A Study of Post-Pandemic Global Order: China’s Role in the World Health Organization


China’s power and influence at the World Health Organization has been overestimated by many. However, with the USA’s step away from the WHO and the international stage more broadly, there is room for major manoeuvring from China to increase the benefit of the WHO to the global community, as well as China’s role in that process. European nations also have space to be assertive in setting priorities in global health.


The mask BEARly fits © Nenad Stojkovic / CC BY 2.0 / Wikimedia Commons

Even before the pandemic occurred, China’s role in the global order has changed considerably over the last 20 years. China has risen to become a major influential figure on the world stage. From joining the World Trade Organization in 2001, to ‘opening itself up to the outside world’ in 2008 by hosting the Olympic Games, China has become a global economic powerhouse.


Due to these changing power dynamics, it is no surprise to see that many nations, including China, desire reform to international governance systems. The calls for international reform may be even more compelling as the world adapts to a new global reality: the post-pandemic economic and global order.


During the early stages of the crisis, China was at the forefront of pandemic discussions. Although the origin of the virus remains unknown at this stage, China was the country with the first known cases. Nation states have taken varying approaches to dealing with the virus and in their dealings with China. Some have accused China of using the crisis for their own benefit to boost its image as a responsible global leader, while others have praised China for going above and beyond in helping other nations deal with the crisis.


China has played a key role in repelling the virus as many countries are dependent on Chinese medical equipment and supplies. According to the World Trade Organization, China is the top exporter of face masks globally, with a 25% market share. It also represents 10% of the global supply of respirators and ventilators. Dubbed ‘the world’s factory’, many countries have become dependent on China as it has a pivotal role in global supply chains.


China was the first country to be severely affected by the virus and is, arguably, the first country to have a comprehensive post-coronavirus long-term economic strategy. China’s economy has shrunk 6.8% in the quarter of 2020. Current government policy will see China scrap its economic growth target for this year, and focus its efforts on stabilising living standards and employment. Many see China’s system as dealing well with the pandemic and as the catalyst for the ‘dawn of Asian century’. Neoliberal economic principles, which are often associated with the United States of America and and western economic thought, have led to deregulation and privatisation of healthcare systems in many countries leading to a deepening of inequalities.


There is great potential for systematic economic and governmental change as the appetite for transformation of the global system is soaring in this time of crisis. Chinese leadership has been very active in collaborating with the WHO; at the recent annual World Health Assembly, Xi Jinping made for himself a starring role when he promised further increased funding and cooperation with WHO and other fellow member states. This is in stark contrast to the United States, who have promised to suspend funding to the organisation.


As this is an ever changing landscape, research on the post-pandemic global order is a fast developing study but nonetheless some academic reading exists at present. This paper will commence with a literature review on a broad range of sources on the economic, political and diplomatic consequences of COVID-19 on China and the WHO in a global context. The main body of this paper will subsequently analyse the role China plays in the WHO.


Literature Review

The existing and potential future economic consequences of COVID-19 are severe. The International Monetary Fund projects the crisis to be the cause of the worst economic downturn since the Great Depression. The impact on international trade is unprecedented, particularly at a time when global supply chains are being heavily disrupted. Researchers have underlined that the severity of economic decline will depend on how the virus progresses.


A widely cited academic paper of preliminary research found that ‘service-oriented economies, such as the UK, will be particularly negatively affected’. Some scholars have noted that the least neoliberal countries in the world, many in the global south, have so far come through the pandemic in better shape, such as China, Vietnam, and South Korea. This impending economic downturn has led academics such as Łukasz Sułkowski to ask whether ‘the strengthening of central government will give rise to de-globalisation tendencies’. Academics such as Richard Baldwin and Eiichi Tomiura view the calls to step back from globalisation and the repatriation of supply chains as a ‘misthinking of the lessons’. They state ‘supply chains were internationalised to improve productivity, their undoing would do the opposite’.


Nonetheless, COVID-19 has also seen a speeding up of virtualisation and digitalisation of our lives and lives may not return to how it was before. The modern world has enabled ‘global virtual teams organized around different technological solutions’ to continue working. This has led to some bold headlines in the media calling it ‘the end of business travel’. The way society uses its money has also changed, with American-based payment network Mastercard seeing a ‘40 percent growth in contactless transactions globally in the first quarter of 2020’. These behavioural changes may lead to positive changes in the global economy. Leading American academics have found that ‘digital technology can mitigate the adversities and strengthen the resiliency and preparedness of manufacturing and supply networks in the future’.


Preparedness for future health emergencies is one of the key roles the World Health Organization (WHO) does as its role as the coordinating authority for global public health. WHO has been in existence since 1946 and China was one of its ten founding members. Today, with 194 member states and counting, it has been the focal point of international health efforts for many crises. For example, it was the global leader in eradicating smallpox and implementing universal standards on Tobacco in 2003. More recently WHO have dealt with the outbreaks of Cholera in Somalia, but was late to organize an international response to Ebola in 2014. WHO waited five months before declaring a Public Health Emergency of International Concern (PHEIC) despite pleas from groups such as Doctors Without Borders.


However, there are many who think there should be a progresssive overhaul of the WHO. An article in the British Medical Journal states that the WHO’s overarching influence ‘discourages countries from developing their own capacity’. Others see the WHO as too slow and inefficient due to its complicated funding mechanisms and competing political pressures and, as such, have suggested different methods of funding altogether.


The WHO is currently funded in two ways; one by mandatory contributions from its member states and the other by voluntary contributions by member states and other organisations. The mandatory contribution makes up around 25% of WHO’s annual budget. It is calculated by a country's population and development. Due to China’s economic growth and significant population, China's WHO contributions increased by 52% since 2014 to around $86 million today. There has been a minor increase in voluntary contributions from the Chinese government rising from $8.7 million in 2014 to $10.2 million in 2019.


Despite the focus on China, it is not a major funder of the WHO, nor is it in the top 10 contributing states or organisations. The United States of America, as well as American philanthropists Bill & Melinda Gates combined contribution totals over 15 times China’s that of China.


This funding mechanism is dominated by ‘restricted’ voluntary contributions for specific projects with limited flexibility and priorities that WHO accomplishes from year to year. For example, the funding for the eradication of polio covered over 20% of WHO’s 2018-2019 budget, and accounted for the salaries of over 1000 staff. As Polio is 99% eradicated, there will be imminent budgetary challenges to the WHO as the institution is widely known to be under-funded. Despite its under-funding, the WHO continues to create bold long-term priorities such as ‘providing health coverage to one billion more people’ and ‘protecting one billion more people from health emergencies such as epidemics’.


The Chinese government also shares bold goals in healthcare for their people: the ‘Health China 2030’ strategy, published in 2016, represents a ‘shift from treatment to prevention’. If successful, this strategic shift will, it is hoped, reduce the economic burden as state expenditure on healthcare continues to rise.


There has been little comprehensive analysis of the developing political implications of COVID-19. However, the strategies of nations and wider blocs are beginning to manifest themselves through policy actions and speeches. Chinese Premier Li Keqiang’s annual work report for the upcoming year, and Chinese actions at the World Health Organization, have demonstrated a clear commitment to multilateralism. The United States of America’s move away from multilateralism in international organisations has become more evident during the COVID-19 crisis. The European Union, which represents 22% of the global economy, has found itself in the middle of increasing tensions between China and the US. Prominent European think tanks such as the Jacques Delors Centre have said that COVID-19 has ‘opened a new chapter of strategic and systemic rivalry with China as an EU struggling with internal solidarity fell prey to the global war of narratives led by China and the US’.


The Race for a Vaccine

Many nations have invested heavily in domestic medical companies to research and produce a vaccine. In many cases, this is being done individually, rather than on a global multilateral basis. For example in the United Kingdom, the British government has made a deal with pharmaceutical company AstraZeneca to produce a vaccine. The contract includes a clause that Britain will have priority access to the potential vaccine. Many scholars have raised concern about the growing vaccine ‘arms race’, with global cooperation limited.


However, China has adopted a different strategy. Beijing announced its intention to invest heavily in the World Health Organization (WHO) in this time of crisis at the recent World Health Assembly. Furthermore, long-term Chinese investment has enabled Chinese pharmaceutical companies to become global leaders in Artificial Intelligence & Synthetic Biology that means that China is well placed in dealing with current world events. The surge in biotechnology and patents for vaccinations have increased China’s capabilities in vaccination production. China has pledged to give any potential vaccine to the world. Xi Jinping said in a recent speech that a Chinese produced vaccine ‘would be made a global public good, which will be China's contribution to ensuring vaccine accessibility and affordability in developing countries’.


Bill Gates, who is one of the principal funders of vaccine development in the world supported the global need for universalism in vaccine development and deployment: ‘governments and industry will need to come to an agreement: during a pandemic, vaccines and antivirals can’t simply be sold to the highest bidder. They should be available and affordable for people who are at the heart of the outbreak and in greatest need’.


China is following an international consensus by promising goodwill with international partners in vaccine development and deployment. This strategy is necessary for China and its economic development and its partners. A vaccination, free at the point of delivery, would also enable a speedy return to international trade. Healthy and prosperous international partners are needed for bilateral trade and China is at the forefront of finding solutions for global needs. Other major international partners, such as the United Kingdom and the United States, have sought to protect their assets and businesses; first, through economic nationalist policies, such as protectionism in international trade and, secondly through health and vaccination policy.


The WHO, at the recent World Health Assembly, was instrumental in encouraging a Covid-19 intellectual property pool - whereby the vaccine would be patent-free - thereby enabling all countries, not just the richest, to develop the vaccine. At the time of writing only 35 countries have committed to this initiative but many, including China have not signed, but remain generally politically supportive. China instead co-signed a resolution underlining the ‘global public good of a vaccine’ with many other nations. The USA have actively dismissed the patent pool and did not co-sign the resolution for UN resolution arguing instead that there needs to be ‘innovation incentives in the development of new health products’.


WHO is lacking in funding and political will: WHO you gonna call?

Due to recent events, there has been increased scrutiny of the World Health Organization and its political will and power. Many scholars and academics have concluded that the WHO is politically weak and is dependent on the leadership at the time. At a time when many countries are preparing to implement severe economic cuts to domestic services and contributions to international organisations such as the United Nations, China is increasing its international influence.


The notion of ‘pandemic politics’ has labelled the present global tensions to be ‘a harbinger for what WHO will confront and have to navigate over the next decade’. If the international relations on display at the recent World Health Assembly are an insight into future diplomatic relations between countries it can lead to many significant observations. China was under heavy scrutiny and pressure, especially in terms of accepting an independent investigation into the origins of COVID-19. Nonetheless, China diplomatically dealt with the situation by including and supporting the request from Australia and others to a unanimous solitary resolution encapsulating the global support and unity in fighting the virus.


China played a vital role at the centre of the talks, by making arguably the most important intervention: the announcement of a $2 billion dollar investment in WHO. The investment was one way in which China moved the international conversation away from their pressures of accepting an international investigation into the origins of COVID-19 but, significantly, it also indirectly underlined the ideological differences between Xi Jinping’s approach to international cooperation and President Donald Trump’s isolationism. Trump did not attend the meeting and, subsequently, the USA took the decision to suspend funding to the WHO due to the organisation being ‘China-centric’.


The accusation that the WHO is China-centric is surprising given that the US is the principal funder of WHO and, therefore, has much more say and political power in the organisation than China does. This rise in anti-China rhetoric is not unique to the USA’s dealings with WHO but rather a systematic policy under the current White House administration. The USA may feel under pressure from the rise of China and its allies, politically and economically, that has led to some scholars declaring that the pandemic ‘will accelerate history rather than reshape it’. The lack of international cooperation, from the United States of America in particular, is in direct contrast to China’s show of cooperation, particularly in Africa, around COVID-19.


China’s Foreign Minister, Wang Yi, has signalled that China will ‘accelerate the construction of the headquarters of the Africa Centers for Diseases Control and Prevention’ as well as work with the G20 to ease the debt burden on countries in Africa. Alongside Chinese government actions, Chinese philanthropists and businesses, such as Jack Ma, have supported international organisations in Africa by donating medical supplies.


China’s political and business leaders' diplomatic relations show that there is a clear understanding that a healthy, and well-functioning, international economy is in the best interest of China, as well as other nation states. Doctors from numerous countries have signalled that the vulnerability of communities when health, food security, and freedom to work are interrupted by “a common threat” is a major issue for the world; as such, the renewal and rebuilding of bilateralism in the global economy is vitally important for not only healthcare and vaccinations, but also economic growth.


China’s leading role in democratising international organisations

The WHO has little political influence but it does have one key instrument to rouse attention from the international community: WHO can issue a Public Health Emergency of International Concern (PHEIC) at the discretion of the Director General. After the first reporting of COVID-19, in December 2019, WHO declared a PHEIC one month later and drew up a strategic preparedness and response plan that initially called for $675 million in funding from donors.


China has been working through multilateralism to further its international standing as well as demonstrate leadership. China has actively supported the democratisation of international affairs in international organisations, by encouraging reforms on UN voting and changes to the WTO. China’s support for democratisation often gives credence to smaller nations who lack political power on the international stage. China has used its increased influence to diversify international organisations such as the WHO. China has been a long-time advocate of international reform including giving the WHO more resources and broader representation of leadership roles at the United Nations. Tedros Adhanom Ghebreyesus, previously Ethiopia’s foreign minister, was elected to a five-year term as Director General of WHO in 2017. He is the WHO’s first leader from Africa and his election was the first time all WHO countries had an equal vote. China supported his candidacy.


Using existing non-conventional forms of diplomacy to boost global health

There are many examples of China boosting its international relations through conventional forms; such as supporting others through multilateralism at international organizations. Furthermore, China boosts its soft power through many non-conventional ways such as the Belt and Road Initiative and foreign direct investment. In terms of healthcare, Xi Jinping has recently spoken about the Health Silk Road (健康丝绸之路), which would be an extension of China’s Belt and Road Initiative.


The term ‘Health Silk Road’ was first mentioned at the Belt and Road Forum for Health Cooperation in 2017, with WHO Director-General, Dr Tedros praising the initiative. This is further evidence that China’s emerging presence on the international stage is not coincidental and not just a response to Covid-19. China is intentionally working to become an influential power in international organizations with real effects, gaining meaningful support from leadership at the UN through its reforms and support.


In addition to China’s emerging role in gaining and utilising influential positions in international organisations, China is using its existing forms of non-conventional diplomacy. Chinese embassies and companies have had a visible presence in foreign nation states by actively organizing to send medical equipment and doctors to affected countries. This has led to many editorials in Chinese state media proclaiming that China is a peaceful rising power, showcasing its ‘benevolent’ nature.


On the highest diplomatic level, China has engaged with various unions of nations. For example, China joined the European Union on their global call for solidarity and international action ‘Coronavirus Global Response’. Xi Jinping has made calls to the African Union and the Association of Southeast Asian Nations (ASEAN) in pledging financial and medical support.


China has used its existing soft power and warm relations through investment and other various means pre-COVID-19 to move from crisis mode to leadership mode. Other global leaders have not made the same transition: for example, the United States of America has been criticised for its continued sanctions on Iran during the pandemic. Serbian President, Aleksandar Vučić, criticised the European Union for limiting exports of medical equipment outside of Europe and turned to China for support instead stating: ‘without China, and our Chinese brothers, we are incapable of doing [defending ourselves from the virus]’.


The Parallel Priorities of the WHO and China

At the World Health Assembly 2020, China showed its zeal to be a global leader in the fight against COVID-19. President Xi Jinping promised to establish a cooperation mechanism for its hospitals to pair up with 30 African hospitals and accelerate the building of the Africa CDC headquarters to help the continent speed up its disease preparedness and control capacity. Long-term global health priorities set by WHO are not so different from China’s own long term-health goals: for example, one of WHO’s key long term priorities in 2019 was to improve protections for 1 billion more people from epidemics. China’s action fits in line with WHO’s global health strategy.


Before the pandemic, China was addressing public health epidemics through policy decisions made at the highest level. In the Chinese Government Work Report of 2019 the annual speech from Li Keqiang set goals in terms of preventing and dealing with epidemics through vaccination programmes and investment.


In the 2020 Government Work Report Li Keqiang defended the measures taken to protect life rather than prioritise the economy: ‘life is invaluable. This is a price we must pay, and a price worth paying’. Many nations around the world have taken differing political choices when it comes to controlling the virus. Countries in the Western world, such as Sweden, the United Kingdom and United States of America, had initially, or are currently, advocating for ‘herd immunity’. Herd immunity has been criticised as ‘sacrificing (elderly or high-risk) citizens to quickly reach herd immunity’.


Policies enacted in China, such as mandatory quarantine and strict lockdowns, were criticised by human rights groups at the time of implementation but have now become commonplace around the globe. Other countries, such as Vietnam and South Korea, have taken measures, often at the condescension of international analysts, resulting in a significant decrease in deaths from COVID-19 compared to countries that did not take action. WHO’s pandemic protocol’s have included measures such as self-isolation, school closures and cancellations of mass gatherings as early as 2007. Subsequently, the WHO has amended its current COVID-19 Strategy to include six tests for exiting lockdown that have underlined the importance of remaining socially distant despite the impact on economic activity.


As the WHO is lacking in budget, especially due to the recent decision of the USA to suspend funding and also the near completion of the programme of funding to eradicate polio, it needs new funding streams. China can build on its key role during the COVID-19 crisis to preserve its key role in preventing and dealing with future health emergencies to increase its global status and power.


Despite China being a resilient authoritarian regime, China has been a vital partner and supporter of the transparency of the World Health Organization. For example, there has been criticism from various nations because China prevents Taiwan from being recognised as an independent nation state and, as such, therefore not privy to the World Health Assembly, despite Taiwan’s success in dealing with the virus. The WHO has taken steps to separate its role as an independent health authority by underlining its cooperation with all health authorities, including Taiwan.


Diversifying international relations: moving beyond its role as the world’s factory

China’s role at various international organisations such as the United Nations, and the World Health Organization, has evolved from a marginal role to a central one in the modern era. This is due to many changes in the world, but one stands out: the economic prowess of China. It is interesting to note that China, and its media apparatus, takes great pride in being a part of the United Nations. For example, the recent 40-year anniversary of China being inducted into the United Nations led to various television specials on Chinese Television and on China’s international news network CGTN.


China’s vast structural development has enabled China to thrive, but also deemed the United Nations an effective role in international politics. For example, the Millennium Development Goals set in 2000, with a conclusion date of 2015, had many key performance indicators. Only one hit its target: Halve, between 1990 and 2015, the proportion of people whose income is less than $1.25 a day. The reduction in poverty was mainly thanks to the great progress of China to take millions of people out of poverty.


China’s economic prowess has enabled it to thrive in a globalised world. However, as the post pandemic order comes to fruition, China is susceptible to a change in the inter-continental trading system of global supply chains. If nation states choose to build more key parts of their basic infrastructure in their native countries in the post-pandemic economic climate, China could lose business.


China is making active steps to diversify economic relations around the world. Many service-led economics will be hardest hit by COVID-19, especially due to a lack of tourists keen to travel. China’s Belt and Road Initiative can help countries improve their infrastructure whilst creating and diversifying international trading options. China’s thirst for international trade, and imports, is ever-increasing due to the emerging middle-class beyond Beijing and Shanghai. In political and economic terms, it is only right for China to be a staunch defender of free trade, globalisation and continued multilateralism. To a significant degree China’s continued dominance depended on it, therefore China’s leadership is now taking steps to expand its own role in the global economy.


A fundamental example of the potential post-pandemic world is the dominance of digitalisation. Many countries and hygiene-conscious consumers are now moving to a cashless system. China was ahead of the game; cashless systems have been commonplace in China for a number of years. Technology companies are able to transform their current existing services to a medical setting and purpose through applications such as health checks and contact tracing have propelled the Chinese economy to potentially facilitate economic productivity more than many of its neighbours. China is well placed to be a global leader in this field.


Long-Term Thinking is Essential for Global Leadership

There is no doubt that China has a unique political system. As such, one of the benefits of the lack of democratic elections for the Chinese Communist Party is the possibility of implementing long-term thinking and strategy such as 10-year work plans and multi-year strategies such as the Belt and Road Initiative. Other global leaders, such as the USA and European Union, are often restricted to more short-term and cosmetic fixes for their own personal or political party’s gain due to the electoral design and pressure from corporations. Economist Robert Reich writes at length in his book ‘Supercapitalism’, about how democracy in the west is ‘enfeebled’ due to contemporary capitalism.


China’s strategies and political functions are not too dissimilar to the bureaucratic nature of complex multi-regional organizations such as the World Health Organization. In China’s 2019 work plan, as well as China’s 2030 health strategy, there are lengthy detailed sections on public health, vaccines and internet healthcare models for remote healthcare services. Many such ideas have also been included in WHO’s multi year plans.


Conclusion

In conclusion, this paper has found that China is using all means possible, conventional and non-conventional, to become an increasingly more influential and powerful player on the world stage. China often goes far beyond the minimum required to be a bold international partner. This has major implications on the global political economy. The significant economic impact China has on the global economy has had several knock on effects, including the weakening of pre-existing western global powers such as the United States of America and the European Union. Due to China’s vital role in global supply chains, even nation states who have political differences with China have had to develop at least a degree of minimal relationship with China.


China’s power and influence at the World Health Organization has been overestimated by many but, with the USA’s step away from WHO and the international stage, there is a room for major manoeuvring from China to increase the benefit of WHO to the global community and China’s role in that process.


When western powers were dealing with internal economic problems, China stepped up to the plate in its support of developing countries. This non-conventional means of diplomacy, such as China’s use of precision economic and medical aid, has improved relations between China and countries far beyond its neighbours. Subsequently, China’s success in non-conventional diplomacy has enabled China to further its objectives in conventional international organizations, as it has a stronger pool of international support, allies, than ever before. China’s active partnerships in donating medical supplies to countries during the pandemic will only strengthen the existing partnerships China already enjoys.


How western powers respond to China’s increasing influence will define the coming years. It may also decide the fate of current ideological global policy-making which is often rooted in neoliberalism. Neoliberal tendencies, including unregulated free-market capitalism in health care, has failed to protect those who are most vulnerable in society during this pandemic.


Western nations often talk up the prospect of multilateralism and globalisation bringing economic prosperity to their people. However, conventional wisdom on fundamental ideas such as these may be up for discussion in the years to come. If there is a lack of willingness to democratise the field of international relations, by facilitating the recognition of many voices rather than the few, many may choose to turn away from internationalism and engage in nationalist and protectionist economic models.


As the existing ‘America First’ strategy demonstrates, China may need to find a more varied and number of stable international partners to trade with. Thanks to its economic power and stability, China has the time and money to have ‘strategic patience’ with unpredictable nations that are evolving into modern economies. Furthermore, China’s long term strategic outputs have enabled the creation and expansion of new markets to match the potential deficits in the US-China relationship. Trading blocs such as the European Union, ASEAN, and the South American trade bloc MERCOSUR may look to China for stability and further economic partnership expansion in the years post-Covid-19.


Much of the post-pandemic global order is up for debate, however, there is no doubt that China will play a critical role in how the global economy develops and how it seeks to further its own role in international organizations in the future. China’s extensive cash reserves will serve it well as it preserves its role as a global leader and in its ability to protect its own economy.


Walker Darke



The opinions expressed here are those of the writer and do not represent the views of European Guanxi.


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