerships in production of public health products. China today seeks to increase its global profile with a heavy focus in the developing world. The government is now calling upon the domestic manufacturers of public health products to explore oversea markets. The National Health and Family Planning Commission, for instance, encourages domestic suppliers to apply for WHO pre-qualification (PQ), with which their products are allowed to enter the global market. Yet only a small percentage of the manufacturers actually pass the PQ due to the high standards required by the WHO. Given the American strength in capital and technology investment as well as China’s solid infrastructure and low manufacturing cost, this is a potential area where U.S. and Chinese companies can develop business cooperatives, hence bringing affordable quality drugs and medical equipment to the developing world.

● Cooperation via international organizations in other health-related issues. As the significance of global governance gains increasing recognition, miscellaneous specialized international organizations have been set up to deal with specific global issues. Going hand-in-hand with this trend of specialization, however, is a greater level of interdisciplinary connections across issues. Refugee crises and illegal immigration somewhat intensify the risks faced by global health security. Environmental problems continue to influence health as well. These pressing issues are in dire need of enlightened leadership but have been so far inadequately cared about because of their peripheral status, which results from the specialization of international organizations. Both parties should strengthen their exchange and dialogue in international organizations, so as to bring new vision and to meet the world’s needs. The United States and China should also strive to reform WHO, the leading organization in global health, in order to reduce its fragmented in internal structure. Otherwise, it will limit WHO’s capacity to examine cross-regional impacts of health incidents.

The four potential areas of focus identified in this article are only the few among a multitude of topics on which China and the United States need to work together. Globalization has brought all the countries around the world closer, and when faced with global health challenges, no country is able to stand aside, for no one will be exempt from them. Cooperation should always be the theme for global health, and as the world’s two most prominent leaders, China and the United States have every responsibility to transform the strength of all countries to one united force.

Yuqian Zhang is a master’s degree student of the Tsinghua-Johns Hopkins SAIS Dual Degree Program.

COMMENT FROM CALEB HUFFMAN (November 21, 2016):

Yuqian, your proposals for a stronger China-U.S. approach to encouraging global health are very convincing.

Suggestion: Chinese companies produce low-cost health products, and U.S. companies produce high quality health products that can pass the rigorous WHO requirements. Companies invest millions of dollars into research and development to produce high quality products—with the intent to sell the product for a profit. In order for the product to remain profitable, the company obtains a patent preventing other companies from profiting from its R&D investment. Companies may be hesitant to work in China if patent laws are unenforced. Likewise, Chinese companies may not be able to compete without large resources for research and development. This may seem like a dilemma, but stronger patent laws are the answer. A China-U.S. mutual respect for patents will foster greater health product innovation, improving medical treatment throughout the world.

COMMENT FROM MINGYAN "AMY" DUAN (November 21, 2016):

You have identified four key areas where China and the United States can increase coordination and cooperation to better address global health issues, developing an integrated strategy that combines the strengths of international NGOs and the public and private sectors. The four proposals look feasible and effective once a sustainable mechanism in which all sides can leverage their power is built up. One example of producing public health products through business partnerships is Bill & Melinda Gates Foundation’s solution for vaccine production and usage in Africa. To emphasize the role of international organizations in improving global health, I’d like to recommend the idea of catalytic philanthropy, which aims to integrate resources and drive systematic change by involving multi-participation and cross-cutting cooperation. Such innovative philanthropy will give full play to the leverage effect on resources. Another area we need to pay attention to is infrastructure construction in countries prone to infectious diseases.