China Paving ‘Health Silk Road’ in Africa

The Beijing-funded African Center for Disease Control (CDC) in Addis Ababa, Ethiopia, is due to open in the next few months. The controversial project is just one example of China’s increasing investment in health care on the African continent since the pandemic as it builds what analysts and Beijing call a “Health Silk Road.”

The reasons behind China’s investments in health care in Africa, according to experts, include the desire to increase its soft power as it vies with the West for influence on the continent, finding markets for its drugs and medical products and strengthening its position with international bodies like the World Health Organization (WHO).

Some critics warn of more opportunistic motivations such as access to natural resources, political favors and even spying.

Controversial African CDC

The $80 million African CDC headquarters is one China-funded health project that has proved contentious. It was originally envisioned as a U.S.-China-Africa collaboration, but when things soured between Washington and Beijing under the Trump administration — which pulled the U.S. out of the WHO — that plan collapsed, and the agreement was recrafted as one between China and the African Union (AU).

“The U.S. was eventually edged out and I think this was a diplomatic win for the Chinese,” Paul Nantulya, a research associate at the African Center for Strategic Studies, told VOA.

At the time, some U.S. officials suggested China was aiming to use the CDC to spy on Africa’s genomic data and gain control over African health management, which China has described as a “ridiculous” allegation.

“It shows that some people in the U.S. always make presumptions,” foreign ministry representative Hua Chunying said in 2020 during a regular press briefing.

Cameron Hudson, a senior associate at the Center for Strategic and International Studies, former director for African affairs on the White House National Security Council, and previously an intelligence analyst in the Africa Directorate at the Central Intelligence Agency, said he still thinks spying could be a possibility in the new African CDC.

“I think Washington would have liked to be more involved in the building of the African CDC, if for no other reason than I think we have to assume that China will, you know, be able to monitor that building,” Hudson told VOA.

Other Chinese health initiatives

The African CDC is just one of China’s many health-related initiatives in Africa. Beijing has been promoting traditional Chinese medicine, opening clinics in many countries on the continent.

During the COVID-19 pandemic, China distributed personal protective equipment and provided vaccines to African nations. Last month, Africa’s largest vaccine cold-storage unit built by a Chinese company opened in Egypt. The North African country is also manufacturing China’s Sinovac vaccine locally for export to the rest of the continent.

These and many other forms of cooperation, such as the deployment of thousands of Chinese medical personnel to African countries, are all part of President Xi Jinping’s trademark Belt and Road Initiative (BRI), which has evolved from originally focusing on building infrastructure in developing countries to including a wide range of other sectors from technology to space to security to medicine.

“The Belt and Road program provides an institutional architecture for many other initiatives not just infrastructure,” said Nantulya.

In terms of its health projects “China stands a lot to gain: by way of diplomatic influence, by way of marketing the Belt and Road itself, but also in terms of marketing its health products,” added Nantulya, who said Beijing is “also trying to increase its competitive edge against the West.”

Asked if China’s health ambitions in Africa were intended to rival the U.S.’s, the Chinese Mission to the African Union responded by email: “Through concrete actions, China has helped African countries respond to various epidemics and diseases and build a public health system, promoting a China-Africa community of health.”

“China-Africa health cooperation is open and inclusive and does not prevent any third party from cooperating with Africa, and we welcome the international community to contribute to enhancing the accessibility of health products in Africa,” it continued. The mission said the CDC was expected to be completed in early 2023.

US-Africa relations

The U.S. said it has supported the Africa CDC since 2014 and earlier this year, signed an agreement with the Africa Union for continued cooperation which includes U.S. agencies helping the Africa CDC to develop its workforce and “capacity-building in vaccine manufacturing … .”

“We’ve developed and implemented a comprehensive, whole-of-government strategy to advance our shared affirmative vision with allies and partners, offering an alternative to the PRC (People’s Republic of China) model,” the State Department’s press office told VOA. The representative added, “We respect the ability of countries to decide for themselves whether to partner with the PRC. However, we echo the long-standing calls from African capitals that PRC actions respect local law and interests, particularly regarding the human and labor rights of all and protections for the environment.”

Other reasons for China’s ‘Health Silk Road’

China has been involved in health projects in Africa since the 1960s, but it was really during the Ebola outbreak in West Africa in 2014-16 that analysts say Beijing stepped up its participation in international responses to health crises.

Hudson said he thinks that is when there was “recognition that health and pandemics really are transnational issues … for China this is an opportunity to broaden the perception and the reality of its engagement in Africa, which has been framed very much as mercantilistic up until this point,” he said.

Lauren Johnston, an analyst with the South African Institute of International Affairs and an expert on the BRI, said she thinks China’s promise to help African countries improve public health after Ebola “was genuine and not any bigger conspiracy.”

However, she said “I do think China wants to capture the low/middle-income consumer/health products sector … for basic bandages, PPE, even MRI machines etc. … fitting out hospitals.”

Nader Habibi, an economics professor at Brandeis University, said China had made progress in medical technology in recent years and was now in a good position to enter the international health care market.

“Overall the quantity of Western investment and support for health care infrastructure in Africa has been limited in recent decades. This is the main reason that African countries have welcomed Chinese investments and support,” he told VOA. “The private sector investors in Western nations are not interested in these types of investments nor are they prepared to accept the political risks of investing in Africa.”

Still, Hudson says, China’s contributions to health care in Africa do not come anywhere near those of the U.S., which has spent billions of dollars on malaria, HIV, AIDS, and other programs over the decades.

“China’s clearly really very far behind. … It’s really only since the COVID outbreak and the distribution of vaccines that you’ve really begun to see China play any kind of meaningful role in the health space on the continent,” he said.

The African Union did not respond to request for comment.

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